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What is COPD

COPD stands for Chronic Obstructive Pulmonary Disease. The term is used most commonly to describe 2 diseases.

• Emphysema
• Chronic bronchitis
  Although the term COPD can be used to describe other diseases such as some asthma and bronchiectasis and others, our discussion will focus on Emphysema and Chronic bronchitis as these are the 2 most common diseases under the umbrella of COPD.

Why is it called COPD

The term is used to describe the pathophysiology of the disease where obstruction to air flow is a prominent feature. This is often seen on Pulmonary Function Testing , which is a test to measure how your lungs are functioning ( Spirometry is discussed below). The disease leads to alterations in air flow while breathing and breathing out. Patient may not effectively empty out their lungs which makes it difficult to breathe in fully. The alterations to air flow develop from damage to the air sacs as well as damage to the bronchial tubes.

Emphysema and Chronic Bronchitis definition

Emphysema is progressive damage to the lungs tissue, specifically destruction of alveoli or lung sacs. source The lung tissue becomes inflamed and there is loss of tissue where gases like oxygen and carbon dioxide are exchanged.
Chronic Bronchitis is inflammation of bronchial tubes which causes a lot of mucus production, swelling and narrowing of the bronchial tubes. It is diagnosed when three is chronic cough and sputum production for 3 months a years for 2 consecutive years. source

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What causes COPD:

The main cause of COPD remains Cigarette smoking.
Air pollution, fumes, chemicals and other substances can cause inhalational injury, usually with chronic exposure leading to COPD.
A genetic disorder causing deficiency of Alpha 1 antitrypsin in the body can cause COPD.

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Symptoms of COPD: source

• Shortness of breath, especially with exertion.
• chronic cough
• phlegm production
• wheezing
  Not all symptoms may be present all the time.

Prevalance of COPD: source

About 12 million Americans Carry the diagnosis and another 12 million probably have the disease, according to CDC.

Diagnosis Issues: source

Patients often attribute their decrease in exertional capacity to the process of aging. The patient may not feel that symptoms are significant enough to report and the physician may not ask the right questions.
In many patients COPD is not diagnosed until Half of lung function is lost.
The diagnosis is usually established based on spirometry. We will discuss this soon. Should smokers be screened for the disease. After evaluation of available data US Preventive Sevices Task Force issued the recommendation: source

The USPSTF recommends against screening adults for chronic obstructive pulmonary disease (COPD) using spirometry.

Thus Patient must understand that regardless of smoking history, unless symptoms are described that may suggest COPD, the physician may not test them for the presence of disease. The burden thus rests on the patient to describe all symptoms regardless of how they perceive them and the burden is on the physician to ask the right questions.

How is a diagnosis of COPD: source

• like most other diagnosis, evaluation begins with assessment of symptoms or patient complaints.
• A chest X-ray May suggest presence of COPD.
• The primary test done to assess and diagnose COPD is called a spirometry.

Spirometry: source

This test is often performed in a physicians office. A machine called a spirometer is used.

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The test involves breathing into a mouth piece attached to a spirometer as directed by the technician doing the test. It takes only a few minutes to do the test. The test is completely painless and the results are available almost immediately.

X-ray: source

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An X-ray may suggest changes of COPD. It cannot be used as a stand-alone test to diagnose COPD or to discard the possibility of the diagnosis.

Treatment and Outcomes:

COPD is a chronic progressive disease. Debilitating shortness of breath can be present. Today, there are many treatment options available that improve breathing and improve quality of life. These are the primary goals of therapy along with getting the patient as functional as possible.

Bronchodilators:

These are inhaled medications that help improve breathing. There are multiple devices and they perform differently in different patients. Failure of a drug to achieve the desired result may have been the result of device selection and improper drug delivery. In 2016, American College of Chest Physicians in a collaborative effort with Sunovion announced the following: source

MARLBOROUGH, Mass. and GLENVIEW, IL– Sunovion Pharmaceuticals, Inc. (Sunovion) and the American College of Chest Physicians (CHEST) have announced a strategic initiative focused on increasing recognition that the way a medicine is delivered should be an important consideration in evaluating a patient’s COPD therapy. As a part of this collaboration, the organizations have launched the Delivery Makes a Difference initiative, which seeks to understand patient and health care provider practices and to provide tools for matching patients with appropriate medications and delivery devices.

“When first-line treatments fail to achieve their desired effect, health care providers often prescribe additional medications, failing to consider that the way the medicine has been delivered may be a significant issue,” said Dr. Nicola Hanania, Chair of the Delivery Makes a Difference Steering Committee, Associate Professor at Baylor College of Medicine. “The Delivery Makes a Difference initiative hopes to provide important data to support the crucial step of choosing appropriate delivery devices for individual patients.”

Oxygen therapy in COPD: source

Ocygen is only helpful if the oxygen numbers suggest a need. There is no benefit if the oxygen numbers don’t fall below a certain number. This number is called oxygen saturation and is generally measured on a standardized test called the six minute walk test. Patients need to understand that regardless of symptoms, oxygen is only issued when criteria are met and symptom resolution alone is not the criteria for which oxygen is issued.

Pulmonary rehabilitation: source

Patients with COPD often show decline in the physical abilities. Pulmonary rehabilitation is an outpatient program of guided, targeted and directed exercise which often results in improving patients quality of life. This program is supported by most insurances.

Smoking cessation: source

The greatest impact you can have on your disease is by quitting smoking. Most patients may need guidance and support due to the addictive nature of smoking.
Fortunately, resources from CDC are available. Kindly visit the site by clicking on resources. From the site:

For support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources, call:

1-800-QUIT-NOW (1-800-784-8669)
1-855-DÉJELO-YA (1-855-335-3569) (en Español)

This is a short post on the subject intended for general information. The subject is extensive and not all aspects can be discussed here.