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Chronic Obstructive Pulmonary Disease

About 14 million people in the United States have COPD. The disease develops over many years. It is almost always caused by cigarette smoking. The best way prevent or keep COPD from getting worse is to quit smoking.

Causes

Predisposing factors include cigarette smoking, recurrent or chronic respiratory tract infections, air pollution, and allergies. Familial and hereditary factors (for example, deficiency of alphalantitrypsin) 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 inflammation in airways, 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

• Shortness of breath ( dyspnea ) persisting for months to years
• Wheezing
• Decreased exercise tolerance
• Cough with or without phlegm

Diagnosis

The diagnostic process for COPD includes a thorough medical history as well as one or more of the following diagnostic procedures.

• Pulmonary Function Tests
• Oximetry
• Radiological Procedures
• Arterial Blood Gases
• Alpha-1-Antitrypsin Level

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 allow treatment of respiratory tract infections. Pneumococcal vaccination and annual influenza vaccinations are important preventive measures.

Prevention

Avoidance of smoking prevents COPD. Early recognition and treatment of small airway disease in people who smoke, combined with smoking cessation, may prevent progression of the disease.

Sound nutrition, including vitamin supplementation, may help to prevent emphysema. Special attention should be given to the intake of antioxidants to prevent the breakdown of functional lung tissue by free radicals. Regular aerobic exercise builds up lung capacity and helps cleanse the lungs of stale air. Walking is an excellent choice, if one avoids polluted areas. Unproven preventive measures often recommended by doctors include yearly pneumonia and influenza vaccinations.