Chronic Obstructive Pulmonary Disease

COPD is now the fourth leading cause of death in the United States, and is the only common cause of death that is increasing in incidence in recent years.

COPD is a group of lung diseases characterized by an obstruction to airflow, i.e. trouble getting the air out of your lungs. It includes such conditions as chronic bronchitis and emphysema, which are most often caused by cigarette smoking. COPD can also include chronic asthma, which is an inflammatory condition of the air passages in the lungs. Bronchitis, emphysema, and asthma all have one thing in common: They limit the flow of air out of your lungs. As a result, you may cough, wheeze, have excess mucus, feel short of breath, and have susceptibility to respiratory infections.

Ø How Healthy Lungs Work

Breathing is your body's way of getting oxygen into your blood and expelling the waste product gas – CO₂.

When you breathe, you take air in through your nose or mouth. The air passes through your throat into the trachea (windpipe) and then into the lungs. A dome-shaped muscle (diaphragm) lies below the lungs. The diaphragm drops down and flattens to expand your chest and draw air in as you inhale, then rises as you exhale.

The primary role of your lungs is to get oxygen to your blood. Air passes from the trachea into the bronchial tubes. These tubes branch, like a tree, into smaller and smaller passages, or airways, which are wrapped by bands of muscle. Air travels through these branches, eventually reaching the smallest airways (bronchioles), which end in balloon like air sacs, called alveoli. Blood vessels surrounding the alveoli absorb oxygen into the bloodstream. At the same time, the alveoli remove carbon dioxide from the blood. The carbon dioxide is then exhaled.

Your lungs also clean the air you breathe in. The lining of the bronchial tubes normally produces a small amount of mucous that traps dust, smoke and other particles. Tiny hairs on the lining of your bronchial tubes, called cilia, then sweep the mucus up the airways to the throat, where it is swallowed.

Ø Risk Factors

In industrialized countries, cigarette smoking accounts for most cases of COPD. Air pollution (particularly with sulfur dioxide and particulates), exposure to certain occupational chemicals and passive smoking may all be risk factors but don't usually lead to COPD unless combined with cigarette smoking. Certain genetic factors also play a role, but role of these are still being worked out.

Ø Diagnosing COPD

Your physician first evaluates your lungs to diagnose your condition.

A medical history will be taken and questions asked such as:

Do you smoke? Have you been exposed to second hand smoke?

Have you been exposed to dust or other inhalants?

Is there a family history of lung disease?

Do you have any symptoms, such as shortness of breath, coughing, wheezing, excess mucus, chest discomfort or swollen ankles?

Your doctor will then give you a complete physical exam, which will include listening to your lungs and heart and examining your nose and throat. Your doctor will also order some tests. These may include routine blood tests, a chest x-ray to screen for lung diseases or damage from prior lung infections, and an ECG (electrocardiogram) to rule out heart disease as the cause of your shortness of breath.

Pulmonary function tests (PFT's) will also be ordered. These tests measure how much air you can take into your lungs and how fast your can blow the air out (spirometry); how much air you exhale and how much air is left in your lungs after your exhale (lung volumes): and how much oxygen is transported from your lungs to your blood (lung diffusion). These tests are done in the physician's office.

Your physician may also order other tests to help diagnose your lung disease. These may include pulse oximetry to measure the level of oxygen in your blood at rest and after exercise; an arterial blood gas (ABG) test to measure the amounts of oxygen and carbon dioxide in your blood; and exercise bike test to see how well your heart and lungs work under stress; and a CT (computed tomography) scan to reveal the condition of your lungs.

Ø When You Have COPD

With COPD, the normal flow of air is blocked by excess mucus and inflammation (chronic bronchitis), by collapsed airways (emphysema), or by tightening of the muscles around the airways (chronic asthma). As a result, you feel short of breath. You may also cough, wheeze or feel weak. Many people who are diagnosed with COPD have more than one of these conditions.

Chronic Bronchitis - is diagnosed when you cough up mucus and feel short of breath three months or more each year for at least two consecutive years. These symptoms occur when the lining of the bronchioles becomes inflamed and produces too much mucus. The swelling and excess mucus narrows the airways and restricts airflow into and out of the lungs, causing shortness of breath. The thin hair-like cells that line the airways (called cilia) that normally help to move mucus out of the airway, are also damaged, and therefore are unable to remove the excess mucus.

Emphysema - destroys the normal, delicate air pockets (alveoli) and makes “Swiss Cheese” out of the lungs thus making it difficult for the lungs to absorb enough oxygen or expel enough carbon dioxide. The walls of the alveoli lose their elasticity and enlarge. As they enlarge, the diaphragm flattens, making it harder for the lungs to move air in and out. With the destruction of surrounding lung tissue, the bronchial tubes become floppy (less elastic). As the bronchial tubes branch out into the lungs, they lose there surrounding structural support and tend to collapse during exhalation. As a result, carbon dioxide gets trapped in the airways and prevents oxygen from getting to the blood.

Chronic asthma - is a hypersensitivity of the airways to allergens and irritants, which inflame the lining of the bronchioles. When the lining swells, the muscles in the bronchial walls tighten and go into spasm. This in turn further constricts the airways. Inflammation may cause the bronchial lining to produce excess mucus as well, which also blocks the airways with asthma; treatment can reverse the swelling and muscle spasms.

Ø How is COPD Treated?

Although there is no cure for COPD, once your condition is diagnosed, your physician will decide the best treatment in your case, to slow down the progression and minimize the discomfort, depending on how severe the symptoms are and the underlying disease (remember that COPD has different causes).

First and foremost, you must stop exposing yourself to fumes or pollutants that may have caused your condition in the first place (i.e. quit smoking, eliminate 2nd hand exposures, etc). Medication may be prescribed for you. You must only take those medications your physician prescribes exactly as ordered. There are four (4) classifications of medications listed below with a brief description of how each works in your lungs and body.

1. Bronchodilators

A. Inhaled (Albuterol, Atrovent, Serevent)

Relax and open airways
Increase movement of cilia to help clear mucus
Help prevent exercise-induced wheezing
Help stop attacks

B. Swallowed (Theophylline)

Relax and open airways
Stimulate the diaphragm and breathing
Are very useful if symptoms occur during sleep
Are long acting

2. Corticosteroids

A. Inhaled and/or Swallowed (Many inhaled brands, prednisone, Medrol)

Reduce inflammation and swelling in airways
Reduce mucus production
Decrease sensitivity of airways to irritants and allergens

3. Nonsteroidal Anti-inflammatory Medications

A. Inhaled (Cromolyn, Nedocromil) and Swallowed (Singulair, Accolate)

Primarily used in asthma
Help reduce or prevent inflammation caused by allergies
Help prevent wheezing
Help prevent exercise-induced asthma

4. Expectorants (Guaifenesin, Duratuss-G, Robitussin)

A. Swallowed

Help liquefy and remove mucus from airways

Oxygen therapy may be prescribed if your lungs aren't getting enough oxygen to your blood. A company that provides home health care services will be sent to your home by your physician's office with precise instructions on how much and when to use your oxygen (this may be all the time). The company will deliver your oxygen and train you to use is. Using prescribed oxygen can help you avoid shortness of breath and be more active. If your lungs don't deliver enough oxygen to your blood (hypoxemia), you may become short of breath, have a headache, or feel tired, irritable, or confused. Prescribed oxygen is not addictive and causes no side effects. And it doesn't mean you have to stay home. You can take a portable unit with you.

Good bronchial hygiene is helpful. A flutter valve, incentive spirometry or chest percussion therapy may be ordered to help loosen mucus to be coughed up to help clear your lungs.

Pursed lip breathing is another useful tool for breathing easier and avoiding increased shortness of breath.

You may be referred to a pulmonary rehabilitation facility to be taught to use these techniques. This has been shown to improve exercise capacity and quality of life among patients with severe COPD and to reduce the amount of health care needed.

Lung Volume Reduction Therapy - An experimental surgical therapy intended to remove emphysematous lung tissue to provide more room in the chest for the relatively normal tissue.

Ø In Summary

Eat a sensible well balanced diet, get plenty of rest and drink plenty of fluids. Conserve your energy but remain active as possible because prolonged inactivity leads to increased disability. Don't smoke and avoid exposure to irritants and respiratory infections.

Follow your physicians plan of treatment and call your physicians office if you experience any increased shortness of breath, have any fever or chills, chest tightness or if your sputum changes in consistency or color for what is normal for you.