Chronic Obstructive Pulmonary Disease

Definition

Chronic obstructive pulmonary disease (COPD) is a gradually progressive and permanent disease of the airways and lungs that is described as a slow loss of lung function. As of 2000, COPD was reported by the National Center for Environmental Health to be one of the leading causes of death, illness, and disability in the United States. As of 2003, it was reported by the National Heart, Lung, and Blood Institute (NHLBI) to be the fourth leading cause of death in the United States. However, leaders of the NHLBI predict that COPD will become the third leading cause of death in the United States by the year 2020. In adults who are 25 years of age and older, about 12.1 million people have been diagnosed with COPD in 2001, although it is estimated that approximately 24 million Americans could have COPD without any knowledge. At the same time, around 1.5 million hospital emergency department visits, 726,000 hospitalizations, and 119,000 deaths have occurred because of COPD.

A greater number of females are reported with COPD than men, along with a greater number of whites over blacks. However, when statistics are adjusted with respect to age, the death rate is about 46 percent higher in males than females and about 63 percent higher in whites than blacks. Cigarette smoking is the most common cause of COPD but the inhalation of chemicals, dust, or pollutions over a long period of time can also contribute to the disease.

Description

The disease of COPD includes such conditions as chronic obstructive bronchitis (emphysema), chronic bronchitis, a mixture of the two, and in some cases asthma. In healthy people, the airways of the lungs remain open and clear, and flexible and strong. They easily inflate and deflate. However, when the lung's airways are subjected to irritants such as smoke and chemicals they lose their elasticity and strength over an extended period. At the same time, cells in the airways produce more sputum (mucus) due to the constant, irritated state of the lungs, which makes it increasingly difficult for the airways to remain open and clear. COPD is developing very slowly. likely over many years, as these harmful changes take place. Eventually the walls of the airways are destroyed. Once COPD develops it is irreversible (that is, permanent) because the damage done to the lungs, airways, and walls of the airways cannot be repaired by the body.

Causes and symptoms

The primary cause of COPD in the United States is cigarette smoking along with the smoking of pipes and cigars. Secondary (passive) exposure to cigarette smoke is also a contributing factor to COPD. Occupational chemicals, dusts, and airborne particulates in the workplace have also been documented to be factors that can lead to the disease, as have air pollutants in the home. Outdoor air pollution has not been documented to be a significant factor to COPD, although such pollution is never good to anyone who is at risk for developing COPD. Genetic and hereditary factors are also a consideration in causing COPD, as are persistent respiratory infections and asthma.

The symptoms of COPD range from chronic cough and sputum production to severe shortness of breath. When a person first is diagnosed with a persistent cough and sputum production, it is usually a good indication that the person may be at risk for later developing symptoms of airflow obstruction and disabling shortness of breath. However, in some individuals, little cough and sputum production is apparent when they are first diagnosed with shortness of breath, which is normally the first indication of COPD. Weather conditions can temporarily make the symptoms worse, as can infections to the body unrelated to the disease.

Diagnosis

The diagnosis of COPD involves determining the presence of airway obstructions when testing with a spirometer in a process known as spirometry. Currently, there is no known cure for COPD. Since about 24 million adults are annually diagnosed with impaired lung functions (and only 12.1 million adults are diagnosed with COPD each year), the disease is considered under-diagnosed by the medical community.

Treatment

Early detection of COPD may help to slow the progress of the disease. A test that measures pulmonary function has been shown to diagnose accurately COPD in current and former tobacco smokers (who are over 45 years of age) and others with continuing respiratory problems. A physician will make a complete evaluation of anyone suspected of having COPD. Coughing and wheezing symptoms will be treated with medication. Respiratory infections will be treated with antibiotics. Persons who cannot obtain enough oxygen through their lungs will be provided oxygen through tanks. However, since no cure is known, health care personnel at COPD treatment centers rely mostly on relieving the symptoms and making the patient as comfortable as possible.

Prognosis

If a person fails to discontinue exposure to smoke, especially tobacco products and other noxious particles, the disease will eventually restrict the person's airways and the ability to breathe will be lost. In 2000, according to the National Heart, Lung, and Blood Institute, about 119,000 people died from COPD. According to the Centers for Disease Control and Prevention, the number of deaths increased to nearly 125,000 in 2002.

Health care team roles

The health care team is are often called to perform emergency procedures on people with COPD. About 1.5 million emergency room visits were made annually at the beginning of the twenty-first century expressly for the treatment of COPD. In addition, about 726,000 people are hospitalized annually for COPD, especially at times when the disease is exacerbated by such external factors as adverse weather conditions (such as smog) and illnesses (such as acute infections). Medical teams work with various state, federal, and world organizations to combat the disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is especially well-known (since its origins in 1997) for its international work with health care professionals and public health providers in seeking a cure for COPD, along with raising awareness of the disease. In the United States, the U.S. COPD Coalition also works to improve the lives of people with the disease.

Prevention

The best way to prevent COPD is the avoidance of smoke of any kind but especially the smoke contained within tobacco products since it has been shown to be the leading cause of COPD.

KEY TERMS

Asthma— A respiratory disease associated with coughing and wheezing, sudden difficulty in breathing, and a tightening in the chest.

Pulmonary— Relating to the lungs.

Spirometry— A test for measuring lung capacity especially concerning the speed and volume of air in the passageway.

Sputum— Coughed-up substances through the throat; often called mucous or phlegm.

Resources

BOOKS

Garrod, Rachel, ed. Pulmonary Rehabilitation: An Interdisciplinary Approach. London, U.K., and Philadelphia: Whurr, 2005.

OTHER

Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD). "Homepage for GOLD" ?http://www.goldcopd.com/? (accessed October 25, 2005).

National Center for Environmental Health, Centers for Disease Control and Prevention. "Facts About Chronic Obstructive Pulmonary Disease (COPD)" ?http://www.cdc.gov/nceh/airpollution/copd/copdfaq.htm? (accessed October 25, 2005).

National Center for Health Statistics, Centers for Disease Control and Prevention. "Chronic Obstructive Pulmonary Disease (COPD)" ?http://www.cdc.gov/nchs/fastats/copd.htm? (accessed October 26, 2005).

National Center for Health Statistics, U.S. COPD Coalition. "Homepage for U.S. COPD Coalition" ?http://www.uscopd.com/? (accessed October 25, 2005).

National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services. "Chronic Obstructive Pulmonary Disease" ?http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf? (accessed October 24, 2005).