A Quick Review of COPD

A Progressive Disease

Chronic Obstructive Pulmonary Disease is a lung disease that causes a blockage or narrowing of the airways.  This results in decreased ability to move air in and out of the lungs. The disease has a slow, progressive course and is irreversible.

Statistics

COPD is the 4th leading cause of death in the US: 120,000 Americans annually.  It is expected that by 2020, COPD will become the 3rd leading cause of death worldwide.  Men are more likely to have COPD than women, and it usually occurs in those over 40 years old.

Types

There are three types of COPD and all of them require the patient to work very hard at breathing.

• Emphysema: Air sacs (alveoli) of the lungs are damaged and enlarged.  This reduces the amount of surface area for the exchange of oxygen and carbon dioxide.  Less oxygen can move into the body and less carbon dioxide can be expelled.
• Chronic Bronchitis: Inflammation of the bronchial tubes which can cause them to swell.  This can leave less room for air movement.
• Bronchiectasis: Permanent widening of the large air tubes which begin at the bottom of the trachea and branch into the lungs.

Causes

The most significant risk factor is, of course, smoking.  The American Lung Association estimates that 80% to 90% of people diagnosed with COPD are chronic smokers.  Secondhand smoke is also a major factor, causing 3,400 lung-related deaths annually.  Research also shows a link between air pollution and work-related exposure, such as coal mine dust, silica, cotton and grain dust.

Symptoms

Most symptoms include: breathlessness with any activity, chronic cough, increased sputum production, wheezing, chest tightness and frequent chest infections.

Other signs and symptoms may include swelling, weight gain and obesity, (which may be a side effect of medication therapy), a round barrel chest, coughing blood, and cyanosis (bluish coloring often seen around the mouth).

Diagnostic Testing

To make a diagnosis of COPD, a complete assessment must be taken including family history, environmental and occupational exposure and smoking history. Additional tests may include:

• Blood work such as arterial blood gases, hemoglobin and hematocrit levels
• Chest x-ray
• Pulmonary function tests
• Bronchoscopy
• Pulse oximetry

Treatment

The main treatments for COPD include medications (bronchodilators, expectorants, antibiotics and corticosteroids), oxygen therapy, pulmonary rehabilitation, and at the end of life, morphine to ease shortness of breath.