UNM COC:  Your Healthcare Primer for Long Term Care

 
Chronic Obstructive Pulmonary Disease (COPD)

Sharon Witemeyer MD (Pediatrician)

Definition

Chronic obstructive pulmonary disease (COPD) is persistent obstruction of the airways caused by emphysema and/or chronic bronchitis.

Introduction

Emphysema and chronic bronchitis are often found together. Emphysema results from a breakdown of the walls of the tiny lung air sacs (alveoli) which causes over-inflation and a decrease in respiratory (lung) function. Chronic bronchitis is inflammation and eventual scarring of the lining of the bronchial tubes. In chronic bronchitis the bronchial glands are enlarged and produce excess mucus. These two conditions cause obstruction of airflow through the lungs. Some of the obstruction is permanent (where air sac walls are destroyed and scarring exists.) Some of the obstruction (that caused by mucus and smooth muscle spasm) may respond to treatment with bronchodilator drugs. About 16.4 million Americans have COPD. It is the fourth leading cause of death and costs nearly 32 billion dollars in healthcare expenditures and indirect costs annually. 80-90% of COPD cases are caused by smoking. A much rarer form of emphysema is caused by Alpha-1-antitrypsin (AAT) deficiency. Approximately 50,000 to 100,000 Americans, mostly of northern European descent, have AAT deficiency. Other causes include frequent lung infections and exposure to certain industrial pollutants. Early symptoms of COPD are cough, wheezing, and shortness of breath. Eventually shortness of breath occurs even with simple activities of daily living such as toileting, dressing, bathing and food preparation and even eating. Many individuals have severe weight loss in the late stages and may develop swelling of the legs due to heart failure. Death may result from respiratory failure, pneumonia, leaking of air into the space between the lungs and chest wall (pneumothorax), heart rhythm abnormalities (arrhythmias), or blockages to the arteries leading to the lungs (pulmonary embolism).

Diagnosis

COPD does not develop overnight. It comes on gradually over many years. Early on the doctor may find nothing abnormal on physical examination or chest X-ray. Pulmonary function tests may show abnormalities but many individuals with a developmental disability are unable to cooperate sufficiently to do these tests reliably. With progression of the disease chest movement decreases during breathing, the individual uses neck and shoulder muscles to help with breathing and breath sounds are harder to hear through the stethoscope. If AAT deficiency is suspected there is a blood test that measures the level of the protein that is missing.

Prevention and Treatment

The three most important things to do to prevent COPD are:

1. Don't start smoking

2. Don't smoke

3. QUIT SMOKING!!!!!

Other suggestions include:

1. Maintain overall good health habits including proper nutrition and hydration, adequate sleep, and regular exercise.

2. Reduce exposure to air pollution.

3. Ask the doctor about vaccinations against influenza and pneumococcal pneumonia.

Treatment

1. QUIT SMOKING

2. For the reversible elements of COPD the physician may prescribe brochodilator drugs such as albuterol which may be inhaled or taken by mouth. In some cases corticosteroids may be prescribed to reduce inflammation but they are only effective in about 20% of patients.

3. Antibiotics can be prescribed for treatment of bacterial infections.

4. Long term oxygen therapy can prolong life, improve mental functioning and improve heart failure caused by COPD.

5. Exercise programs including breathing exercises strengthen the muscles used in breathing are part of a pulmonary rehabilitation program.

6. If the person has AAT deficiency then the missing protein can be replaced but it is very expensive and requires weekly intravenous infusion (IV.)

7. Lung volume reduction surgery is very complex and long-term outcomes are not known.

8. Lung transplantation.

9. Research is looking at possible gene therapy.

Emergency Situations – What can go wrong?

COPD is a chronic condition and there are no specific acute risks other than aspiration that can be particularly dangerous in the face of already compromised lung function.

Conclusion

COPD is a chronic lung disease characterized by obstruction to airflow. It develops over years and is usually caused by smoking. Recurrent lung infections, exposure to certain industrial pollutants and AAT deficiency are much less common causes. The very most important thing a person can do to prevent and treat COPD is to STOP SMOKING. Doctors can help people with COPD live comfortably with their disease for many years but short of lung transplantation there is no cure. Prevention is the best approach. 

Sharon Witemeyer MD (Pediatrician)