Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease (COPD) is a group of chronic, irreversible diseases which cause dyspnea (difficult breathing) because the air is not correctly exhaled from the lungs. In time, chronic obstructive pulmonary disease worsens and can lead to shallow breathing, heart damage and death. The two diseases generally associated with COPD are chronic bronchitis and emphysema. Both diseases are caused by smoking. In chronic bronchitis, the bronchi (routes that carry air to the lungs) are inflamed, fact which determines their narrowing and the appearance of dyspnea. The characteristic symptom of chronic bronchitis is the productive cough (with expectoration of sputum). In emphysema, the lung tissue and alveoli (terminal parts of the bronchi, the smallest components of the respiratory system, called respiratory bags) are affected, blocking the air inside them. This causes shortness of breath which is the characteristic symptom of emphysema. It is believed that besides smoking, other lung irritants (such as passive smoking, air pollution, industrial dust, volatile chemicals substances), inhaled for a long time, contribute to the development of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease can not be cured, but can be improved and controlled. The only sure method of slowing the progression of the disease is to quit smoking. Drugs can reduce or relieve symptoms. Lifestyle changes such as physical exercises, breathing exercises and rest may relieve the symptoms of the disease.
The exacerbations (worsening) of chronic obstructive pulmonary consist of sudden shortness of breath, wheezing (wheezy breathing that can be heard with a stethoscope or either with the ear) and, possibly, severe, dry or productive cough. The exacerbations can be life threatening and may require hospitalization.
What is chronic obstructive pulmonary disease?
This disease consists of a group of chronic lung diseases (which have a long term evolution) that causes shortness of breath. In COPD, the airflow to the lungs and from the lungs outside is partially blocked out, causing dyspnea. As the disease worsens, breathing becomes more difficult, and daily activities can become very difficult to accomplish. Although it can be improved, at present there is no cure for this disease. Chronic obstructive pulmonary disease is often a combination of two diseases, namely chronic bronchitis and emphysema. In chronic bronchitis, the inflammation is located in the bronchus. The inflammation narrows the bronchi, which causes a difficult breathing. In this disease, the cough is chronic and productive. In emphysema, the respiratory bags and the lung tissue are damaged. When the respiratory bags (alveoli) are damaged, the air is held within the lungs, this leading to shortness of breath.

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Risk Factors


People with COPD usually have symptoms of both chronic bronchitis and emphysema. The symptoms vary depending on the severity of chronic obstructive pulmonary disease.
The characteristic symptoms are:
- Chronic cough
- Chronic sputum production along with coughs
- Repeated episodes of acute bronchitis
- Short breaths, and persistent symptoms that worsen, occurring during physical exercises and worsening during respiratory infections, such as catarrh.
The episodes of worsening of the symptoms (such as cough, sputum production and / or shortness of breath) can be installed quickly, and most of the times suddenly, and may be extended, especially if the main component of chronic obstructive pulmonary disease is chronic bronchitis. These episodes are called exacerbations of COPD, and can be life-threatening, requiring hospitalization. The medical organizations have classified COPD on the basis of symptoms and lung function.
The evaluation of the pulmonary function is performed through tests of pulmonary spirometry, which measure the volume of air that the patient exhales compared with a healthy person, this value being called the predictive value. Other specific tests determine the amount of air the patient exhales in a second, in a forced exhalation (forced expiratory volume, or FEV1) and the air volume the patient can exhale after a deep, forced inspiration (forced vital capacity or FCV).


The most common cause of chronic obstructive pulmonary disease is smoking. Almost all patients with COPD (that is, between 80-90% of them) have been smokers for a long time. Studies say that smoking increases the risk of developing COPD. At least 10-15% of smokers develop symptomatic COPD. Some studies reveal the fact that up to 50% of chronic smokers aged over 45 have COPD. This percentage is due to the genetic factors (inherited genes), and on the other hand, to the exposure to certain factors that affect the risk of developing COPD. Chronic obstructive pulmonary disease is often a combination of the two diseases, namely chronic bronchitis and emphysema. Although patients may have either chronic bronchitis or emphysema, most of them develop a mixture of the two diseases.

Risk Factors

The risk factors for developing COPD include controllable factors such as smoking, and factors that can not be controlled, such as the inherited factors (genes).
Controllable risk factors
Smoking is the most important risk factor for COPD. All other factors are minor compared to smoking. At least 10-15% of all smokers have symptomatic COPD. Some studies show that up to 50% of smokers for long periods, aged more than 45 years, have COPD. The inherited factors (genes) and exposure factors are those which determine the smokers that develop COPD. Pipe and cigar smokers have a lower risk for COPD than cigarette smokers, but have a higher risk than nonsmokers. The risk for COPD increases along with the amount of tobacco smoked per day and the number of years of smoking.


Diagnostic laboratory tests
COPD is usually diagnosed by anamnesis (discussion with the patient who reveals information about the symptoms and the sufferings in the past) and the pulmonary functional tests such as spirometry. Your doctor will do a complete physical examination and may recommend chest X-ray in order to reveal other sufferings or coexisting conditions that may worsen and make difficult the treatmeant for COPD.
The early diagnosis of COPD is very important. The sooner smoking is abandoned and the environmental factors that contribute to COPD avoided, the slower the destruction of airways and lungs is.
Routine tests
Anamnesis and the physical examination reveal important information for the diagnosis and monitoring of COPD treatment. The pulmonary functional tests measure the volume of air in the lungs and the speed at which air is expired and inspired. These reveal essential information for the diagnosis, gradation, treatment and monitoring of COPD. Spirometry is the most important functional test. Chest radiography confirms or denies whether there is any pulmonary or heart damage (such as cancer) that causes the symptoms or not. The hemoleucogram (counting all blood cells such as leukocytes, white blood cells, red blood cells, etc..) reveals information about the oxygen saturation of blood and about a possible infection.


Drugs are used to improve shortened breathing, to control cough and wheezing (wheezy breathing) and to prevent and improve COPD exacerbations. Most sick people acknowledge that drugs improve their breathing. Bronchodilator drugs and corticosteroids are often administered by using inhalers or nebulizers (mask or mouthpiece through which the medicine is administered). Most specialist recommend to those that use inhalers to use at the same time an instrument for spacing, which distributes more effficiently the drug in the lungs and makes it easier to control the dose which is administered. The use of the instrument for spacing is important, especially when medicines containing corticosteroids are administered through the inhaler. Many people use inhalers incorrectly and do not get the full benefit of drugs.
Surgery in the treatment of COPD
Lung surgery is rarely used to treat COPD. Surgery is never the first treatment option and it is taken into account only in severe cases of COPD, in which pain was not relieved by other treatments.
Types of surgery:
Subtotal pneumonectomy consists of the excision of portions of one or both lungs, making more space for the remaining lung tissue in order to work more efficiently. This surgery is taken into consideration only in cases of patients with severe emphysema who are carefully selected. It is not recommended for routine in the COPD treatment.
Alternative treatments
Other possible treatments for COPD are:
Pulmonary rehabilitation is made by a team of specialists who monitor and treat the aspects of COPD from a medical, phisical and emotional point of view. This method combines physical exercises, breathing therapy, emotional support, diet and education. Pulmonary rehabilitation is recommended for patients after the subtotal pneumonectomy or lung transplantation. The oxygen therapy increases the level of oxygen in the blood and can improve breathing and prolong the survival of patients with severe COPD. The ventilatory devices are used to ease breathing. They are most commonly used during hospitalization for COPD exacerbations. Alpha-1 antitrypsin injections can be effective for patients with alpha 1 antitrypsin deficiency (an inherited condition that can cause COPD). Alpha 1 antitrypsin is a protein that prevents the destruction of lung tissue.


The most effective method of preventing the development and progression of COPD is to quit smoking. The worsening of COPD may be caused by other inhalling irritants as well (such as air pollution, volatile chemical substances, dust), but they are much less important than smoking in causing this disease. Smoking cessation is especially important for patients with low serum levels of alpha 1 antitrypsin. For these patients, the risk of developing COPD can be reduced by early administering artificial alpha 1 antitrypsin injections. There are many associations managing quit smoking programs. Also, the doctor can make recommendations regarding the quit smoking program.




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