Chronic Obstructive Pulmonary Disease


Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema two commonly co-existing diseases of the lungs in which the airways (bronchial tubes) become narrowed. This leads to a reduction of the flow of air to and from the lungs causing shortness of breath. Unlike in asthma, the reduced airflow is poorly reversible and usually worsens over time. COPD is caused by noxious particles or gases, most commonly from cigarette smoking, which leads to inflammation in the lung. Inflammation in the larger airways results in chronic bronchitis (which is characterized by cough and sputum production). Inflammation in the air sacs (alveoli) causes destruction of the tissues of the lung, and this results in emphysema. The natural course of COPD is characterized by occasional sudden worsening of symptoms called acute exacerbations, most of which are caused by infections or air pollution. COPD is the 4th leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity. The primary risk factor for COPD is chronic tobacco smoking. In the US, 80 to 90% of cases of COPD are due to smoking. Exposure to cigarette smoke is measured in pack-years, the average number of packages of cigarettes smoked daily multiplied by the number of years of smoking. Other factors include exposure to certain workplace dusts and chemicals, air pollution, and genetics. The diagnosis of COPD is considered in anyone who has shortness of breath, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease such as regular tobacco smoking. No single symptom can adequately confirm or exclude the diagnosis of COPD although COPD is uncommon under the age of 40 years. The diagnosis of COPD is confirmed by lung function testing (spirometry). Spirometry can also help to determine the severity of COPD.

Your MLA physician will evaluate COPD by taking a careful history, performing a physical examination as well as reviewing or ordering a chest x-ray, and any other information that you bring to the office visit. If not already done pulmonary function tests will be ordered. COPD management not only consists of appropriate medications but attention to lifestyle change (exercise, smoking cessation), pulmonary rehabilitation, nutrition and if needed, supplemental oxygen therapy.