chronic%20obstructive%20pulmonary%20disease
CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is an inflammatory respiratory disease characterized by reversible airflow limitation.

The patient usually has chronic cough, sputum production or dyspnea with or without history of risk factors for the disease.

The chronic airflow limitation is caused by a combination of small airways disease and parenchymal destruction.

It is a preventable and treatable disease.

Chronic%20obstructive%20pulmonary%20disease Signs and Symptoms

Introduction

  • Chronic Obstructive Pulmonary Disease (COPD) should be suspected in any patient who has chronic cough, sputum production or dyspnea with or without history of risk factors for the disease

Definition

  • A preventable and treatable disease with overall severity contributed by exacerbations and comorbidities
  • The persistent airflow limitation is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
  • The chronic airflow limitation is caused by a mixture of small airways disease and parenchymal destruction

Signs and Symptoms

A diagnosis of COPD should be considered in patients over 40 years of age who have a suggestive medical history (ie presence of risk factors) and who present with any of the following:

  • Chronic cough (present intermittently or daily)
    • Does not reflect the major impact of airflow limitation on the morbidity and mortality in patients with COPD
    • Cough may be unproductive
  • Exertional breathlessness, wheezing, pursed-lip breathing, dyspnea with or without wheezing
  • Rhonchi, prolonged expiratory phase of respiration, chest hyperinflation, use of accessory muscles for respiration, decreased breath sounds
  • Signs of cor pulmonale: Neck vein distention, increased pulmonic component of 2nd heart sound, lower extremity edema, hepatomegaly
  • The absence of wheezing or chest tightness does not rule out a diagnosis of COPD

Risk Factors

Host Factors

  • Airway hyper-responsiveness
    • Includes asthma
    • May also develop after exposure to tobacco smoke or other environmental insults
  • Lung growth and development
    • Individuals may have reduced maximal attained lung function due to processes during gestation and childhood
  • Infections
    • Reduced lung function can be associated with a history of severe childhood respiratory infections
    • Previous tuberculosis
  • Hereditary deficiency of alpha-1 antitrypsin

Exposures

  • Tobacco smoke
    • Most commonly encountered risk factor
    • Includes history of tobacco use or prolonged exposure to second-hand smoke
    • Smoking during pregnancy can put the fetus at risk
  • Occupational dusts and chemicals
  • Air pollution
  • Smoke from home cooking and heating fuels
  • Low socioeconomic status
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Regular, low-dose, oral sustained-release morphine improved the health status of patients with moderate-to-very-severe chronic breathlessness due to chronic obstructive pulmonary disease (COPD), the MORDYC* trial has shown, validating its palliative role for chronic breathlessness.