Chronic Obstructive Pulmonary Disease

Introduction

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. It's expected to take about 126,000 lives this year, making it the only one of the 10 leading killers that's increasing each year. And COPD is also a major cause of disability since some 24 million Americans suffer from the condition; although it has traditionally been a predominantly male disease, COPD is on the rise in American women. COPD is not curable, but it is treatable. Lifestyle changes and medication can help patients cope with chronic lung disease and live longer, fuller lives. And if you understand COPD, you'll know that most cases can be prevented. (Nardini,53)

Discussion

COPD is a complex disorder. There are two major forms of the disease, chronic bronchitis and emphysema. In both, narrowed bronchi make it hard to exhale. Narrowed bronchi also cause asthma—but in asthma, the narrowing is temporary and reversible, while in COPD, it's permanent. In chronic bronchitis, an enlargement of the mucous glands and excessive mucus production cause the narrowing. In emphysema, the narrowing comes from damage to the bronchi themselves and is more severe. Most patients with COPD have a mixture of chronic bronchitis and emphysema. Narrowed bronchial tubes are the hallmark of COPD, but the damage doesn't stop there. (Kunik,127)

It takes more force to exhale through narrow airways, and, in emphysema, the air sacs become hyperinflated, filled with too much air. But pressure is not the main culprit in emphysema. Rather, it's inflammation triggered by inhaled irritants. White blood cells respond to the irritation, but instead of controlling the problem, they release chemicals that damage and eventually destroy lung tissue. Patients with chronic bronchitis are spared the worst aspects of tissue destruction, but they can still suffer significant damage.

Causes

Smoking is responsible for about 85% of cases; heavy smokers are at highest risk. Airborne toxins account for COPD in many nonsmokers; secondhand smoke is another likely contributor. In others, an inherited deficiency of a protein (alpha-1 antitrypsin) that keeps the lungs healthy is to blame. But in some cases, no cause is apparent. (Dore,204)



Symptoms

COPD starts gradually and progresses slowly; that's why cases continue to increase years after many Americans quit smoking. At first, there are no symptoms—but little by little, problems appear, usually in middle age. A morning “smoker's cough” is often the first complaint. The cough gradually gets worse and occurs throughout the day. Next, shortness of breath develops. In the beginning, patients only notice shortness of breath during exercise, but as the disease progresses, breathing becomes a chore even at rest. Wheezing is another common symptom. (Dore,204)

Most patients also become tired and weak; morning headaches may be prominent. Patients with chronic bronchitis have a recurrent cough that brings up large amounts of thick, discolored phlegm almost every day for three months or longer. Over time, the lung disease puts a strain on the heart, and patients develop a type of heart failure called cor pulmonale. As a result, they ...