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    Chronic Obstructive Pulmonary Disease (COPD)

    Overview
    Causes
    Treatment
    Where To Seek Treatment

    Contributed by Dept of Respiratory & Critical Care Medicine

    Overview

    Chronic Obstructive Pulmonary Disease (COPD) is a disease where both lungs are damaged and airways become irreversibly narrowed. It is also known as chronic obstructive airway disease (COAD) or chronic obstructive lung disease (COLD). Patients present with breathlessness on exertion that progresses over time. In the end, breathlessness may occur even at rest.

    Is COPD the same as asthma?

    No. COPD usually caused by cigarette smoking while the cause of asthma is multifactorial. COPD tends to afflict the older population while asthma is more frequently seen in the young. The obstruction of the airways is usually fixed and progressive whereas in asthma it is usually reversible.

    Is COPD contagious?


    No. As the cause is not an infectious agent, it is not contagious.

    Causes

    The most important cause of COPD is cigarette smoking. Chemicals in tobacco damage the lungs with chronic smoking. Other less common causes include alpha1 anti-trypsin deficiency which is inherited.

    Treatment

    COPD cannot be cured. The damage to the lungs is irreversible. However, symptoms may be controlled with medication and smoking cessation. In fact, the most important measure is to stop smoking completely. Smoking cessation slows disease progression and improves survival.

    Why does breathlessness persist even when smoking has been stopped?

    Lung function will still continue to deteriorate even when smoking has been stopped. However the rate of deterioration will slow down and symptoms will not worsen so rapidly. Even a normal person will have age-related deterioration of lung function.

    Lung volume reduction surgery

    Lung volume reduction surgery (LVRS) is a new form of treatment for a subset of COPD patients. This surgery involves removing small parts of the lung which are diseased. By doing so, normal areas of the lung which are compressed by these diseased areas are now able to expand more normally. This is associated with an improvement of symptoms. Patients with emphysema may be suitable for this form of treatment. They are usually require to undergo pulmonary rehabilitation to maximize their effort tolerance before going for LVRS.

    Home oxygen

    For patients who have severe COPD, blood oxygen level may be persistently low. This may result in worsening breathlessness and heart failure. These patients will benefit from using oxygen for at least 15 hours a day. Oxygen therapy at home can be provided either by an oxygen concentrator or oxygen tanks. The disadvantage of using oxygen tanks is that they are cumbersome and require regular refill. Patients will have their oxygen requirements determined in hospital before they are prescribed home oxygen therapy.

    Is it dangerous to have home oxygen while I'm smoking?


    Although oxygen on its own is not combustible, it promotes combustion in the presence of a flame. Ideally, a patient who requires home oxygen therapy should stop smoking for two reasons. Firstly, smoking causes rapid deterioration of lung function in these patients who are already severely compromised and secondly because of the risk of burns and fire if cigarettes are accidentally lit in front of the oxygen. If the patient still insists on smoking or if members of the family smoke, they must be advised not to smoke in the same room with the oxygen. Patients should not use oxygen when they have lit a cigarette.

    Medications

    The common medications for COPD are bronchodilators and inhaled steroids. These medications come in the form of inhalers and they play a role in relieving symptoms and preventing hospitalization. They do not reverse the lung damage done.

    Pulmonary rehabilitation

    The severe breathlessness that COPD patients have often leaves them physically deconditioned. Rehabilitation involves more than exercise training. Patient education, proper inhaler/medication use, dietary advice and psychological counseling are the other components.

    Vaccination

    Vaccination against pneumococcus (common cause of pneumonia) and influenza (yearly) is advised.

    Lung transplantation

    Lung transplantation is considered in the most severe cases.


    Useful Links


    American Lung Association: http://www.lungusa.org
    Canadian Lung Association: http://www.lung.ca
      


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