COPD: Chronic Obstructive Pulmonary Disease

COPD is a term used to describe emphysema and chronic bronchitis. It is the fourth leading cause of death in the United States. The rate of COPD mortality in women tripled in the U. S. from 1980 to 2000. Early diagnosis and treatment including drug treatment and pulmonary rehabilitation are key components in slowing progression of the disease and improving the quality of life.

COPD is caused by chronic inflammation of the small airways and gradual destruction of the alveoli (air sacs). The small bronchioles collapse or are blocked by mucous. Air becomes trapped and causes hyperinflation of the lungs. As the air sacs die and bronchioles are plugged the exchange of oxygen and carbon dioxide is impaired. This impairment drops the patient’s oxygen concentration and raises the carbon dioxide concentration in the blood.

Risk factors for COPD include old/middle age, genetic factors, exposure to second hand smoke, history of childhood respiratory infections, and prolonged exposure to air pollution. However, the most important risk factor is a history of cigarette smoking.

Symptoms of COPD are:
➢ Shortness of breath
➢ Chronic cough
➢ Wheezing
➢ Chest tightness
➢ Increased sputum production
➢ Change in color of sputum
➢ Blood in sputum
➢ Fatigue
➢ Sleep difficulty
➢ Headaches, restlessness, dizziness

Treatment of COPD includes limiting continued exposure to the causative irritants including cigarette smoking and pollutions. Influenza and pneumococcal vaccinations are important to prevent infections that can cause further lung damage. Drug treatment includes long-acting bronchodilator inhalers. Short term, bronchodilators may be useful for acute exacerbations. Inhaled and oral steroids are useful as the condition worsens. Mucolytic agents are sometimes useful to help patients clear their airways. Cough medications are not usually helpful. Antibiotics are occasionally useful during acute exacerbations, but are not useful for chronic management.

Mark Smith, MD
March 13, 2006