Disease: COPD (Chronic Obstructive Pulmonary Disease)

    What is chronic obstructive pulmonary disease (COPD)?

    Chronic obstructive pulmonary disease (COPD) is a slowly progressive obstruction of airflow into or out of the lungs. The incidence of COPD has almost doubled since 1982. The disease occurs slightly more often in men than in women. The symptoms come on slowly and many people are consequently diagnosed after age 40-50, although some are diagnosed at a younger age.

    What are the risk factors for COPD?

    People who smoke tobacco are at the highest risk for developing COPD. Other risk factors include exposure to secondhand smoke from tobacco, and exposure to high levels of air pollution, especially air pollution associated with wood or coal. In addition, individuals with airway hyper-responsiveness such as those with chronic asthma are at increased risk.

    Finally, there is a genetic factor called alpha-1 antitrypsin deficiency that places a small percentage (less than 1%) of people at higher risk for COPD because a protective factor (alpha-1 antitrypsin protein) for lung tissue elasticity is decreased or absent.

    What other diseases or conditions contribute to COPD?

    In general, three other non-genetic problems related to the lung tissue play a role in COPD. Two of the conditions, chronic bronchitis and emphysema, are thought by many to be variations of COPD and considered part of the progression of COPD.

    Chronic bronchitis is defined as a chronic cough that produces sputum for three or more months during two consecutive years. Emphysema is an abnormal and permanent enlargement of the air spaces (alveoli) located at the end of the terminal bronchioles in the lungs.

    Infectious diseases of the lung may damage areas of the lung tissue and contribute to COPD.

    What causes COPD?

    The primary cause of COPD is cigarette smoking or exposure to tobacco smoke. It is estimated that 90% of the risk for development of COPD is related to tobacco smoke. The smoke can also be secondhand smoke (tobacco smoke exhaled by a smoker and then breathed in by a non-smoker).

    Other causes of COPD are related to air pollution, such as that seen with burning coal or wood and with industrial air pollutants.

    Infectious diseases that destroy lung tissue and patients with hyperactive airways or asthma may also contribute to causing this disease.

    The physical changes or causes are airway obstruction by thick mucus or by poor lung tissue compliance (the elasticity, or ability of the lung tissue to expand) that can either block air from entering the alveoli or by not permitting the alveoli to expel CO2 because the elastic tissue becomes nonfunctional. The overall result is that oxygen in the air cannot get by obstructions (for example, thick mucus plugs) to reach alveoli; or as is the case with emphysema or alpha-1 antitrypsin deficiency, the oxygen or air that reaches alveoli cannot be expelled. In either case, the exchange of oxygen and carbon dioxide that usually occurs in healthy alveoli is either inhibited or prevented. Consequently, the person exhibits a progressive difficulty, first coughing to remove obstructions like mucus, and then in breathing, especially with exertion.

    Healthy Lung

    What are the signs and symptoms of COPD?

    COPD is a slowly progressive disease so it is not unusual for the initial signs and symptoms to be a bit different from those in the late stages of the disease. There are many ways to evaluate or stage COPD, often based on symptoms.

    Usually the first signs and symptoms of COPD include a productive cough usually in the morning, with colorless sputum (mucus). Individuals who may develop sudden or severe (acute) chest pain should be evaluated at an emergency department to be sure there is no cardiac problem that causes symptoms similar to COPD.

    Perhaps the most significant symptom of COPD is breathlessness, termed shortness of breath (dyspnea). Early on, this symptom may occur occasionally with exertion and eventually may progress to breathlessness while doing a simple task such as standing up, or walking to the bathroom. Some people may develop wheezing (a whistling or hissing sound while breathing).

    There have been efforts to stage COPD based on symptoms and other measures. One of the most recent efforts is the Global Initiative for Chronic Obstructive Lung Disease program (GOLD). The staging is based on the results of a pulmonary function test. Specifically, the forced expiratory volume in one second (FEV1) of a standard predicted value is measured, based on the individual patient's physical parameters. The staging of COPD by this method is as follows:

    • Stage I is FEV1 of equal or more than 80% of the predicted value
    • Stage II is FEV1 of 50% to 79% of the predicted value
    • Stage III is FEV1 of 30% to 49% of the predicted value
    • Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure

    Other staging methods are similar but are based on the severity of the shortness of breath symptom that is sometimes subjective. The above staging is measurable objectively, providing the patient is putting forth their best effort.

    When should I call my doctor about COPD?

    A person should see their doctor if they experience any of the signs and symptoms of COPD and are members of a high-risk group for developing COPD, such as smokers.

    In general, patients who notice an increasing shortness of breath that wasn't present recently, especially with any minor exertion, should make an appointment to see their doctor. Patients already diagnosed with COPD who notice an increase in symptoms should also see their doctor.

    How is COPD diagnosed?

    COPD is preliminarily diagnosed by a patient's breathing history, the history of tobacco smoking or exposure to secondhand smoke, and/or air pollutants, and/or a history of lung disease (for example, pneumonia) in a patient with COPD symptoms.

    Chest X-rays or a CT scan of the chest may be done. Other tests such as an arterial blood gas or a pulse oximeter may be performed to look at the saturation level of oxygen. In addition, the patient may be sent to a lung specialist (pulmonologist) to determine their FEV1 level that is used by some physicians to stage COPD as described above.

    What is the treatment for COPD?

    There are many treatments for COPD; perhaps the first and best is to stop smoking immediately.

    Medical treatments of COPD include beta-2 agonists and anticholinergic agents (bronchodilators), steroids, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation.

    Home remedies for COPD?

    The most effective home remedy – in fact the most effective preventive therapy for COPD – is to avoid contact with tobacco smoke. If you use tobacco products – quit.

    If a person with COPD has mild to moderate symptoms, often they can benefit from exercise programs that can increase their stamina and slow the advancing pace of COPD disease.

    Medications for COPD

    Nicotine replacement therapy

    The first line of therapy that involves medication is related to smoking cessation with nicotine replacement therapy. Nicotine replacement therapy can help patients quit smoking tobacco because it can help reduce the withdrawal symptoms due to nicotine. Replacement therapies include nicotine-containing chewing gum and patches that allow nicotine to be absorbed through the skin. In these types of therapy, nicotine is gradually reduced. This medication can work well for those patients who are seriously attempting to quit tobacco.

    Quitting smoking oral medication

    Varenicline (Chantix) is an oral medication that is prescribed to promote cessation of smoking. This is also an alternative to try to quit smoking.

    Bronchodilators

    Bronchodilators are used for COPD treatment because they open up the airway tubes and allow air to more freely pass in and out of the lung tissue. There are both short-term (several hours) and long-term (12 or more hours) types of bronchodilators.

    Some short-term medications include:

    • albuterol (Ventolin, Proventil), 
    • metaproterenol (Alupent),
    • levalbuterol (Xopenex), and
    • pirbuterol (Maxair).

     Some long-term bronchodilators include:

    • salmeterol (Serevent),
    • formoterol (Foradil),
    • arformoterol (Brovana), and
    • indacaterol (Arcapta).

    Anticholinergic bronchodilators include:

    • ipratropium (Atrovent),
    • tiotropium (Spiriva), and
    • aclidinium (Tudorza).

    Other bronchodilators such as theophylline are occasionally used but are not favored because of unwanted side effects including anxiety, tremors, seizures, and arrhythmias.

    Also on the market are combined to drugs using steroids and long-acting bronchodilators. Roflumilast (Daxas, Daliresp) is a new drug that inhibits the enzyme phosphodiesterase type 4, has been utilized in patients with symptoms of chronic bronchitis.

    Other therapies

    Other supplementary therapies such as treatment with antibiotics to reduce pathogen (viral, fungal, bacterial) damage to lung tissue, mucolytic agents to help unblock mucus-clogged airways, or oxygenation therapies to increase the available oxygen to lung tissues may also reduce the symptoms of COPD. In some patients oxygen therapy will increase a patient's life expectancy and improve quality of life. This is especially true with patients who have chronically low oxygen levels in the blood. It may also help exercise endurance. Oxygen delivery systems are now easily portable and have reduced costs compared to earlier designs.

    Surgery for COPD

    There are three types of surgery generally available to treat certain types of patients with COPD that include:

    1. bullectomy,
    2. lung volume reduction surgery, and
    3. lung transplant surgery.

    Surgery may not be available or desirable for many COPD patients.

    Bullectomy surgery is the removal of giant bullae. Air–filled spaces usually located in the lung periphery that occupy lung space most often in patients with emphysema are termed bullae. Giant bullae may occupy over 33% of the lung tissue, compress adjacent lung tissue, and reduce blood flow and ventilation to healthy tissue. Surgical removal can allow compressed lung tissue that is still functional to expand.

    Lung volume reduction surgery is removal of lung tissue that has been most damaged by tobacco smoking, usually the 20% to 30% of lung tissue located in the upper part of each lung. This procedure is not done often; it is usually done on patients who have severe emphysema and marked hyperinflation of the airways and air spaces.

    Lung transplantation is surgical therapy for people with advanced lung disease. Patients with COPD are the largest single category of people who undergo lung transplantation. In general, these COPD patients are usually at COPD stage three or four with severe symptoms and generally, without transplantation, have a life expectancy of about two years or less.

    Can COPD be prevented?

    Except for COPD due to genetic problems, COPD can be prevented in many people by simply never using tobacco products. In addition, avoiding wood, oil, and coal-burning fumes along with limiting one's exposure to air pollutants may also decrease or prevent COPD. Getting vaccines to avoid infections can help reduce lung damage and the COPD symptoms that accompany with lung damage.

    What causes COPD?

    The primary cause of COPD is cigarette smoking or exposure to tobacco smoke. It is estimated that 90% of the risk for development of COPD is related to tobacco smoke. The smoke can also be secondhand smoke (tobacco smoke exhaled by a smoker and then breathed in by a non-smoker).

    Other causes of COPD are related to air pollution, such as that seen with burning coal or wood and with industrial air pollutants.

    Infectious diseases that destroy lung tissue and patients with hyperactive airways or asthma may also contribute to causing this disease.

    The physical changes or causes are airway obstruction by thick mucus or by poor lung tissue compliance (the elasticity, or ability of the lung tissue to expand) that can either block air from entering the alveoli or by not permitting the alveoli to expel CO2 because the elastic tissue becomes nonfunctional. The overall result is that oxygen in the air cannot get by obstructions (for example, thick mucus plugs) to reach alveoli; or as is the case with emphysema or alpha-1 antitrypsin deficiency, the oxygen or air that reaches alveoli cannot be expelled. In either case, the exchange of oxygen and carbon dioxide that usually occurs in healthy alveoli is either inhibited or prevented. Consequently, the person exhibits a progressive difficulty, first coughing to remove obstructions like mucus, and then in breathing, especially with exertion.

    Healthy Lung

    What are the signs and symptoms of COPD?

    COPD is a slowly progressive disease so it is not unusual for the initial signs and symptoms to be a bit different from those in the late stages of the disease. There are many ways to evaluate or stage COPD, often based on symptoms.

    Usually the first signs and symptoms of COPD include a productive cough usually in the morning, with colorless sputum (mucus). Individuals who may develop sudden or severe (acute) chest pain should be evaluated at an emergency department to be sure there is no cardiac problem that causes symptoms similar to COPD.

    Perhaps the most significant symptom of COPD is breathlessness, termed shortness of breath (dyspnea). Early on, this symptom may occur occasionally with exertion and eventually may progress to breathlessness while doing a simple task such as standing up, or walking to the bathroom. Some people may develop wheezing (a whistling or hissing sound while breathing).

    There have been efforts to stage COPD based on symptoms and other measures. One of the most recent efforts is the Global Initiative for Chronic Obstructive Lung Disease program (GOLD). The staging is based on the results of a pulmonary function test. Specifically, the forced expiratory volume in one second (FEV1) of a standard predicted value is measured, based on the individual patient's physical parameters. The staging of COPD by this method is as follows:

    • Stage I is FEV1 of equal or more than 80% of the predicted value
    • Stage II is FEV1 of 50% to 79% of the predicted value
    • Stage III is FEV1 of 30% to 49% of the predicted value
    • Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure

    Other staging methods are similar but are based on the severity of the shortness of breath symptom that is sometimes subjective. The above staging is measurable objectively, providing the patient is putting forth their best effort.

    When should I call my doctor about COPD?

    A person should see their doctor if they experience any of the signs and symptoms of COPD and are members of a high-risk group for developing COPD, such as smokers.

    In general, patients who notice an increasing shortness of breath that wasn't present recently, especially with any minor exertion, should make an appointment to see their doctor. Patients already diagnosed with COPD who notice an increase in symptoms should also see their doctor.

    How is COPD diagnosed?

    COPD is preliminarily diagnosed by a patient's breathing history, the history of tobacco smoking or exposure to secondhand smoke, and/or air pollutants, and/or a history of lung disease (for example, pneumonia) in a patient with COPD symptoms.

    Chest X-rays or a CT scan of the chest may be done. Other tests such as an arterial blood gas or a pulse oximeter may be performed to look at the saturation level of oxygen. In addition, the patient may be sent to a lung specialist (pulmonologist) to determine their FEV1 level that is used by some physicians to stage COPD as described above.

    What is the treatment for COPD?

    There are many treatments for COPD; perhaps the first and best is to stop smoking immediately.

    Medical treatments of COPD include beta-2 agonists and anticholinergic agents (bronchodilators), steroids, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation.

    Home remedies for COPD?

    The most effective home remedy – in fact the most effective preventive therapy for COPD – is to avoid contact with tobacco smoke. If you use tobacco products – quit.

    If a person with COPD has mild to moderate symptoms, often they can benefit from exercise programs that can increase their stamina and slow the advancing pace of COPD disease.

    Medications for COPD

    Nicotine replacement therapy

    The first line of therapy that involves medication is related to smoking cessation with nicotine replacement therapy. Nicotine replacement therapy can help patients quit smoking tobacco because it can help reduce the withdrawal symptoms due to nicotine. Replacement therapies include nicotine-containing chewing gum and patches that allow nicotine to be absorbed through the skin. In these types of therapy, nicotine is gradually reduced. This medication can work well for those patients who are seriously attempting to quit tobacco.

    Quitting smoking oral medication

    Varenicline (Chantix) is an oral medication that is prescribed to promote cessation of smoking. This is also an alternative to try to quit smoking.

    Bronchodilators

    Bronchodilators are used for COPD treatment because they open up the airway tubes and allow air to more freely pass in and out of the lung tissue. There are both short-term (several hours) and long-term (12 or more hours) types of bronchodilators.

    Some short-term medications include:

    • albuterol (Ventolin, Proventil), 
    • metaproterenol (Alupent),
    • levalbuterol (Xopenex), and
    • pirbuterol (Maxair).

     Some long-term bronchodilators include:

    • salmeterol (Serevent),
    • formoterol (Foradil),
    • arformoterol (Brovana), and
    • indacaterol (Arcapta).

    Anticholinergic bronchodilators include:

    • ipratropium (Atrovent),
    • tiotropium (Spiriva), and
    • aclidinium (Tudorza).

    Other bronchodilators such as theophylline are occasionally used but are not favored because of unwanted side effects including anxiety, tremors, seizures, and arrhythmias.

    Also on the market are combined to drugs using steroids and long-acting bronchodilators. Roflumilast (Daxas, Daliresp) is a new drug that inhibits the enzyme phosphodiesterase type 4, has been utilized in patients with symptoms of chronic bronchitis.

    Other therapies

    Other supplementary therapies such as treatment with antibiotics to reduce pathogen (viral, fungal, bacterial) damage to lung tissue, mucolytic agents to help unblock mucus-clogged airways, or oxygenation therapies to increase the available oxygen to lung tissues may also reduce the symptoms of COPD. In some patients oxygen therapy will increase a patient's life expectancy and improve quality of life. This is especially true with patients who have chronically low oxygen levels in the blood. It may also help exercise endurance. Oxygen delivery systems are now easily portable and have reduced costs compared to earlier designs.

    Surgery for COPD

    There are three types of surgery generally available to treat certain types of patients with COPD that include:

    1. bullectomy,
    2. lung volume reduction surgery, and
    3. lung transplant surgery.

    Surgery may not be available or desirable for many COPD patients.

    Bullectomy surgery is the removal of giant bullae. Air–filled spaces usually located in the lung periphery that occupy lung space most often in patients with emphysema are termed bullae. Giant bullae may occupy over 33% of the lung tissue, compress adjacent lung tissue, and reduce blood flow and ventilation to healthy tissue. Surgical removal can allow compressed lung tissue that is still functional to expand.

    Lung volume reduction surgery is removal of lung tissue that has been most damaged by tobacco smoking, usually the 20% to 30% of lung tissue located in the upper part of each lung. This procedure is not done often; it is usually done on patients who have severe emphysema and marked hyperinflation of the airways and air spaces.

    Lung transplantation is surgical therapy for people with advanced lung disease. Patients with COPD are the largest single category of people who undergo lung transplantation. In general, these COPD patients are usually at COPD stage three or four with severe symptoms and generally, without transplantation, have a life expectancy of about two years or less.

    Can COPD be prevented?

    Except for COPD due to genetic problems, COPD can be prevented in many people by simply never using tobacco products. In addition, avoiding wood, oil, and coal-burning fumes along with limiting one's exposure to air pollutants may also decrease or prevent COPD. Getting vaccines to avoid infections can help reduce lung damage and the COPD symptoms that accompany with lung damage.

    Source: http://www.rxlist.com

    There are many treatments for COPD; perhaps the first and best is to stop smoking immediately.

    Medical treatments of COPD include beta-2 agonists and anticholinergic agents (bronchodilators), steroids, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation.

    Source: http://www.rxlist.com

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