Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is characterized by:
- Chronic bronchitis. This is a chronic, productive cough that lasts for at least three months in each of two consecutive years. To be considered bronchitis, tests must rule out infections or diseases such as tuberculosis, lung cancer or chronic heart failure.
- Emphysema. This is an abnormal, permanent enlargement of the air spaces inside the lungs, which occurs because the disease destroys the walls of the tiny air sacs. No obvious fibrosis is seen. The enlargement of the air spaces is irregular.
- Blocking of the flow of air into and out of the lungs, such as with asthma. This generally gets worse over time. It may also involve airways that are sensitive and react quickly and intensely to stimuli. The blockage reverses itself or responds to treatment. The reversal may not be complete.
To be considered as having COPD, a person must have features of all three conditions.
A person with COPD will have the coughing and difficulties breathing typical of bronchitis, emphysema and asthma. Other signs of COPD include:
- Redness of the skin because the capillaries are congested
- Fluid collecting in the lungs and airways and linings of the throat
- Production of a great deal of mucous and other secretions, sometimes including pus
- Enlarged glands
- Changes in the cells of the lungs and airways that can be seen with a microscope
People who have smoked more than 20 cigarettes a day for more than 20 years may develop a productive cough in their 40s or early 50s. Breathlessness during exercise or exertion usually doesn't become bad enough to see to a doctor until the COPD patient is in his or her 50s or mid-60s.
Gradually, patients may produce increasing fluid or mucus in their lungs or airways, initially occurring only in the morning.
Severe chest conditions (coughs, production of pus-filled fluid or mucus, wheezing, breathlessness and sometimes fever) may happen from time to time. As the disease gets worse, the time between severe bouts gets shorter. Late in the disease, these bouts may be so severe that the blood doesn't get enough oxygen and the person's skin turns bluish. The patient may develop a morning headache indicating too much carbon dioxide in their blood. There may also be a loss of weight.
Causes and Risk Factors
Some of the factors that make a person more likely to develop COPD are:
- Age. People are more likely to develop COPD as they get older.
- Smoking cigarettes
- Gender. More men than women develop this condition.
- Race. More whites than nonwhites develop COPD.
- Education and employment. Generally, persons who work at blue-collar jobs and those who have fewer years of formal education are more likely to develop the condition.
Age and cigarette smoking account for more than 85% of the risk of developing COPD.
It is not yet understood what the role of air pollution is in causing COPD. Working around airborne chemical fumes or biologically inactive dust may also lead to higher risk of developing COPD.
A doctor takes a patient's medical history and performs a physical examination. He or she conducts tests to rule out other conditions, such as cancer, tuberculosis or chronic heart failure, which may cause similar symptoms. The doctor also determines whether the patient has COPD rather than bronchitis, emphysema or asthma.
The following tests may be needed to diagnose COPD:
- A chest X-ray, bronchoscopy or other studies to rule out cancer, tuberculosis or other conditions if a person is coughing up blood
- Blood tests
- Examination of sputum (fluid or mucus that the patient coughs up) under a microscope
- Lung function
- Measurement of blood gases, which show how much oxygen is in the blood and whether carbon dioxide is building up
- Two-dimensional echocardiography and Doppler techniques to determine whether there is high blood pressure in the lungs
In the early stages of COPD, a physical exam may show very little except for the sound of wheezes when a person breathes out. As the disease develops, signs of the lungs being overinflated with air become apparent. The size of the chest gets larger.
The diaphragm, which in a healthy person moves up and down to cause the lungs to empty and fill with air, may move less. The sounds of the heart become distant. Crackles may be heard at the base of the lungs. The veins of the neck may stick out, especially when a person is breathing out, indicating increased pressure inside the chest.
The patient may have jerky movements as a result of the buildup of carbon dioxide in his or her blood.
At the end stages of COPD, the patient's difficulty in breathing will be very clear:
- All muscles used in breathing will be in full use
- Breathing out will often be through pursed lips
- The chest appears overinflated and enlarged
- The skin and complexion may seem bluish
Treatment of COPD patients generally consists of relieving symptoms or underlying problems that make the condition worse. Specific treatment approaches will vary depending on how severe the COPD is and what has caused it.
- Annual flu shots to avoid the risk of serious complications from influenza
- Drug therapy, which can improve airflow, reduces inflammation and muscle spasms inside the lungs and cut or thin down secretions and fluid buildup. Antibiotics may be helpful in taking care of infections that may contribute to COPD.
- Eliminating or reducing environmental irritants at work or elsewhere
- Learning how to conserve energy during activities of daily living
- Lung transplantation
- Lung volume reduction surgery
- Mechanical ventilation. This may be needed if the blood gas levels aren't in good balance.
- Nutrition to balance the additional energy used to do the work of breathing. The extra challenge of breathing with COPD causes the patient's resting use of energy to rise. Without food to balance this energy usage, a person with a chronic condition such as COPD will begin to lose weight.
- Oxygen therapy
- Patient education in the signs of infections or the worsening of the condition that may require medical intervention such as antibiotics.
- Pulmonary rehabilitation programs. These help people with severe COPD deal with the physical limitations brought by the disease while improving their independence, quality of life, ability to exercise and they help avoid days in the hospital.
- Quitting smoking. This is extremely important especially in patients who have mild or moderate COPD. It can improve some symptoms of COPD and delay others.
- Vaccination against pneumonia