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Chronic obstructive pulmonary disease (COPD) 

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Overview of COPD

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible.1 It is an inflammatory disorder secondary to the chronic inhalation of primarily tobacco smoke leading to progressive deterioration in the pulmonary function.

Chronic obstructive pulmonary disease encompasses

  • Chronic bronchitis
  • Emphysema and
  • A range of other lung disorders

Chronic bronchitis: Chronic bronchitis is defined clinically as chronic productive cough for 3 months in each of two successive years in a patient in whom other causes of productive chronic cough have been ruled out.

Read more about Bronchitis

Emphysema: Emphysema is defined pathologically as the presence of permanent enlargement of the airspaces beyond the terminal bronchioles. Patients with COPD may have either of those conditions.

Read more about Emphysema

 

Symptoms of COPD     

Although often misdiagnosed as asthma, COPD should not be confused with asthma as these two diseases display significantly different inflammatory processes, clinical courses, responses to treatment and outcomes.

Patients with COPD present with a combination of signs and symptoms of chronic bronchitis, emphysema and asthma.

Symptoms COPD include:

  • Worsening dyspnea
  • Progressive exercise intolerance, and 
  • Alteration in mental status.

The dyspnea could be accompanied by wheezing and a persistent productive cough.

Occasionally, the sputum may contain blood (hemoptysis) due to damage of the blood vessels of the airways. Severe COPD could lead to cyanosis (bluish decolorization of the lips and fingers) caused by lack of oxygen in the blood.

The signs and symptoms of COPD appear in many patients only after the forced expiratory volume in 1 second (FEV1) is <50% predicted.

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Diagnosis of COPD

Due to its progressive nature, the early diagnosis and treatment of COPD are essential to prevent complications and exacerbations associated with the condition.

Diagnosis of COPD is based on an assessment of risk factors such as smoking and evaluation of symptoms.

Further confirmation is done using spirometry or lung function test.2

Office spirometry for all smokers and ex smokers as well as those with respiratory symptoms is an important mean of achieving early diagnosis and improving long-term outcomes.

 

Management of COPD

Today, COPD is a steadily growing global healthcare problem with increasing morbidity and mortality.1

The effective management of COPD depends primarily on

  • Early identification
  • The use of bronchodilators to improve pulmonary function.


Non pharmacological treatment

Smoking cessation remains a mainstay of COPD therapy. Even at a late stage of the disease, it can reduce the rate of disease deterioration.3

Other nonpharmacological treatment includes

  • Avoidance of risk factors,
  • Patient education,
  • Pulmonary rehabilitation and
  • Oxygen therapy, when necessary.


Pharmacological treatment

Once COPD is diagnosed pharmacologic treatment depends on symptoms as well as the severity of disease.

The mainstays of therapy for acute exacerbations of COPD are

  • Oxygen
  • Bronchodilators and
  • Definitive airway management.

Mild disease: Management of mild disease includes smoking cessation and use of short-acting bronchodilators as needed.

Moderate and severe disease: For moderate and severe disease, one or more long-acting bronchodilators are added to the treatment described for mild disease.

Recurrent exacerbations: Inhaled corticosteroids are prescribed in patients with recurrent exacerbations. These may reduce frequency and severity of exacerbation when combined with long-acting beta-2 agonists.

Long-term oxygen therapy is indicated for all patients with documented hypoxemia.

In patients with very severe disease, lung transplantation or other surgical therapy such as lung volume reduction surgery should be considered when appropriate.

Pulmonary rehabilitation benefits most patients.

Lifestyle changes to manage copd


Written by: Healthplus24 team
Date last updated: November 01, 2012