CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Definition of COPD

It is characterized by a progressive obstruction of the airways interfering with normal breathing. It includes chronic bronchitis and emphysema which often coexist :

chronic bronchitis is characterized by a chronic inflammation and a narrowing of the airways. Less air is thus able to flow to and through the lungs and heavy mucus or phlegm is coughed up.
emphysema is characterized by a progressive destruction of the lung air sacks (alveoles) and their walls: the lungs loose their elasticity and the air accumulates partially inside the lungs.

Frequency of COPD

Between 5 to 10% of the adult population in industrialized countries suffers from COPD. In the USA more than 11 millions adults were estimated to have COPD in 2004 and about 24 millions presented an impaired lung function, suggesting an under-diagnosis of COPD.

According to the World Health Organization, it is the forth leading cause of death, beyond heart attack, cancer and stroke, claiming the lives of 3 million people every year. Of all the main causes of death, it is the only one which is expanding and is expected to become the 3rd leading cause by 2010. This is due to the rise in smoking in developing countries and its maintenance in the others, as well as to the aging of the population.

COPD symptoms

The main symptoms are:

cough
increased mucus
frequent clearing of the throat
shortness of breath (dyspnea).

Diagnosis of COPD

It is diagnosed quickly and painlessly with a simple respiratory test, called spirometry that evaluates the grade of bronchial obstruction by measuring the amount of air that a patient can breathe in and out.

Risk factors for COPD

Active smoking is the main risk factor as 80-90% of the smokers or ex-smokers suffer from COPD. It is generally accepted that smoking one pack per day during 10 years leads to the development of this disease, but there is of course a lot of individual variations. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked, compared to 12 times in men.
History of respiratory tract infections during childhood
Professional exposure to pollutants and air pollution including passive smoking
Genetic factors.

Consequences of COPD

The quality of life of a person suffering from COPD decreases as the disease progresses. At the beginning, there is very little shortness of breath, but this can evolve up to needing supplemental oxygen, mechanical respiratory assistance and hospitalization.

This disease limits the ability to work, normal physical exertion, household chores, social and family activities.

Costs of COPD

It is a very costly burden with respect to

direct costs : doctors, medications and other treatments, as well as hospitalisations
indirect costs : expenses for absence from work, disability, caregivers, premature mortality.

In 2002, the total direct costs reached nearly 37 billion € in the European Union, and 18 billion $ in the USA where the indirect costs reached 14 billion $.

Management of COPD

Its goal is to provide relief of symptoms, prevent respiratory tract infections and complications, stop or slow-down the progression of the disease and improve quality of life.

Smoking cessation is the most important measure as it is the primary risk factor for COPD
Bronchodilators are central to managing the symptoms as they relax and open the air passages in the lungs. They are inhaled by aerosol spray or taken orally on an as-needed basis or on a regular basis to prevent or reduce symptoms and exacerbations
Inhaled corticosteroids taken in addition to bronchodilator treatment is appropriate for patients suffering from severe symptomatic COPD and repeated exacerbations.
Influenza vaccines can reduce serious illness and pneumococcal polysaccharide vaccine is recommended for patients aged 65 and older or in younger patients with a severe COPD
Other pharmacological treatments are also available, for instance an immunostimulating bacterial extract decreasing the severity and frequency of COPD infectious exacerbations. As regards mucolytics and antitussives, their regular use is not recommended.
Exercise training programs improve symptoms of shortness of breath and tiredness
Long-term administration of oxygen to patients with chronic respiratory failure has been shown to increase survival
General measures such as loosing extra kilos, practising some sport in particular walking, avoiding draughts, dressing warmly in cold weather are all beneficial for COPD patients.

The importance of the Global initiative for chronic Obstructive Lung Disease (GOLD)

GOLD is an institution initiated in 1998 by the US National Health, Lung and Blood Institute and the World Health Organization. It is present in more than 60 countries and recommends effective diagnosis, patient management and preventive methods against COPD. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management and Prevention of COPD, published in 2001 and updated in 2003, 2004, 2005 and 2006.
GOLD is also organizing each year since 2001 the World COPD Day to improve awareness and care of COPD around the world. The next World COPD Day will take place on November 19 th, 2008.
The above sections on COPD are widely based on the GOLD report.

Any medical information on this website is not intended as a substitute for informed medical advice. No action should be taken before consulting with a healthcare professional.

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