Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) — also called chronic obstructive lung disease — results from emphysema, chronic bronchitis, asthma, or any combination of these disorders. Usually, more than one of these underlying conditions coexist; most often, bronchitis and emphysema occur together. (See Understanding chronic obstructive pulmonary disease, pages 192 to 195.)
The most common chronic lung disease, COPD affects an estimated 17 million Americans, and its prevalence is rising. It affects more men than women and more whites than blacks. It doesn’t always produce symptoms and causes only minimal disability in many patients. However, COPD tends to worsen with time.
Causes
Predisposing factors include cigarette smoking, recurrent or chronic respiratory tract infections, air pollution, occupations involving exposure to dusts or noxious gases, and allergies. Familial and hereditary factors (for example, deficiency of alpha1-antitrypsin) may also predispose a person to COPD.
Smoking is by far the most important of these factors; it impairs ciliary action and macrophage function and causes airway inflammation, increased mucus production, destruction of alveolar septae, and peribronchiolar fibrosis. Early inflammatory changes may reverse if the patient stops smoking before lung destruction is extensive.
Signs and symptoms
The typical patient, a long-term cigarette smoker, has no symptoms until middle age, when his ability to exercise or do strenuous work gradually starts to decline and he begins to develop a productive cough. Although subtle at first, these signs become more pronounced as the patient grows older and the disease progresses.
Eventually the patient develops dyspnea on minimal exertion, frequent respiratory tract infections, intermittent or continuous hypoxemia, and grossly abnormal pulmonary function studies. In its advanced form, COPD may cause thoracic deformities, overwhelming disability, cor pulmonale, severe respiratory failure, and death.
Diagnosis
X-rays rule out associated problems and may show emphysema, hyperinflation, and pulmonary hypertension as the COPD advances.
Pulmonary function studies reflect degree of impairment.
Treatment
The main goal of treatment is to relieve symptoms and prevent complications. Bronchodilators can help alleviate bronchospasm and enhance mucociliary clearance of secretions. Effective coughing, postural drainage, and chest physiotherapy can help mobilize secretions.
Administration of low concentrations of oxygen helps relieve symptoms; arterial blood gas analysis determines oxygen need and helps avoid carbon dioxide narcosis.
Antibiotics help treat respiratory tract infections. Pneumococcal vaccination and annual influenza vaccinations are important preventive measures.
Some patients benefit from inhaled corticosteroids as maintenance therapy. Oral corticosteroids are occasionally needed for acute exacerbations.
Special considerations
❑ Most COPD patients receive outpatient treatment, so provide comprehensive patient teaching to help them comply with therapy and understand the nature of this chronic, progressive disease. (See Living with COPD.)
❑ If the patient is to continue oxygen therapy at home, teach him how to use the equipment correctly. Patients with COPD rarely require more than 3 L/minute to maintain adequate oxygenation. Higher flow rates will further increase the partial pressure of arterial oxygen, but patients whose ventilatory drive is largely based on hypoxemia commonly develop a markedly increased partial pressure of arterial carbon dioxide. In such patients, chemoreceptors in the brain are relatively insensitive to the increase in carbon dioxide.
Clinical tip Teach the patient and his family that excessive oxygen therapy may eliminate the hypoxic respiratory drive, causing confusion and drowsiness, which are symptoms of carbon dioxide narcosis.
❑ Help the patient and his family adjust their lifestyles to accommodate the limitations imposed by this debilitating chronic disease. Instruct the patient to allow for daily rest periods and to exercise daily as directed.
❑ To help prevent COPD, advise all people, especially those with a family history of COPD or those in its early stages, not to smoke.
❑ Assist in the early detection of COPD by urging patients to have periodic physical examinations, including spirometry. Also, if the patient has a chronic cough or recurring respiratory tract infections, advise him to promptly seek medical treatment.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.
More About Causes of Lung symptoms
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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