Chronic Obstructive Pulmonary Disease Overview

 

Definition of COPD

• A preventable & treatable disease w/ overall severity contributed by exacerbations & comorbidities
• The persistent airflow limitation is usually progressive & associated w/ an enhanced chronic inflammatory response in the airways & the lung to noxious particles or gases
• The chronic airflow limitation is caused by a mixture of small airways disease & parenchymal destruction

• Hereditary deficiency of alpha-1 antitrypsin
• Airway hyper-responsiveness
  
  • Includes asthma
  • May also develop after exposure to tobacco smoke or other environmental insults
• Lung growth & development
  
  • Individuals may have reduced maximal attained lung function due to processes during gestation & childhood
• Infections
  
  • Reduced lung function can be associated w/ a history of severe childhood resp infections
  • Previous tuberculosis

• Tobacco smoke
  
  • Most commonly encountered risk factor
  • Includes history of tobacco use or prolonged exposure to second-hand smoke
  • Smoking during pregnancy can put the fetus at risk
• Occupational dusts & chemicals
• Air pollution
• Smoke from home cooking & heating fuels
• Socioeconomic status

• An acute event wherein the patient’s symptoms worsen beyond normal daily variations that leads to change in medication
• Viral & bacterial respiratory tract infections are the common causes
  • Exacerbations caused by bacterial etiology in 50% of patients
• Other causes: air pollution, interruption of maintenance medications, other comorbidities (GERD)

• Increased breathlessness, wheezing, chest tightness
• Increased cough & sputum, change in color &/or tenacity of sputum
• Fever, malaise, fatigue, depression, confusion, sleep disturbances, decreased exercise tolerance
• Resp rate >25 breaths/min, heart rate >110/min, use of accessory muscles for breathing &/or dyspnea at rest may indicate severe acute exacerbation

Below is the overview of the disease management of Chronic Obstructive Pulmonary Disease:

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Arrange For Follow-Up Assessments

• A follow-up assessment must be carried out w/in 4-6 wk following discharge from hospital for exacerbations
• Check patient’s ability to cope in his environment
• Measure FEV₁
• Check inhaler technique
• Check understanding & ability to follow of treatment regimen
• Assess need for long-term O₂ therapy &/or home nebulizer for patients w/ very severe COPD
• Check status of comorbidities

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Version: 31 July 2015

Guideline References:

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