COPD risk factors, pathophysiology, symptoms, and treatment approaches

COPD

Chronic obstructive pulmonary disease (COPD) is actually a family of diseases affecting the respiratory system including chronic bronchitis and emphysema. Primary risk factors include smoking and environmental pollutants. Therefore, most cases of COPD are preventable. According to the Global Initiative for Chronic Obstructive Lung Disease (2011), COPD is the fourth leading cause of death worldwide, and according to the American Lung Association (2015), is the third leading cause of death domestically. The disease is not only preventable, but also curable, particularly when it is detected early.

However, there is no actual cure for COPD. Once COPD has developed, it is irreversible, although symptoms can be managed. Pathophysiology centers on the inflammation or destruction of the airways and the destruction of lung tissues. With emphysema, the walls of air sacs become damaged and lose their shape, affecting the rate and quantity of air exchange in the lungs. Moreover, emphysema destroys air sacs and therefore directly reduces gas exchange capacity in lungs. With chronic bronchitis, the lining of the airways becomes inflamed and irritated, leading to a thickening of airway lining and the creation of mucus as a response (National Heart, Lung, and Blood Institute, n.d.). The mucus in turn blocks airflow and impacts the ability to breathe or achieve necessary oxygen/carbon dioxide exchanges. With COPD, many patients develop both emphysema and chronic bronchitis, making the COPD designation more relevant. Symptoms of both emphysema and chronic bronchitis will be similar, including chronic cough, shortness of breath (dyspnea), frequent respiratory infections, fatigue, weakness, and increased mucus production (American Lung Association, 2015). As the American Lung Association (2015) points out, shortness of breath is not normal and should never be attributed to the natural aging process. Shortness of breath almost always signals an underlying issue such as COPD or another respiratory infection. Other signs and symptoms of COPD include a chronic cough.

Unfortunately, many people are unaware they have COPD and fail to seek treatment in a timely manner. Women are more likely than men to die of the disease, in spite of the fact that men and women suffer from COPD at equal rates (American Lung Association, 2015; HealthyPeople2020, 2015). The number of deaths from COPD has been increasing, making treatment outreach and education critical (ALA 2015). One of the primary objectives of HealthyPeople2020 (2015) is to "promote respiratory health through better prevention, detection, treatment, and education efforts." Thankfully, risk factors for COPD are easy to detect, understand, and communicate. Smoking is the number one risk factor, but working in environments with high levels of pollution, exposure to toxins, and other environmental issues may also be risk factors for developing the disease. Therefore, people who smoke or who are exposed regularly to airborne pollutants should receive regular checkups. Checkups for COPD will include FEV tests like spirometry, tests that measure lung health by having the patient blow into a tube. Spirometry is the most "widely available, reproducible test of lung function," (Global Initiative for Chronic Obstructive Lung Disease, 2011). However, some persons with chronic bronchitis will test normal in spirometry, which is why spirometry alone cannot be used as an indicator of disease status (Global Initiative for Chronic Obstructive Lung Disease, 2011).

Other diagnostic and laboratory tools used for detecting and measuring the progress of COPD include chest X-rays and HRTC scans. Both chest X-rays and HRCT scans are especially helpful when narrowing down the cause of symptoms, and ensuring that the symptoms are indeed indicative of COPD as opposed to other problems. Another benefit of using HRTC scans is that they may determine patient suitability for surgeries (Global Initiative for Chronic Obstructive Lung Disease, 2011). Blood tests can also be used to determine how effectively the lungs are processing oxygen, completing gas exchange, and delivering the necessary oxygen to vital organs through blood. Pulse oximetry and arterial blood gas management are techniques that are especially helpful to measure progress of COPD in patients who have been diagnosed with the disease and are receiving treatment interventions (Global Initiative for Chronic Obstructive Lung Disease, 2011).

Although genetics are almost never a direct cause of COPD, genetic factors most likely increase a person's susceptibility for developing the disease (HealthyPeople2020, 2015). A smoker who has one or more family members diagnosed with a respiratory infection may be at a high risk for developing COPD. There is no cure for COPD and much of the damage to the airways, sacs, and lungs may be irreversible. Still, quitting smoking halts the progress of COPD, which is progressive in nature. Stopping smoking as early as possible will ensure the minimization of symptoms and promote longevity and overall well-being. Extricating oneself from a polluting environment would also be recommended in cases in which the individual developed COPD from the workplace or a geographic setting. Once diagnosed, there are several treatment interventions in addition to lifestyle changes. Those interventions may include several classes of medications, which are often delivered in the form of inhalers, pulmonary rehabilitation exercise, oxygen therapy, complementary care, nutritional counseling, and in rare cases, surgery. Ongoing treatment and monitoring is usually required.

Because COPD is often caused by lifestyle choices, patient education remains one of the most important public health strategies for reducing prevalence and mortality rates of COPD. Educational strategies begin in childhood, to prevent young people from smoking. However, education also includes targeting workplace health and safety managers and policy makers. Persons at risk should minimize exposure to irritants, such as second hand smoke, air pollution, nanoparticles, dust, and pesticides. Therefore, comprehensive harm reduction programs include the monitoring and control of particles and toxins. Persons who work in at-risk work environments need to use safety gear. The costs associated with COPD are tremendous. As HealthyPeople2020 (2015) points out, "The burden of respiratory diseases affects individuals and their families, schools, workplaces, neighborhoods, cities, and states. Because of the cost to the health care system, the burden of respiratory diseases also falls on society."