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Chronic Obstructive Pulmonary Disease

COPD


Presentation

Symptoms and signs may include:

Fatigue
  • Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant.[ncbi.nlm.nih.gov]
  • The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%.[ncbi.nlm.nih.gov]
  • 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]
  • For example, the once-daily anticholinergic bronchodilator tiotropium increases inspiratory capacity, 6-minute walk distance, and cycle exercise endurance time, and it decreases isotime fatigue or dyspnea.[ncbi.nlm.nih.gov]
  • 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]
Weight Loss
  • Roflumilast in particular was associated with weight loss during the trial period and an increase in insomnia and depressive mood symptoms.[ncbi.nlm.nih.gov]
  • Severe cases may be complicated by weight loss, pneumothorax, frequent acute decompensation episodes, right heart failure, and acute or chronic respiratory failure.[web.archive.org]
  • Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital.[web.archive.org]
  • Eventually, these patients develop muscle wasting and weight loss and are identified as "pink puffers."[emedicine.com]
Chills
  • CASE PRESENTATION: An 80-year-old Japanese man with chronic obstructive pulmonary disease and congestive heart failure visited the Kariya Toyota General Hospital, Aichi, Japan with the chief complaint of fever accompanied by chills and left leg pain.[ncbi.nlm.nih.gov]
  • […] 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]
Cough
  • BACKGROUND: Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD).[ncbi.nlm.nih.gov]
  • This case report emphasizes that not all chronic cough and dyspnea are attributable to COPD.[ncbi.nlm.nih.gov]
  • Symptoms are productive cough and dyspnea that develop over years; common signs include decreased breath sounds, prolonged expiratory phase of respiration, and wheezing.[web.archive.org]
  • The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough.[who.int]
  • Common signs and symptoms of COPD include: An ongoing cough or a cough that produces a lot of mucus (often called "smoker's cough") Shortness of breath, especially with physical activity Wheezing (a whistling or squeaky sound when you breathe) Chest tightness[web.archive.org]
Pneumonia
  • Pneumonia further affects their prognosis and early diagnosis of pneumonia in AECOPD is important to initiate treatments.[ncbi.nlm.nih.gov]
  • pneumonia risk is currently available.[ncbi.nlm.nih.gov]
  • In the trials with data on pneumonia, ICS therapy was associated with a significantly higher incidence of pneumonia (777 cases among 5405 patients in the treatment group and 561 cases among 5371 patients in the control group; RR, 1.34; 95% CI, 1.03-1.75[ncbi.nlm.nih.gov]
  • Objective: 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]
  • There was moderate quality evidence of an increased risk of pneumonia with ICS/LABA. There was moderate quality evidence that treatments had similar effects on mortality.[ncbi.nlm.nih.gov]
Dyspnea
  • MEASUREMENT OF DYSPNEA IN COPD Section: The two purposes of measuring dyspnea are: to differentiate between patients who have less dyspnea and those who have more dyspnea (discriminate), and to determine whether dyspnea has changed over time and/or as[dx.doi.org]
  • Thus, hyperinflation is directly associated with patient-centered outcomes such as dyspnea and exercise limitation.[ncbi.nlm.nih.gov]
  • The corollary of this is that any intervention that reduces end-expiratory lung volume will improve effort-displacement ratios and alleviate dyspnea.[ncbi.nlm.nih.gov]
  • The corollary of this is that any intervention that reduces end-expiratory lung volume will improve effort–displacement ratios and alleviate dyspnea.[oadoi.org]
Chronic Cough
  • This case report emphasizes that not all chronic cough and dyspnea are attributable to COPD.[ncbi.nlm.nih.gov]
  • Abstract The diagnosis of chronic obstructive pulmonary disease (COPD) should be suspected in patients with risk factors (primarily a history of smoking) who report dyspnea at rest or with exertion, chronic cough with or without sputum production, or[ncbi.nlm.nih.gov]
  • The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough.[who.int]
  • It is manifested clinically in middle-aged horses with recurrent episodes of dyspnea, chronic cough, and their reduced athletic and working capacity. Pulmonary emphysema and lack of pulmonary collapse are the most common gross lesion.[ncbi.nlm.nih.gov]
Sputum Production
  • Abstract The diagnosis of chronic obstructive pulmonary disease (COPD) should be suspected in patients with risk factors (primarily a history of smoking) who report dyspnea at rest or with exertion, chronic cough with or without sputum production, or[ncbi.nlm.nih.gov]
  • The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough.[who.int]
  • BACKGROUND: Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD).[ncbi.nlm.nih.gov]
  • production, with thinner viscosity and lighter color, and alleviated clinical signs of infection).[ncbi.nlm.nih.gov]
Tachycardia
  • The severity of COPD correlates with various arrhythmic manifestations such as atrial fibrillation, atrial flutter, and either sustained or nonsustained ventricular tachycardia.[ncbi.nlm.nih.gov]
  • 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]
  • […] of QRS complexes 5 mm in the limb leads or 10 mm in the precordial leads right ventricular hypertrophy right axis deviation dominant R wave in V1 with an amplitude 7mm often associated with "P pulmonale" ( right atrial enlargement ) multifocal atrial tachycardia[radiopaedia.org]
  • […] was known to be associated with mild decreased heart rate variability, 10 which is a known risk factor for cardiac mortality and sudden cardiac death. 11 The Lung Health Study investigators reported a RR for hospitalisations due to supraventricular tachycardia[dx.doi.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]
  • Cf Blue bloater. pink puffer A facetious term sometimes used by doctors to describe patients breathless from CHRONIC lung disease but still able to maintain sufficient oxygenation of the blood to avoid CYANOSIS. Compare BLUE BLOATER.[medical-dictionary.thefreedictionary.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 of COPD include: breathlessness after exertion in severe cases, breathlessness on minimal exertion or even at rest wheezing coughing coughing up sputum (mucus or phlegm) fatigue cyanosis – a blue[betterhealth.vic.gov.au]
Chest Pain
  • PE should receive increased awareness in patients with unexplained AE-COPD, especially when pleuritic chest pain and signs of cardiac failure are present, and no clear infectious origin can be identified.[ncbi.nlm.nih.gov]
  • 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]
  • pain 253 1.5 52 19 Complication of device, implant or graft 247 1.4 15 20 Liveborn 220 1.3 137 Total for top 20 conditions 7,857 46.0 937 Total for all hospitalizations 17,085 100 2,068 Abbreviation: CCS, Clinical Classifications Software Source: Agency[web.archive.org]
Hepatomegaly
  • Affected infants may present in the newborn period with cholestatic jaundice, sometimes with acholic stools (pale or clay-coloured) and hepatomegaly.[dx.doi.org]
Irritability
  • The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms.[medlineplus.gov]
  • Main risk factors for COPD Tobacco smoking Indoor air pollution (such as biomass fuel used for cooking and heating) Outdoor air pollution Occupational dusts and chemicals (vapours, irritants, and fumes) More information on COPD Causes of COPD Burden of[who.int]
  • 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]
  • Whatever the exact cause may be, the common factor is airway irritation, which leads to inflammation and then damage.[symptoma.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.

Right Axis Deviation
  • axis deviation dominant R wave in V1 with an amplitude 7mm often associated with "P pulmonale" ( right atrial enlargement ) multifocal atrial tachycardia In contrast to asthma, the histologic changes of COPD are irreversible and gradually progress over[radiopaedia.org]
  • Findings of right ventricular hypertrophy include an R or R ′ wave as tall as or taller than the S wave in lead V 1 ; an R wave smaller than the S wave in lead V 6 ; right-axis deviation 110 without right bundle branch block; or some combination of these[merckmanuals.com]
Poor R Wave Progression
  • ECG poor R wave progression requires an R wave in V3 3 mm clockwise rotation of the heart secondary to hyperinflation results in a delayed precordial transition zone the lead in which the R/S ratio becomes 1, usually occurring in V3 or V4, shifts laterally[radiopaedia.org]
Hypercapnia
  • Before mechanical ventilation, coma could be confirmed to be due to CO2 narcosis caused by exorbitant arterial hypercapnia (PCO2, 193 mm Hg). Pneumothorax was diagnosed in the hospital by chest x-ray and resolved after pleural drainage.[ncbi.nlm.nih.gov]
  • Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia.[ncbi.nlm.nih.gov]
  • All patients requiring hospitalization for an acute exacerbation should undergo testing to quantify hypoxemia and hypercapnia. Hypercapnia may exist without hypoxemia.[merckmanuals.com]
  • Eventually, hypercapnia and respiratory acidosis develop, leading to pulmonary artery vasoconstriction and cor pulmonale.[emedicine.com]
Right Bundle Branch Block
  • Findings of right ventricular hypertrophy include an R or R ′ wave as tall as or taller than the S wave in lead V 1 ; an R wave smaller than the S wave in lead V 6 ; right-axis deviation 110 without right bundle branch block; or some combination of these[merckmanuals.com]
Decreased Vital Capacity
  • Other test abnormalities may include Increased total lung capacity Increased functional residual capacity Increased residual volume Decreased vital capacity Decreased single-breath diffusing capacity for carbon monoxide (DL co ) Findings of increased[merckmanuals.com]
Increased Total Lung Capacity
  • Other test abnormalities may include Increased total lung capacity Increased functional residual capacity Increased residual volume Decreased vital capacity Decreased single-breath diffusing capacity for carbon monoxide (DL co ) Findings of increased[merckmanuals.com]
P Pulmonale
  • pulmonale" ( right atrial enlargement ) multifocal atrial tachycardia In contrast to asthma, the histologic changes of COPD are irreversible and gradually progress over time.[radiopaedia.org]

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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Last updated: 2018-06-21 17:26