• Progressive or more severe symptoms may include
○ respiratory distress,
○ use of accessory respiratory muscles,
○ peripheral edema,
○ chronic wheezing,
○ abnormal lung sounds,
○ prolonged expiration,
○ elevated jugular venous pulse, and
• The primary cause of chronic obstructive pulmonary disease is cigarette smoking and or exposure to tobacco smoke. Other causes include air pollution, infectious diseases, and genetic conditions. COPD’s risk factors are increased by smoking tobacco, secondhand smoke, air pollution, alpha-1 antitrypsin deficiency, and a few other conditions.
• Chronic bronchitis, emphysema, asthma, and infectious diseases can contribute to chronic obstructive pulmonary disease development.
• The stages of chronic obstructive pulmonary disease range from stage I to stage IV.
• This COPD diagnosis involves taking the patient’s breathing history and exposure to irritants such as cigarette smoking or other agents. A pulmonologist usually determines the stage of COPD by their FEV1 level.
• The treatment for this health condition includes avoiding any of the risks and causes of COPD such as cigarette smoke or toxic fumes, medications, or a small number of patients, lung surgery, or lung transplant.
• Medical treatments for COPD include medications to stop smoking, various bronchodilators, anticholinergics, steroids, and enzyme inhibitors.
• Other therapies for this health condition may include antibiotics, mucolytic agents, oxygen, endurance exercises, and yoga.
• Surgery for COPD may include bullectomy, lung volume reduction, or lung transplant.
• The prognosis and life expectancy for individuals with chronic obstructive pulmonary disease range from good to poor, depending on their COPD stage, with a decreasing outlook as the stages progress toward stage IV.
• Individuals with COPD should contact their health-care professional before treating themselves with home remedies (for example, vitamins, antioxidants, omega-3 fatty acids).
• Prevention or lowering the risk factors for chronic obstructive pulmonary disease includes avoiding the causes and irritants (for example, smoking) or vaccines that protect the lungs from infection (for example, the flu and pneumococcal vaccines).
• Depending upon the chronic obstructive pulmonary disease stage, other doctors besides the patient’s primary care physician may be involved. They may include pulmonologists, lung surgeons, and or other professionals such as pulmonary rehabilitation specialists and other team members.
Individuals should contact their doctors about COPD if they experience any of the signs or symptoms of COPD.
Chronic obstructive pulmonary disease is a slowly progressive disease, so it is not unusual for the initial signs and symptoms to be slightly different from those in the late stages of the disease. There are many ways to evaluate or stage chronic obstructive pulmonary disease, often based on symptoms.
Usually, COPD’s first signs and symptoms include a productive cough, generally in the morning, with colorless or white mucus (sputum).
The most significant chronic obstructive pulmonary disease symptom is breathlessness, termed shortness of breath (dyspnea). Early on, this symptom may occasionally occur with exertion and eventually progress to breathlessness while doing a simple task such as standing up or walking to the bathroom. Some people may develop wheezing (a whistling or hissing sound while breathing).
Signs and symptoms of chronic obstructive pulmonary disease include:
• Cough, with usually colorless sputum in small amounts
• Acute chest discomfort
• Shortness of breath (usually occurs in patients aged 60 and over)
• Wheezing (especially during exertion)
As the disease progresses from mild to moderate, symptoms often increase in severity:
• Respiratory distress with simple activities like walking up a few stairs
• Rapid breathing (tachypnea)
• Bluish discoloration of the skin (cyanosis)
• Use of accessory respiratory muscles
• Swelling of extremities (peripheral edema)
• Over-inflated lungs (hyperinflation)
• Wheezing with minimal exertion
• Course crackles (lung sounds usually with inspiration)
• Prolonged exhalations (expiration)
• Diffuse breath sounds
Elevated jugular venous pulse
One way to stage chronic obstructive pulmonary disease is the Global Initiative for Chronic Obstructive Lung Disease program (GOLD). The staging is based on the results of a pulmonary function test. Precisely, the forced expiratory volume (how much air one can exhale forcibly) in one second (FEV1) of a standard predicted value is measured, based on the individual patient’s physical parameters.
The staging of chronic obstructive pulmonary disease by this method is as follows:
• Stage I is FEV1 of equal or more than 80% of the predicted value
• Stage II is FEV1 of 50% to 79% of the predicted value
• Stage III is FEV1 of 30% to 49% of the predicted value
• Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure
Other staging methods are similar but are based on the severity of the shortness of breath symptom that is sometimes subjective. The above staging is measurable objectively, providing the patient is putting forth their best effort.
The primary cause of chronic obstructive pulmonary disease is cigarette smoking or exposure to tobacco smoke. It is estimated that 90% of the risk for chronic obstructive pulmonary disease development is related to tobacco smoke. The smoke also can be secondhand smoke (tobacco smoke exhaled by a smoker and then breathed in by a non-smoker).
Other causes of chronic obstructive pulmonary disease are:
• Prolonged exposure to air pollution, such as that seen with burning coal or wood and with industrial air pollutants
• Infectious diseases: Infectious diseases that destroy lung tissue in patients with hyperactive airways or asthma also may contribute to causing this COPD.
Damage to the lung tissue over time causes physical changes in the lungs’ tissues and clogging of the airways with thick mucus. The tissue damage in the lungs leads to poor compliance (the lung tissue’s elasticity or ability to expand). The decrease in the lungs’ elasticity means that oxygen in the air cannot get by obstructions (for example, thick mucus plugs) to reach air spaces (alveoli) where oxygen and carbon dioxide exchange occurs in the lung. Consequently, the person exhibits a progressive difficulty, first coughing to remove obstructions like mucus and breathing, especially with exertion.
People who smoke tobacco are at the highest risk for developing chronic obstructive pulmonary disease. Other risk factors include exposure to secondhand smoke from tobacco and elevated air pollution levels, especially air pollution associated with wood or coal. Also, individuals with airway hyper-responsiveness, such as those with chronic asthma, are at increased risk.
There is a genetic factor called alpha-1 antitrypsin deficiency that places a small percentage (less than 1%) of people at higher risk for COPD (and emphysema) because of a protective factor (alpha-1 antitrypsin protein) for lung tissue elasticity is decreased or absent.
Other factors that may increase the risk for developing chronic obstructive pulmonary disease include
• intravenous drug use,
• immune deficiency syndromes,
• vasculitis syndrome,
• connective tissue disorders, and
• Genetic problems such as Salla disease (an autosomal recessive disorder of sialic acid storage in the body).
Other diseases or conditions contributing to COPD
In general, three other non-genetic problems related to lung tissue play a role in chronic obstructive pulmonary disease. 1) chronic bronchitis, 2) emphysema, and 3) infectious diseases of the lung.
• Chronic bronchitis and emphysema are thought to be variations of chronic obstructive pulmonary disease. They are considered part of the progression of chronic obstructive pulmonary disease by many researchers. Chronic bronchitis is a chronic cough that produces sputum for three or more months during two consecutive years.
• Emphysema is an abnormal and permanent enlargement of the air spaces (alveoli) located at the end of the terminal bronchioles in the lungs.
Infectious diseases of the lung may damage lung tissue areas and contribute to chronic obstructive pulmonary disease.
Doctors make a preliminary diagnosis of COPD in a person with chronic obstructive pulmonary disease symptoms by noting
• his/her breathing history,
• the history of tobacco smoking or exposure to secondhand smoke, and or
exposure to air pollutants, and or a history of lung disease (for example, pneumonia).
Other tests to diagnose COPD include:
• Chest X-rays
• CT scan of the lungs
Arterial blood gas or a pulse oximeter to look at the oxygen saturation level in the patient’s blood.
There are many treatments for chronic obstructive pulmonary disease. The first and best is to stop smoking immediately.
Medical treatments of chronic obstructive pulmonary disease drugs include nicotine replacement therapy, beta-2 agonists and anticholinergic agents (bronchodilators), combined drugs using steroids and long-acting bronchodilators, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation.
The treatments are often based on the stage of chronic obstructive pulmonary disease, for example:
• Stage I – short-acting bronchodilator as needed
• Stage II – short-acting bronchodilator as needed and long-acting bronchodilators plus cardiopulmonary rehabilitation
• Stage III – short-acting bronchodilator requires long-acting bronchodilators, cardiopulmonary rehabilitation, and inhaled glucocorticoids for repeated exacerbations
• Stage IV – as needed, long-acting bronchodilators, cardiopulmonary rehabilitation, inhaled glucocorticoids, long-term oxygen therapy, possible lung volume reduction surgery, and possible lung transplantation (stage IV has been termed “end-stage” chronic obstructive pulmonary disease)
The three primary goals of the comprehensive treatment and management of chronic obstructive pulmonary disease are:
1. Lessen airflow limitation
2. Prevent and treat secondary medical complications (for example, hypoxemia, infection)
Decrease respiratory symptoms and improve quality of life
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