COPD
 

 

 

 

 

 


COPD

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow.

The main symptoms include shortness of breath and cough with sputum production. COPD is a progressive disease, meaning it typically worsens over time.

Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow.

The main symptoms include shortness of breath and cough with sputum production.

Eventually, everyday activities such as walking or getting dressed become difficult.

Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.

Most cases of COPD can be prevented by reducing exposure to risk factors.

While treatment can slow worsening, no cure is known. COPD treatments include smoking cessation, vaccinations, respiratory rehabilitation, and often inhaled bronchodilators and steroids.

Some people may benefit from long-term oxygen therapy or lung transplantation. In those who have periods of acute worsening, increased use of medications and hospitalization may be needed.

Signs and symptoms

1. Wheezing - The sound of wheezing as heard with a stethoscope.

2. The most common symptoms of COPD are sputum production, shortness of breath, and a productive cough. These symptoms are present for a prolonged period of time and typically worsen over time.

Cough - A chronic cough is often the first symptom to develop.
Early on it may just occur occasionally or may not result in sputum. When a cough persists for more than three months each year for at least two years, in combination with sputum production and without another explanation, it is by definition chronic bronchitis.
Chronic bronchitis can occur before the restricted airflow and thus COPD fully develops.

The amount of sputum produced can change over hours to days. In some cases, the cough may not be present or may only occur occasionally and may not be productive.
Some people with COPD attribute the symptoms to a "smoker's cough".

Vigorous coughing may lead to rib fractures or a brief loss of consciousness.

Shortness of breath is often the symptom that most bothers people. It is commonly described as: "my breathing requires effort," "I feel out of breath," or "I can't get enough air in".

Typically, the shortness of breath is worse on exertion of a prolonged duration and worsens over time.

Other symptoms

In COPD, breathing out may take longer than breathing in. Chest tightness may occur, but is not common and may be caused by another problem.

Those with obstructed airflow may have wheezing or decreased sounds with air entry on examination of the chest with a stethoscope. A barrel chest is a characteristic sign of COPD, but is relatively uncommon.

Advanced COPD leads to high pressure on the lung arteries, which strains the right ventricle of the heart.

This situation is referred to as cor pulmonale, and leads to symptoms of leg swelling and bulging neck veins.

Exacerbation

An acute exacerbation of COPD is defined as increased shortness of breath, increased sputum production, a change in the color of the sputum from clear to green or yellow, or an increase in cough in someone with COPD.

They may present with signs of increased work of breathing such as fast breathing, a fast heart rate, sweating, active use of muscles in the neck, a bluish tinge to the skin, and confusion or combative behavior in very severe exacerbations.

Crackles may also be heard over the lungs on examination with a stethoscope.

Cause

The primary cause of COPD is tobacco smoke, with occupational exposure and pollution from indoor fires being significant causes in some countries. Typically, these must occur over several decades before symptoms develop.

Occupational exposure

Intense and prolonged exposure to workplace dusts, chemicals, and fumes increases the risk of COPD in both smokers and nonsmokers.

Genetics

Genetics play a role in the development of COPD. It is more common among relatives of those with COPD who smoke than unrelated smokers.

Other

Tentative evidence indicates that those with asthma and airway hyperreactivity are at increased risk of COPD.

Birth factors such as low birth weight may also play a role, as do a number of infectious diseases, including HIV/AIDS and tuberculosis.

Respiratory infections such as pneumonia do not appear to increase the risk of COPD, at least in adults.

Diagnosis

The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath, a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease.

Spirometry measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator, a medication to open up the airways.

Two main components are measured to make the diagnosis, the forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in the first second of a breath, and the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a single large breath.

Other tests

A chest X-ray and complete blood count may be useful to exclude other conditions at the time of diagnosis.
Characteristic signs on X-ray are overinflated lungs, a flattened diaphragm, increased retrosternal airspace, and bullae, while it can help exclude other lung diseases, such as pneumonia, pulmonary edema, or a pneumothorax.
A high-resolution computed tomography scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.
Differential diagnosis

COPD may need to be differentiated from other causes of shortness of breath such as congestive heart failure, pulmonary embolism, pneumonia, or pneumothorax.

Prevention

Most cases of COPD are potentially preventable through decreasing exposure to smoke and improving air quality.

Smoking cessation

Keeping people from starting smoking is a key aspect of preventing COPD.

In those who smoke, stopping smoking is the only measure shown to slow down the worsening of COPD.

Even at a late stage of the disease, it can reduce the rate of worsening lung function and delay the onset of disability and death.

Management

No cure for COPD is known, but the symptoms are treatable and its progression can be delayed.

The only measures that have been shown to reduce mortality are smoking cessation and supplemental oxygen.

Inhaled bronchodilators are the primary medications used, and result in a small overall benefit. The two major types, both exist in long-acting and short-acting forms.

Corticosteroids are usually used in inhaled form, but may also be used as tablets to treat and prevent acute exacerbations. While inhaled corticosteroids (ICSs) have not shown benefit for people with mild COPD, they decrease acute exacerbations in those with either moderate or severe disease.

Surgery

For those with very severe disease, surgery is sometimes helpful and may include lung transplantation or lung volume-reduction surgery, which involves removing the parts of the lung most damaged by emphysema, allowing the remaining, relatively good lung to expand and work better.

COPD usually gets gradually worse over time and can ultimately result in death. It is estimated that 3% of all disability is related to COPD. Eventually, everyday activities such as walking or getting dressed become difficult.

Some people may benefit from long-term oxygen therapy or lung transplantation. In those who have periods of acute worsening, increased use of medications and hospitalization may be needed.

In the advanced stages, or end stage pulmonary disease, it occurs during rest and may be always present. It is a source of both anxiety and a poor quality of life in those with COPD.

Other symptoms

In COPD, breathing out may take longer than breathing in. Chest tightness may occur, but is not common and may be caused by another problem.

Those with obstructed airflow may have wheezing or decreased sounds with air entry on examination of the chest with a stethoscope. A barrel chest is a characteristic sign of COPD, but is relatively uncommon.

Advanced COPD leads to high pressure on the lung arteries, which strains the right ventricle of the heart.

This situation is referred to as cor pulmonale, and leads to symptoms of leg swelling and bulging neck veins.

Diagnosis

The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath, a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease.

Other tests

A chest X-ray and complete blood count may be useful to exclude other conditions at the time of diagnosis.

Characteristic signs on X-ray are overinflated lungs, a flattened diaphragm, increased retrosternal airspace, and bullae, while it can help exclude other lung diseases, such as pneumonia, pulmonary edema, or a pneumothorax.

A high-resolution computed tomography scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.

Differential diagnosis

COPD may need to be differentiated from other causes of shortness of breath such as congestive heart failure, pulmonary embolism, pneumonia, or pneumothorax.

Prevention

Smoking cessation

Keeping people from starting smoking is a key aspect of preventing COPD.

In those who smoke, stopping smoking is the only measure shown to slow down the worsening of COPD.

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