Everything About COPD

By: Nancy Gerrard, Kendra Hood, Alana Boso, and Megan Tucker

Pathogenesis

1. COPD causes damage to the airways and alveoli

- Progress to cough with mucous

a. Eventually causes difficulty with breathing

2. Two main conditions that fall under COPD

- Emphysema

a. Disease of the alveoli

b. Fibers that make up walls of alveoli are damaged

c. Alveoli become less elastic and able to function upon exhalation

- Chronic Bronchitis

a. Bronchioles becomes inflamed

3. Causes of COPD

- Smoking is the number one cause of COPD

a. 80% of COPD diagnoses are a direct effect of smoking

b. Some studies show that up to half of long term smokers older than 60 develop COPD.

- Preterm birth that leads to lung damage

a. Neonatal lung disease

- Long term Exposure to lung irritants

a. Industrial dust and/or chemical fumes

- Inherited factors

a. Alpha-1 antitrypsin deficiency

-Rare disorder

1. Body may not be able to make enough alpha-1 antitrypsin which protects lungs from damage.

2. People with this disorder (who smoke) show signs of emphysema in their 30s and 40s.

3. People with this disorder (who don’t smoke) generally start to show symptoms in their 80s.

Risk Factors

Exposure to tobacco smoke: The biggest risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers are at risk, also people exposed to large amounts of secondhand smoke.

People with asthma who smoke: The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.

Occupational exposure to dusts and chemicals: Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.

Age: COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin.

Genetics: the uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

Infections: Bacterial and viral infections are major causes of exacerbations, and may contribute to the pathogenesis and progression of COPD.

Gender: Some studies have indicated that women are more susceptible to the effects of tobacco smoke than men.1,3,4 This is of concern given the increasing rate of smoking among women. Women with severe COPD exhibit smaller airway lumens and disproportionately thicker airway walls relative to men with the same disease severity, illustrating the different impact of the disease on each sex.

Socioeconomic status: There is evidence that the risk of developing COPD is inversely related to socioeconomic status.1 However this pattern may reflect that poverty is generally associated with exposure to indoor and outdoor pollutants, crowding and poor nutrition.

Lung growth and development: Factors that affect lung growth during gestation can affect an individual’s later risk of developing COPD. For example, early childhood lung infections and lower birth weight are associated with a decrease in FEV1 in adulthood.

Diagnostics

Lung Function Tests: Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

The main test for COPD is spirometry (spi-ROM-eh-tre). Other lung function tests, such as a lung diffusion capacity test, also might be used.

Spirometry: During the test, a technician will ask the person to take a deep breath in. Then, they'll blow as hard as they can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out.

A chest x ray or chest CT scan: These tests create pictures of the structures inside the chest, such as heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing symptoms.

An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.

Treatments

Smoking cessation is the most essential step in any treatment plan for COPD. It's the only way to keep COPD from getting worse. It's also a good idea to avoid secondhand smoke exposure whenever possible.

Medications: Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. Some of these meds include;

Bronchodilators which relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza).

Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent) and budesonide (Pulmicort) are examples of inhaled steroids.

Combination inhalers

Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort).

Oral steroids

For people who have a moderate or severe acute exacerbation.

Theophylline

helps improve breathing and prevents exacerbations.

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but are not generally recommended for prevention.

Doctors often use these additional therapies for people with moderate or severe COPD:

Oxygen therapy: If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. ​

Pulmonary rehabilitation program: These programs typically combine education, exercise training, nutrition advice and counseling. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life.

Managing exacerbations

Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. When exacerbations occur, you may need additional medications (such as antibiotics or steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible.

Surgery

Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active, but it's a major operation that has significant risks, such as organ rejection, and it obligates you to take lifelong immune-suppressing medications.

Signs and Symptoms

chronic cough that produces a lot of mucus "smoker's cough"

shortness of breath, especially during activity

wheezing

frequent flare-ups of signs and symptoms

chest tightness

frequent infections of the cold or flu

lips or fingernails turing blue or gray (cyanosis)

not mentally alert

tachycardia

fatigue

bulging chest

sleeping difficulty

weight loss

symptoms get worse as the disease progresses.

it is worse or better based on how much damage you have to your lungs, the more smoking the worse the symptoms. Symptoms can get better with decreased smoking.

References

COPD. (n.d.). Retrieved December 3, 2015, from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/

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COPD Foundation | Take Action Today. Breathe Better Tomorrow. (n.d.). Retrieved December 3, 2015, from http://www.copdfoundation.org

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Chronic Obstructive Pulmonary Disease (COPD). (n.d.). Retrieved December 3, 2015, from http://emedicine.medscape.com/article/297664-overview

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What Is COPD? (n.d.). Retrieved December 3, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/copd

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What Is COPD? (n.d.). Retrieved December 3, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/copd

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