What is COPD?
Chronic obstructive pulmonary disease (COPD), also called chronic obstructive lung disease, is a term that is used for two closely related diseases of the respiratory system: chronic bronchitis and emphysema. In many patients these diseases occur together, although there may be more symptoms of one than the other. Most patients with these diseases have a long history of heavy cigarette smoking.
COPD gets gradually worse over time. At first there may be only a mild shortness of breath and occasional coughing. Then a chronic cough develops with clear, colorless sputum. As the disease progresses, the cough becomes more frequent and more and more effort is needed to get air into and out of the lungs. In later stages of the disease, the heart may be affected.
Cigarette smoking is the most important risk factor for COPD; it would probably be a minor health problem if people did not smoke. Other risk factors include age, heredity, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections. Living in low socioeconomic conditions also seems to be a contributing factor.
How Is Chronic Obstructive Pulmonary Disease Treated?
Pulmonary rehabilitation programs, along with medical treatment, are useful in certain patients with COPD. The goals are to improve overall physical endurance and generally help to overcome the conditions which cause dyspnea (episodes of breathlessness) and limit capacity for physical exercise and activities of daily living. General exercise training increases performance, endurance, and overall sense of well-being.
Administration of oxygen and nutritional supplements when necessary can improve respiratory muscle strength. Relaxation techniques may also reduce the perception of ventilatory effort and dyspnea. Breathing exercises and breathing techniques, such as pursed lips breathing and relaxation, improve functional status.
Keeping air passages reasonably clear of secretions is difficult for patients with advanced COPD. Some commonly used methods for mobilizing and removing secretions are the following:
- Postural bronchial drainage helps to remove secretions from the airways. The patient lies in prescribed positions that allow gravity to drain different parts of the lung. This is usually done after inhaling an aerosol. In the basic position, the patient lies on a bed with his chest and head over the side and his forearms resting on the floor
- Chest percussion or lightly clapping the chest and back, may help dislodge tenacious or copious secretions
- Controlled coughing techniques are taught to help the patient bring up secretions
- Bland aerosols, often made from solutions of salt or bicarbonate of soda, are inhaled. These aerosols thin and loosen secretions. Treatments usually last 10 to 15 minutes and are taken three or four times a day. Bronchodilators are sometimes added to the aerosols
Home oxygen therapy can improve survival in patients with advanced COPD who have hypoxemia, low blood oxygen levels. This treatment can improve a patient’s exercise tolerance and ability to perform on psychological tests which reflect different aspects of brain function and muscle coordination. Increasing the concentration of oxygen in blood also improves the function of the heart and prevents the development of cor pulmonale (a serious heart condition).
Oxygen can also lessen sleeplessness, irritability, headaches, and the overproduction of red blood cells. Continuous oxygen therapy is recommended for patients with low oxygen levels at rest, during exercise, or while sleeping. Many oxygen sources are available for home use; these include tanks of compressed gaseous oxygen or liquid oxygen and devices that concentrate oxygen from room air.
Although there is no cure for COPD, the disease can be prevented in many cases. And, in almost all cases the disabling symptoms can be reduced. Because cigarette smoking is the most important cause of COPD, not smoking almost always prevents COPD from developing, and quitting smoking slows the disease process.
If the patient and medical team develop and adhere to a program of complete respiratory care, disability can be minimized, acute episodes prevented, and hospitalizations reduced.
More than 13.5 million Americans are thought to have COPD. It is the fifth leading cause of death in the United States. Between 1980 and 1990, the total death rate from COPD increased by 22 percent. In 1990, it was estimated that there were 84,000 deaths due to COPD, approximately 34 per 100,000 people. Although COPD is still much more common in men than women, the greatest increase in the COPD death rate between 1979 and 1989 occurred in females, particularly in black females (117.6 percent for black females vs. 93 percent for white females). These increases reflect the increased number of women who smoke cigarettes.
* Information provided by National Heart, Lung, and Blood Institute. For more information, visit http://www.nhlbi.nih.gov