An in-depth report on the causes, diagnosis, treatment, and prevention of COPD -- emphysema and chronic bronchitis.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the U.S. The disease is characterized by an abnormal inflammatory response in the lungs and restricted airflow (documented by spirometry). The disease typically occurs after age 35.
Cigarette smoking remains the major cause of COPD, but it isn't the only cause. In most studies, smoking accounts for about 80% of COPD cases. Quitting smoking can improve lung function and help to prevent death from COPD. Other causes, such as genetic syndromes (alpha-1 antitrypsin deficiency) and exposures to pollutants such as dust, irritants and fumes are also involved in the development of the disease.
An overall treatment strategy may include one or several medications, lifestyle changes, education, pulmonary rehabilitation, oxygen therapy and perhaps surgery.
- One National Institute of Health (NIH) -funded trial showed that daily azithromycin (plus usual treatment) reduced the frequency of COPD exacerbations and improved quality of life. The long- term effects of taking azithromycin, a broad spectrum antibiotic, are not known. Daily azithromycin is not suitable for patients at risk for abnormal heart rhythms or ear damage.
- The choices among options for inhaled therapy may be based on patient preference, side effects and/or cost. Much research is underway to assess the merits of individual (mono-therapy) vs. combination therapy options, such as these recent findings:
- Alone, tiotropium, a long-acting anticholinergic drug, was found to be significantly better than the beta2-agonist salmeterol in reducing exacerbations in patients with moderate to severe COPD in a one year study.
- Both long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) yield similar benefits across most outcomes when used as individual therapies. Given their potential side effects, current guidelines support long-acting beta-agonists as primary therapy, supplemented by regular use of corticosteroids for patients who experience frequent exacerbations.
Other Treatments and Guidelines
- Pulmonary rehabilitation may offer a management strategy for patients who experienced a recent exacerbation of COPD. It may reduce hospital admissions and mortality, and improve quality of life.
- In 2009, the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS), updated
its 2007 clinical guidelines on the diagnosis and management of COPD. It stresses the importance of patient history and physical examination for predicting airflow obstruction, spirometry for screening or diagnosis of COPD, and assessing management strategies included inhaled medications, pulmonary rehabilitation and supplemental oxygen.
Chronic obstructive pulmonary disease (COPD) is a condition in which there is reduced airflow in the lungs. The disease develops and worsens over time. COPD is not reversible, but therapy can slow its progress.
Although patients can breathe in normally, changes in the small airways cause the tubes to narrow during expiration, making it hard to breathe out. In many patients with COPD, the small sacs where oxygen and carbon dioxide are exchanged are destroyed, gradually depriving the body of enough oxygen.
COPD is associated with a set of breathing-related symptoms:
- Being out of breath, at first when doing physical activities, but as lung function deteriorates, also at rest
- Chronic cough
- Spitting or coughing mucus (phlegm)
The ability to exhale (breathe out) gets worse over time.
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The lungs are located in the chest cavity and are responsible for breathing. The alveoli are small sacs where oxygen is exchanged in the lungs.
The two major diseases in this category are emphysema and chronic bronchitis, both of which are covered in this report. The third, less common disease, is obstructive bronchiolitis, an inflammatory condition of the small airways. Asthma shares some of the same symptoms, but it is a very different disease. People can have asthma and COPD at the same time.
Because smoking is a common cause of both emphysema and chronic bronchitis, these conditions often develop together and frequently require similar treatments and approaches. When chronic bronchitis occurs together with emphysema, it is often difficult for a physician to distinguish between the two diseases.
Emphysema is a disease in which the alveoli. grape-like clusters of air sacs at the end of the smallest airways (the bronchioles) are destroyed. It generally takes the following course:
The walls of the alveoli become inflamed and damaged. Over time they lose the ability to stretch and shrink (elasticity), and pockets of stagnant air (called bullae ) form in the injured areas.