COPD

Introduction:

Chronic Obstructive Pulmonary Disease (COPD) is actually a combination of two diseases, emphysema and chronic bronchitis. These diseases, for the most part, are caused by long-term exposure to tobacco smoke. Tobacco smoke slowly alters the structure of the airways of the lungs. Given enough time, the lungs begins to retain excessive amounts of air, which prevents effective exchange of oxygen and carbon dioxide between the air and blood. This may lead to feelings of shortness of breath, and it lowers tolerance to physical exertion.

COPD is similar to asthma in that they are both disorders that cause the lungs to retain excessive amounts of air. However, there is one major difference. COPD is caused by a permanent alteration of structure of the airways of the lungs, whereas asthma is caused by an overreaction by the airways to irritants. COPD is irreversible and asthma is reversible.

There is a rare variant of emphysema that is caused by an absence of a protein. This disease is genetic in nature, and is often inherited.

Diagnosis:

When diagnosing COPD physicians look for a history of shortness of breath, especially under exertion, as well as history of cough, either productive or not. They also look for a current or past history of smoking. On examination, the physicians are looking for a "barrel-shaped" chest, and listening for wheezing and decreased breath sounds. To confirm COPD, physicians will perform spirometry, both before and after treatment with albuterol. If the physician is concerned that the patient needs oxygen, the physician will ask the patient to perform a 6 minute walk test, or monitor your night time blood oxygen levels.

Treatment:

As COPD is permanent and essentially incurable, its treatment focuses on reducing the symptoms of the disease. At the heart of COPD therapy are the inhalers. Albuterol to treat attacks of breathlessness in the short-term, and a combination of long-acting albuterol-like inhalers, the long-acting anticholinergic Spiriva, and inhaled steroids to prevent the attacks of breathlessness. These drugs work together to both lower the inflammation and dilate the airways as much as possible so that the lungs do not retain air, allowing the patient to breathe easier.

In the hospital, similar drugs are used. Inhalation treatments albuterol and the anticholinergic ipatropium are given every four to six hours to prevent attacks. However, instead of inhaled steroids, systemic steroids are preferred since they have superior anti-inflammatory effects.

If the physician finds that the inhaler medication is not sufficiently treating the symptoms of shortness of breath, the physician will prescribe oxygen. Oxygen is the only treatment that is proven to prolong the lives of people with COPD.