Chronic Obstructive Pulmonary Disease (COPD) Overview

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disorder of the lungs, which causes long-lasting obstruction of the airways. It is also recognized by the names chronic obstructive airway disease or chronic obstructive lung disease.

Two common forms of the disease are chronic bronchitis and emphysema. These diseases cause a progressive, chronic obstruction of the airways in the lungs. Smoking accounts for about 90% cases of COPD.

Chronic, persistent cough and shortness of breath are the major symptoms. This lung disorder is the fourth leading cause of death in the United States. About 14.2 million people are diagnosed with this disease in the United States.

Chronic Bronchitis: Chronic bronchitis causes swelling and inflammation of the lining of the airways and thickening of the bronchial walls. This can cause narrowing and obstruction of the airways.

The production of mucous due to inflammation can lead to further obstruction of the airways. Approximately 12.5 million people are diagnosed with chronic bronchitis in the United States.

Emphysema: Emphysema causes a permanent, abnormal enlargement of the alveoli (air spaces) located at the end of terminal bronchioles (breathing passage of the lungs). The destruction of the alveolar walls can lead to reduction in the elasticity of the lungs.

This causes obstruction of the airflow out of alveoli, which interferes with the exchange of gases within the lungs. About 1.7 million people are affected by emphysema in the United States.

People with COPD could also be affected by chronic asthma and bronchiectasis. Asthma is caused by obstruction of airflow due to inflammation of the airways and muscle spasm surrounding the airways (bronchospasm). In bronchiectasis, there may be repeated serious lung infections and permanent damage to the airways.

Cigarette smoking is the leading cause of this medical condition. Not all, but about 15% of smokers are affected by it. Smokers with COPD are more likely to have deterioration in the lung function and frequent respiratory symptoms as compared to the nonsmokers.

Environmental tobacco smoke or second hand smoke can also contribute in developing the respiratory infections, leading to reduced lung function. Chronic bronchitis is triggered by infection, allergies, and air pollution. A deficiency of protein alpha-1 antitrypsin, can increase the risk of emphysema in the nonsmokers.

Cigarette smoking and exposure to tobacco are the major risk factors. It causes irritating effects on the cells of the lungs, leading to inflammation. Smoke stimulates these cells to release an enzyme elastase that causes breakdown of elastic fibers in the lung tissues.

A family history of this medical condition and long-term exposure to lung irritants like air pollution, dust, and chemical fumes are some of the other risk factors.

People, after frequent smoking for more than 20 years, develop the symptoms such as chronic cough, frequent respiratory infections, and shortness of breath (dyspnea). In emphysema, shortness of breath is the main symptom. Generally, it is experienced with increased physical activities. But as emphysema progresses, dyspnea can also occur at rest.

Chronic bronchitis or bronchiectasis causes symptoms like chronic cough and sputum production. There is higher risk of chest infections, which can cause coughing, dyspnea, fever, wheezing, and production of discolored, cloudy sputum. Some other symptoms are fatigue, depression, confusion, memory loss, and decreased exercise tolerance.

In the advanced stage, there may be cyanosis (a bluish discoloration of lips and nail beds) due to deficiency of oxygen in the blood. The affected people may also be faced with the problems such as morning headaches, weight loss, and anorexia.

In this advanced stage, the blood flow through the lungs is blocked, which can cause pulmonary hypertension (increased pressure in the blood vessels of the lungs).

There is also a risk of cor pulmonale (failure of the right ventricle of the heart), leading to swelling of the ankles and feet. Due to the damage caused to the inner lining and blood vessels of the airways, the affected person may cough up blood, which is known as hemoptysis. This could be an indication of the development of lung cancer.

This disease is diagnosed on the basis of findings of physical examination and medical history of the affected person, as well as various tests and laboratory investigations. Certain tests such as X-ray, CT scan, or MRI scan of the chest, pulmonary function test (PFT), as well as some laboratory investigations are performed to confirm the diagnosis.

Chest X-ray and CT scan can help to rule out the possibility of lung infections like pneumonia and lung cancer. The laboratory investigations include determination of arterial blood gases (ABG) and sputum analysis.

The treatment aims at relieving the symptoms and exacerbations, preventing further deterioration in lung function, preserving normal lung function, and improving performance of daily activities and thus, overall quality of life. The people diagnosed with this medical condition should immediately quit smoking.

If smoking is continued, then it could lead to a more rapid loss of lung function. Since nicotine present in a cigarette is addictive, cessation of smoking can give rise to symptoms like anger, irritability, fatigue, depression, anxiety, difficulty in concentration, and extreme cravings for cigarettes.

However, nicotine replacement therapies are helpful to relieve these nicotine withdrawal symptoms. Furthermore, nicotine chewing gum and nicotine skin patches can effectively help decrease cigarette cravings. Use of antidepressants like bupropion or oral corticosteroids is also beneficial.

The airways obstruction can be treated with bronchodilators. These medications would help relax the muscles surrounding the airways and thus in turn, open the airways. Bronchodilators can be taken orally, inhaled,or administered intravenously. Beta2-agonists like albuterol, levalbuterol, isoetharine, and metaproterenol also show the bronchodilator effects.

Use of aerosolized anticholinergic agents like ipratropium bromide is effective in relieving the symptoms such as shortness of breath. Some long-lasting bronchodilators such as methylxanthines (theophylline and aminophylline) act by opening the breathing passages, reducing inflammation, improving respiratory muscle function, and stimulating the brain respiratory center.

Corticosteroids like triamcinolone acetonide, fluticasone, budesonide, and beclomethasone dipropionate are the anti-inflammatory medications, which can help to reduce inflammation of the airways that causes airflow obstruction.

In the affected people, chronic infection of the airways is very common. Therefore, an antibiotic therapy including amoxicillin, cefaclor, clarithromycin, azithromycin, or trimethoprim/sulfamethoxazole is administered in order to treat acute exacerbations.

This medical condition generally interferes with the oxygenation of the blood (hypoxemia). Therefore, oxygen therapy including supplemental oxygen would prove beneficial to the affected people. Emphysema may result from severe alpha-1 antitrypsin deficiency (AAT). It can be treated with replacement of active AAT by injection.

Certain surgical options such as bullectomy and lung volume reduction surgery are effective in improving the symptoms and restoring the lung function in people with emphysema. Moreover, lung transplantation is the latest surgical option used to treat the advanced lung disease.

On a conclusive note, the only way to prevent this hazardous lung disorder is to quit smoking. Since smoking is the root cause of a number of health problems, avoiding it would be beneficial for a good overall health. You should stay away from stress, avoid exposure to smoke, allergens and air pollutants, which are the triggering factors for this health disorder.

Disclaimer: This story is for informative purposes only, and should not be used as a replacement for expert medical advice.