Overview of Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible.1 It is an inflammatory disorder secondary to the chronic inhalation of primarily tobacco smoke leading to progressive deterioration in the pulmonary function.
Chronic obstructive pulmonary disease encompasses chronic bronchitis, emphysema and a range of other lung disorders. Chronic bronchitisis defined clinically as chronic productive cough for 3 months in each of two successive years in a patient in whom other causes of productive chronic cough have been ruled out. Emphysemais defined pathologically as the presence of permanent enlargement of the airspaces beyond the terminal bronchioles. Patients with COPD may have either of those conditions.
Today, COPD is a steadily growing global healthcare problem with increasing morbidity and mortality.1 The effective management of COPD depends primarily on early identification, cessation of smoking and the use of bronchodilators to improve pulmonary function. Inhaled steroids may reduce frequency and severity of exacerbation and can be combined with long-acting beta-2 agonists. Pulmonary rehabilitation benefits most patients. Patients with hypoxemia due to severe disease may require a long-term oxygen therapy.
Clinical Features – Symptoms of Chronic obstructive pulmonary disease (COPD)
Although often misdiagnosed as asthma, COPD should not be confused with asthma as these two diseases display significantly different inflammatory processes, clinical courses, responses to treatment and outcomes.
Patients with COPD present with a combination of signs and symptoms of chronic bronchitis, emphysema and asthma. Symptoms include worsening dyspnea, progressive exercise intolerance, and alteration in mental status. The dyspnea could be accompanied by wheezing and a persistent productive cough. Occasionally, the sputum may contain blood (hemoptysis) due to damage of the blood vessels of the airways. Severe COPD could lead to cyanosis (bluish decolorization of the lips and fingers) caused by lack of oxygen in the blood.
The signs and symptoms of COPD appear in many patients only after the forced expiratory volume in 1 second (FEV1) is <50% predicted.
Diagnosis of Chronic obstructive pulmonary disease (COPD)
Due to its progressive nature, the early diagnosis and treatment of COPD are essentialto prevent complications and exacerbations associated with the condition.2 Diagnosis of COPD is based on an assessment of risk factors such as smoking and evaluation of symptoms. Further confirmation is done using spirometry or lung function test.2 Office spirometry for all smokers and exsmokers as well as those with respiratory symptoms is an important mean of achieving early diagnosis and improving long-term outcomes.
Management of Chronic obstructive pulmonary disease (COPD)
Smoking cessation remains a mainstay of COPD therapy. Even at a late stage of the disease, it can reduce the rate of disease deterioration.3 Other nonpharmacological treatment includes avoidance of risk factors, patient education, pulmonary rehabilitation and oxygen therapy, when necessary. Once COPD is diagnosed pharmacologic treatment depends on symptoms as well as the severity of disease.
The mainstays of therapy for acute exacerbations of COPD are oxygen, bronchodilators and definitive airway management. Management of mild disease includes smoking cessation and use of short-acting bronchodilators as needed. For moderate and severe disease, one or more long-acting bronchodilators are added to the treatment described for mild disease. Inhaled corticosteroids are prescribed in patients with recurrent exacerbations. Long-term oxygen therapy is indicated for all patients with documented hypoxemia. In patients with very severe disease, lung transplantation or other surgical therapy such as lung volume reduction surgery should be considered when appropriate.
- Malakauskas K, Sakalauskas R. Diagnosis and management of chronic obstructive pulmonary disease. Medicina (Kaunas). 2005; 41(2):171-179.
- Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: NHLBI/WHO Workshop Report. National Institute of Health. 2001. NIH Publication No. 2701. http://www.goldcopd.com. Updated: 2005.
- Kumar P, Clark M (2005). Clinical Medicine, 6th edn. Elsevier Saunders. pp 900-901.