Chronic Obstructive Pulmonary Disease
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KeywordsChronic Obstructive Pulmonary Disease COPD Patients Varenicline Decrease Dyspnea Follow Disease Progression
Chronic obstructive pulmonary disease (COPD), one of the leading causes of morbidity and mortality worldwide, is a chronic disease of the lung that is characterized by irreversible decreased airflow. The disease is also associated with a chronic inflammatory response to inhaled toxins, mainly cigarette smoke. Therefore, all COPD patients with smoking habit should be encouraged to quit smoking. The mainstay drugs of COPD are bronchodilators, including beta agonists and anticholinergics.
Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death worldwide, and WHO predicts that this will rise to number three by 2030, resulting in the huge burden of the disease on healthcare systems. This chronic disease of the lung is characterized by decreased air flow and associated abnormal inflammation of the lungs. The disease results from interaction between individual risk factors (like alpha1-antitrypsin deficiencies) and environmental exposures to toxic agents (like cigarette smoking). The main mechanisms that may contribute to airflow limitation in COPD are fixed narrowing of small airways, emphysema and luminal obstruction with mucus secretions.
The definition does not use the terms chronic bronchitis and emphysema, although most patients with COPD have them. Chronic bronchitis is diagnosed based on the clinical presentation, such as a chronic cough and sputum production. The diagnosis of emphysema, which is the term used to describe damage to the air sacs in the lung, is made from a pathological and/or morphological standpoint.
The respiratory symptoms of COPD are dyspnea, chronic cough, and sputum production. The dyspnea may initially be noticed only during exertion. Patients with a COPD exacerbation complain of increased cough and sputum, wheezing, and dyspnea, with or without fever.
Most patients with COPD have a history of cigarette smoking or other inhalant exposure. Therefore, when a person with a history of exposure to risk factors, especially smoke, has dyspnea, chronic cough, and sputum production, a diagnosis of COPD should be considered. Measurements of lung function are essential for the diagnosis of COPD. It is also used to determine the severity of the airflow obstruction and follow disease progression. Spirometry measures forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0). An FEV1.0/FVC ratio less than 70% generally indicates airway obstruction.
The overall goals of treatment of COPD are to prevent further deterioration in respiratory function, relieve symptoms, improve quality of life, and reduce mortality.
First of all, reduction of risk factors is needed. All COPD patients with smoking habit should be encouraged to quit smoking. Even a few minutes of counseling could be effective. Pharmacotherapy, such as nicotine replacement and varenicline, is also recommended. Preventive care is also very important, and all patients should be recommended to get an immunizations, including influenza and pneumococcal vaccines.
The mainstay drugs of COPD are bronchodilators, and inhaled therapy is preferred. Beta agonists, anticholinergics, and methylxanthines are given alone or in combination depending upon the severity of disease and each patient’s individual response to therapy. Inhaled glucocorticoids can reduce the frequency of the acute exacerbation, although it cannot improve lung function. Systemic glucocorticoids are not recommended for a long-time treatment. Mucolytic drugs might be beneficial for selected patients.
Non-pharmacological treatment is equally important for managing COPD. It includes pulmonary rehabilitation and oxygen administration. Pulmonary rehabilitation has been shown to improve exercise capacity, decrease dyspnea, and improve quality of life and should be considered as an addition to medication therapy for the patients at all stages of disease. Long-term oxygen therapy improves survival and quality of life in the patients with hypoxemia.
References and Further Reading
- GOLD. (2017). Global strategy for the diagnosis, management, and prevention of COPD. Available from http://www.goldcopd.org.
- NICE. Guideline – COPD in over 16s: Diagnosis and management. Available from https://www.brit-thoracic.org.uk/standards-of-care/guidelines/nice-guideline-copd-in-over-16s-diagnosis-and-management/.
- Petty, R. L., & Nett, L. M. (2001). COPD: Prevention in the primary care setting. The National Lung Health Education Program.Google Scholar
- Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. (1995). American Journal of Respiratory and Critical Care Medicine, 152, S77.Google Scholar