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COPD

Chronic obstructive pulmonary disease (COPD) is a permanent narrowing of the airways caused by emphysema or chronic bronchitis. Chronic obstructive pulmonary disease affects about 14 million people in the United States. This disease is a second cause of work disability after heart disease, and th... read more

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Chronic obstructive pulmonary disease (COPD) is a permanent narrowing of the airways caused by emphysema or chronic bronchitis.

Chronic obstructive pulmonary disease affects about 14 million people in the United States. This disease is a second cause of work disability after heart disease, and the fourth leading cause of death. More than 95% of all deaths occur from chronic obstructive pulmonary disease in people over 55 years of age.

It more often affects men than women and it is more common cause of death in men. It is more common cause of death in Caucasians than in other races, as well as in the manual workers compared to knowledge workers.

Chronic obstructive pulmonary disease is more common in some families, so it seems that there is a hereditary tendency. Working in an environment contaminated by chemical fumes or dust can increase the risk of chronic obstructive pulmonary disease. However, smoking increases the risk much more than the profession.

10-15% of smokers may get COPD. Smokers of pipes and cigars get it more frequently than non-smokers, but not as often as cigarette smokers. Cigarette smokers have a higher death rate from chronic bronchitis and emphysema than non-smokers. With age pulmonary function weakens much more in smokers than in nonsmokers. As the person smokes more cigarettes, he or she is at greater risk of the loss of pulmonary function.

Symptoms

The earliest symptoms of chronic obstructive pulmonary disease, which can occur even after 5-10 years of smoking, are cough and mucus production, usually after getting up. Cough is generally mild and often replaced with "normal" smoker's cough, although, of course, this is not a normal cough. Often there is a tendency of rhinitis descending toward the chest. During the catarrhal inflammation sputum often turns yellow or green because of the content of mucus. As the years pass the diseases of the chest can become more and more frequent. They may be accompanied by wheezing more often noticed by family members than the patients.

Around the age of 60 patients often experience shortness of breath on exertion, which slowly progresses. Finally the patient experiences dyspnea during everyday activities such as personal hygiene, washing, dressing up and preparing food. About a third of patients noticeably lose weight which is at least partially caused by the worsening of breathlessness after meals. There is also swelling of the legs which can be due to heart problems. In the late stages, chest pain which is well tolerated at an early stage can cause severe shortness of breath at rest; it is an indicator of acute respiratory failure.

Treatment

Since smoking is the most important cause of chronic obstructive pulmonary disease, the most important treatment is smoking cessation. When the narrowing of the airways is mild or moderate smoking cessation slows down the development of disabling dyspnea. However, smoking cessation at any stage of the disease leads to some relief. One should moreover try to avoid exposure to other irritants in the air.

COPD can be significantly worse if a person gets the flu or pneumonia. Therefore, the person with the disease must be vaccinated against influenza every year, and every 6 years against pneumococcal.

Return causes of the narrowing of the airways include muscle tightness, inflammation and increased mucus secretion. Improving each of them will generally reduce symptoms. Muscle contractions can be reduced with the use of bronchodilators:

Inflammation can be reduced with the use of corticosteroids, but only in about 20% of patients the symptoms respond to corticosteroids. Available combinations of bronchodilators (salmeterol) and corticosteroids (fluticasone) in a form of pressurized inhalation suspension (Advair HFA Inhaler, Respiro) and pre-dispensed inhalation powder (Advair Diskus, Airflusal Forspiro).

In order to dilute the mucus to facilitate expectoration one may use carbocysteine (Availnex, Mucodyne). Also, by avoiding dehydration one can suppress the secretion of thick mucus. Based on practical experience, it is advisable to take plenty of fluids to keep the urine pale.

Worsening of the chronic obstructive pulmonary disease is sometimes due to a bacterial infection that can be treated with antibiotics. The treatment often lasts from 7 to 10 days. Many doctors supply their patients with antibiotics and advise them to start taking them immediately in case of worsening of the disease.

 

Treatment of COPD according to the GOLD classification

 

Stage of

COPD 

Characteristics   Recommended treatment 

Stage 0:

Increased risk

Chronic difficulties

- cough

- expectorant

Without spirometric disorders
• Treatment is not necessary 

Stage I: mild

COPD

FEV1/FVC < 70 %

FEV1 > 80 % expected

With or without symptoms
• Short-acting bronchodilators if necessary
Stage IIA:  moderate COPD 

FEV1/FVC < 70%

50% < FEV1< 80% expected

With or without symptoms

• Regular application of one or more bronchodilators

• Rehabilitation

• Inhaled corticosteroids if achieved a significant response regarding the reduction of symptoms and recovery of lung function

Stage IIB: severe

COPD

FEV1/FVC < 70%

30% < FEV1 < 50% expected

With or without symptoms

• Regular application of one or more bronchodilators

• Rehabilitation

• Inhaled corticosteroids if you achieve a significant response regarding the reduction of symptoms and recovery of lung function or if there is frequent worsening
Stage III: very severe COPD

FEV1/FVC < 70%

FEV1 < 30% expected or respiratory failure or right-sided heart failure

• Regular application of one or more bronchodilators

• Rehabilitation

• Inhaled corticosteroids if you achieve a significant response regarding the reduction of symptoms and recovery of lung function or if there is frequent worsening

• Treatment of complications

• Long-term oxygen therapy in case of respiratory failure

• Consider the possibility of surgical treatment

 

The FEV1 (forced expiratory volume 1) is the volume of air forcefully exhaled in 1 second, whereas the FVC (forced vital capacity) is the volume of air that can be maximally forcefully exhaled - and therefore contains the FEV1 within it. If the FEV1/FVC ratio is <80%, it indicates that an obstructive defect is present.