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Chronic Obstructive Pulmonary Disease

COPD


Presentation

Symptoms and signs may include:

Cough
  • The presence of nasal discharge (43.4%) was associated with more cough and sputum symptoms, whereas post-nasal drip (13.1%) was associated with more sputum symptoms. On multivariate analyses, nasal discharge was associated with more cough symptoms.[ncbi.nlm.nih.gov]
  • These include the following: Coughing every day over a period of months. Smokers often refer to this as "smoker's cough."[rush.edu]
  • **Not everyone who has COPD has a chronic cough. Not everyone with a cough has COPD or will develop it in the future.[copdfoundation.org]
  • Bronchitis is generally considered chronic when you have: a productive cough (cough up mucus) and shortness of breath that lasts about three months or more each year for two or more years in a row.[my.clevelandclinic.org]
  • Symptoms are productive cough and dyspnea that develop over years; common signs include decreased breath sounds, prolonged expiratory phase of respiration, and wheezing.[merckmanuals.com]
Pneumonia
  • Worldwide, community-acquired pneumonia (CAP) is a common infection that occurs in older adults, who may have pulmonary comorbidities, including chronic obstructive pulmonary disease (COPD).[ncbi.nlm.nih.gov]
  • […] postoperative blood gas conditions, and postoperative clinical parameters of the patients such as appearance of PIC window, time of invasive ventilation, total time of ventilation, hospital stay, weaning success rate, reintubation rate, ventilator-associated pneumonia[ncbi.nlm.nih.gov]
  • Risk of exacerbation and pneumonia occurrence were considered. Pharmaceutical costs were calculated with dosages according to indication and public ex-factory prices.[ncbi.nlm.nih.gov]
  • The flu and pneumonia can make your symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce COPD flare-ups. Oxygen therapy may be helpful if the oxygen levels in your blood are too low.[uvahealth.com]
  • Outcomes are pneumonia, COPD exacerbation, mortality and time to treatment change.[ncbi.nlm.nih.gov]
Chronic Cough
  • The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough.[who.int]
  • People with COPD may have difficulty breathing, chronic cough, fatigue, and chest tightening. COPD can also result in reduced blood oxygen levels, causing fatigue and leading to adverse health conditions.[sleepfoundation.org]
  • ., several years), chronic coughing, and obstructed airways under some conditions.[ccohs.ca]
  • It is accompanied by chronic coughing and sputum production.[airliquide.com]
  • You develop a chronic cough trying to clear your airways. Cigarette smoke and other irritants In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking.[mayoclinic.org]
Dyspnea
  • […] changes in exercise capacity, dyspnea, and disease-specific quality of life following pulmonary rehabilitation.[ncbi.nlm.nih.gov]
  • However, YQBSHXD may help to alleviate the severity of dyspnea on exertion, as measured by 6MWD (P   .03), and to improve the quality of life, as assessed by the SGRQ (P   .01).[ncbi.nlm.nih.gov]
  • COPD: What you should know Although they have symptoms in common, like coughing and difficulty breahting ( dyspnea ), COPD is not the same as asthma . It's vital to get an accurate diagnosis, because COPD and asthma require different treatments.[rush.edu]
  • The primary outcome was severity of dyspnea on exertion (DOE), measured by the 6-minute walk test (6MWT) scale.[ncbi.nlm.nih.gov]
  • Umeclidinium significantly improved trough FEV 1 , dyspnea, and QOL scores 36 .[f1000research.com]
Sputum Production
  • Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). Extrapulmonary comorbidities, such as gastroesophageal reflux disease (GERD) and post-nasal drip, also cause bronchitis symptoms.[ncbi.nlm.nih.gov]
  • production, with thinner viscosity and lighter color, and alleviated clinical signs of infection).[ncbi.nlm.nih.gov]
  • Patients with chronic bronchitis usually have a cough and sputum production for many years before they develop shortness of breath.[northwell.edu]
  • The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough.[who.int]
  • It's characterized by daily cough and mucus (sputum) production.[mayoclinic.org]
Fatigue
  • At baseline and after the intervention, fatigue and sleep quality was assessed. Data obtained were analyzed in SPSS.[ncbi.nlm.nih.gov]
  • People with COPD may have difficulty breathing, chronic cough, fatigue, and chest tightening. COPD can also result in reduced blood oxygen levels, causing fatigue and leading to adverse health conditions.[sleepfoundation.org]
  • Emphysema and chronic bronchitis can be difficult to tell apart since each causes the restriction of breathing as well as symptoms of fatigue, wheezing, and excessive mucus production.[verywell.com]
  • Authors' conclusions: Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition.[cochrane.org]
  • There was a reduction in the severity of leg fatigue on completion of an exercise test (MD -1.12 units, 95% CI -1.81 to -0.43).[ncbi.nlm.nih.gov]
Weight Loss
  • Severe cases may be complicated by weight loss, pneumothorax, frequent acute decompensation episodes, right heart failure, and/or acute or chronic respiratory failure.[merckmanuals.com]
  • Nutritionists can help teach patients with COPD necessary diet changes to combat excessive weight loss and maintain energy levels.[medstarfranklinsquare.org]
  • Complications Worsening of the condition/stage Lung scarring and fibrosis Pneumonia Right sided heart failure Weight loss Arrhythmias Pneumothorax Need for oxygen mask In most patients, COPD is the result of long-term heavy cigarette smoking; about 10%[symptoma.com]
  • loss Breathing through pursed lips Desire to lean forward to improve breathing More frequent flare-ups (periods of more severe symptoms) Testing for COPD Your doctor will need to test how impaired your lungs are.[uvahealth.com]
  • Some of the conditions they mentioned included weight loss, arthritic pain, cancer, cardiac problems, female and male osteoporosis, depression, hypertension, sleep apnea, and diabetes.[copdfoundation.org]
Chronic Fatigue Syndrome
  • fatigue syndrome Producing a lot of mucus or phlegm Having to clear your throat first thing in the morning, due to excess mucus in your lungs Unintended weight loss (in later stages) If you have one or more of these symptoms on a regular basis, then[draxe.com]
Chills
  • […] wheezing more Chest feels tight or “full” (call 911 immediately if you have chest pain or severed chest tightness) Some trouble with daily activities Trouble concentrating No appetite Feeling very tense or restless Sore throat and runny nose Fever and chills[intermountainhealthcare.org]
Cyanosis
  • The is caused by the lack of oxygen in the bloodstream, a condition known as cyanosis . Decreased oxygen can also lead to the swelling in the legs and ankle ( peripheral edema ).[verywell.com]
  • […] pulse, and cyanosis.[medicinenet.com]
  • Wheezing Chest tightness Having to clear your throat first thing in the morning, due to excess mucus in your lungs A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish Blueness of the lips or fingernail beds (cyanosis[mayoclinic.org]
  • Symptoms of chronic obstructive pulmonary disease Symptoms include: breathlessness after exertion in severe cases, breathlessness even when at rest wheezing coughing coughing up sputum fatigue cyanosis – a blue tinge to the skin caused by insufficient[betterhealth.vic.gov.au]
  • In advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed.[emedicine.medscape.com]
Chest Pain
  • For people with COPD, symptoms such as coughing, chest pain, and frequent nighttime urination may profoundly impact sleep. In addition, medications used to treat COPD may cause insomnia or daytime sleepiness.[sleepfoundation.org]
  • Symptoms and signs may include: Fatigue Dyspnea Paroxysmal nocturnal dyspnea (PND) Chest tightness Wheezing Cough with sputum (mucoid and/or purulent) Fever Chest pain Workup consists of a detailed history, tests and physical examination.[symptoma.com]
  • pain or severed chest tightness) Some trouble with daily activities Trouble concentrating No appetite Feeling very tense or restless Sore throat and runny nose Fever and chills Sudden weight gain (3 to 5 pounds overnight) and swelling in ankles.[intermountainhealthcare.org]
  • Severe chest pain occurs, or chest pain is quickly getting worse. You cough up large amounts of bright red blood.[northshore.org]
Tachycardia
  • The lack of oxygen combined with the build-up of carbon dioxide can lead to a myriad of symptoms , including: Shortness of breath Wheezing Persistent cough Excessive mucus production Chronic fatigue Rapid heartbeat ( tachycardia ) More than four million[verywell.com]
Lip Cyanosis
  • The consequence of these changes is a limitation of airflow. [13] Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as "blue bloaters" because of the bluish color of the skin and lips (cyanosis[physio-pedia.com]
Urticaria
  • Vasculitis syndrome Hypocomplementemic vasculitis urticaria syndrome (HVUS) may be associated with obstructive lung disease. Other manifestations include angioedema, nondeforming arthritis, sinusitis, conjunctivitis, and pericarditis.[emedicine.medscape.com]
Irritability
  • Between 10% and 20% of COPD in the United States is estimated to be caused by occupational or other exposure to chemical vapors, irritants, and fumes.[annals.org]
  • Chronic bronchitis Chronic bronchitis is irritation and inflammation (swelling) of the lining in the bronchial tubes (air passages). The irritation causes coughing and an excess amount of mucus in the airways.[my.clevelandclinic.org]
  • Avoid exposure to air pollution or irritants. Wear protective gear if exposed to irritants or toxins at work. MAKE AN APPOINTMENT Call 434.243.3675 . Content was created using EBSCO’s Health Library.[uvahealth.com]
  • Cigarette smoke and other irritants In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking.[mayoclinic.org]
  • Other irritants that may contribute to COPD include second-hand smoke, air pollution, and exposure to chemical fumes in the workplace.[medicare.com]
Altered Mental Status
  • mental status Increase in hypoxemia or hypercapnia Inability to tolerate oral medications such as antibiotics or steroids See Treatment and Medication for more detail.[emedicine.medscape.com]

Workup

Workup consists of a detailed history, tests and physical examination.

Laboratory Tests

  • Complete blood count
  • Arterial blood gases
  • Serum electrolytes
  • Spirometry
  • Serum BNP levels
  • Sputum culture
  • Pulmonary function tests
  • Pulse oximetry

Imaging Studies

  • Chest radiography
  • CT scan

Test Results

On the results of laboratory tests and radiography, diagnosis is made and treatment is immediately begun.

Hypercapnia
  • Oxygen In a cluster randomised, controlled parallel group trial, in 405 patients, titrated oxygen significantly reduced mortality, hypercapnia and respiratory acidosis.[symptoma.com]
  • The end point is to maintain oxygen tension at approximately 60 to 65mm Hg, thereby assuring near-maximal hemoglobin saturation while minimizing the potential for deleterious hypercapnia.[clevelandclinicmeded.com]
  • Eventually, hypercapnia and respiratory acidosis develop, leading to pulmonary artery vasoconstriction and cor pulmonale .[emedicine.medscape.com]

Treatment

Oxygen

In a cluster randomised, controlled parallel group trial, in 405 patients, titrated oxygen significantly reduced mortality, hypercapnia and respiratory acidosis [8].

Medications

Medications that can be used include:

  • Bronchodilators: These are given in pumps, to be inhaled as many times as prescribed. 
  • Corticosteroids: These are given to stop the inflammation from worsening. They can be used as inhalers (inhaled corticosteroids ICS) in mild to moderate disease, or given per oral in advanced disease. 
  • Leukotriene inhibitors: To stop action of leukotrienes in the inflammatory pathway 
  • Long-acting Beta 2 Agonists: Their use is associated with improved quality of life and reduced exacerbations, but they have not been shown to reduce mortality or serious adverse events significantly. [9]. 
  • Antibiotics: For prophylactic treatment.

Cessation of smoking

Smoking should be immediately stopped to prevent the disease from worsening.

Removal of pollutants

Prolonged exposure to pollutants, such as smoke, asbestos, silica, etc should be avoided.

Prognosis

COPD is due to irreversible damage to the airways. This means this disease can be managed, not treated. Prognosis depends upon the stage of the disease and the treatment started. With appropriate treatment and cessation of smoking, COPD can be prevented from worsening and a relatively healthy life style can be adopted.

Complications

Etiology

In most patients, COPD is the result of long-term heavy cigarette smoking; about 10% of patients are nonsmokers [3]. Other causes may include alpha-1 anti-trypsin deficiency, bronchiectasis and cystic fibrosis. Exposure to large amounts of air pollutants may also lead to development of COPD.

Whatever the exact cause may be, the common factor is airway irritation, which leads to inflammation and then damage. This results first in mucosal and glandular changes in the airways, and as the disease progresses, these changes are unable to match up with the continuously on going irritation, and irreversible damage occurs. The type of COPD depends upon the exact causative factor.

Epidemiology

Incidence

COPD is estimated to be the fourth leading cause of death in the United States and the sixth leading cause of death world wide.

Sex and Race

There is a clear cut association between heavy cigarette smoking and emphysema, and women and African-Americans are more susceptible than other groups [2]. However, generally men are much more commonly found to be suffering from COPD than women.

Age

COPD is more common in people, particularly men, aged 40 years and above.

Sex distribution
Age distribution

Pathophysiology

COPD is a vast term that is used to describe three prominent disorders collectively. These include the following:

Emphysema

Emphysema is a condition of the lung characterised by irreversible enlargement of the air spaces distal to the terminal bronchiole, accompanied by destruction of their walls without obvious fibrosis [4].

Chronic bronchitis

It is defined clinically as persistent productive cough for at least 3 months in 2 (or more) consecutive years. The earliest feature of chronic bronchitis is hypersecretion of mucus in the large airways, associated with hypertrophy of the submucosal glands in the trachea and bronchi [5].

Asthma

It is a chronic inflammatory disorder in which patients suffer from recurrent episodes of wheezing, breathlessness and cough. Many cells play a role in the inflammatory response, in particular lymphocytes, eosinophils, mast cells, macrophages, neutrophils and epithelial cells [6].

Chronic bronchiolitis, or small airway disease, also comes under the COPD category and shares many characteristics with the former two conditions. In a recent study, the overlap between these three disorders was found to be substantial [7].

Prevention

The use of continuous prophylactic antibiotics results in a clinically significant benefit in reducing exacerbations in COPD [10].
COPD can be easily prevented by not smoking tobacco and other such harmful agents. Also, avoiding exposure to pollutants can also prevent this disease from occurring.

Summary

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition involving the airways and characterised by airflow limitation [1]. It is diagnosed based on clinical findings and results of pulmonary function tests. In acute COPD, symptoms are mild and the disease is often missed. As the disease progresses, varying symptoms present in different people.

Patient Information

COPD is a collective term for many respiratory disorders such as asthma, emphysema and chronic bronchitis. It may also include other airway diseases.

The most common causative factor is heavy smoking. People exposed to a large amount of air pollutants are also at risk for developing this disease. It has no cure, but can be appropriately managed with cessation of smoking, removing pollutants (if any) and by taking prescribed medications.

References

Article

  1. Buist AS, McBurnie MA,Volmer WM, et al. International variation in the prevalence of COPD (the BOLD study): a population based prevalence study. Lancet 2007;379:741
  2. Cazzola M et al. One hundred years of chronic obstructive pulmonary disease (COPD). Respir Med 101:1049, 2007
  3. Shaw RJ et al. The Role of small airways in lung disease. Respir Med 96:67, 2002
  4. Snider G:The definition of emphysema:report of the National Heart, Lung and Blood Institute, Division of Lung Diseases Workshop. Am Rev Respir Dis 132:182, 1985
  5. deMello DE, Reid L. Pathology of Pulmonary Disease. Philadelphia. JB Lippincott, 1994.
  6. Bloemen K, et al. The allergic Cascade: review of the most important molecules in the asthmatic lung. Immunol Lett 113:6,2007
  7. Ware LB: Pathophysiology of acute lung injury and the acute respiratory distress syndrome. Semin Respir Crit Care Med 27:337, 2006
  8. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R: Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital settings:randomised control trial. BMJ. Oct 18 2010;341:c5462
  9. Kew KM, Mavergames C, Walters JA: Long acting beta2 agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013, Oct 15;10CD:010177. 
  10. Herath SC, Poole P; Prophylactic antibiotic therapy for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013, Nov 28;11:CD009764 

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