Chronic Obstructive Pulmonary Disease (COPD) and Emphysema
COPD stands for chronic obstructive pulmonary disease. Emphysema is a form of COPD.
- COPD is a group of diseases that cause damage to the lungs and restrict their ability to obtain oxygen, restricting oxygen flow in the blood.
- Medical and rehabilitation programs and therapy are available to patients with COPD to help them combat their symptoms
- Surgical treatments for COPD include lung volume reduction surgery and lung transplantation
Over 15 million Americans have been diagnosed with COPD. Evidence suggests that another 15 million have COPD but remain undiagnosed. COPD is presently the third leading cause of death in this country and the 2nd leading cause of disability.
Most COPD is related to cigarette smoking, but recent evidence suggests that 25% of those with COPD never smoked. Increasingly environmental factors are felt to play a role in the development and worsening of COPD. There is also an inherited form of COPD called alpha-1 antitrypsin deficiency.
All COPD is not the same. There are those with more of a chronic bronchitic form of COPD and some with a more emphysematous form, meaning it is related to emphysema.
Emphysema is a progressive, destructive lung disease in which the walls between the tiny air sacs are damaged. As a result, the lungs lose their elasticity causing exhalation, or breathing out, to become more and more difficult. Air remains trapped in the overinflated lungs, leading to progressive shortness of breath.
COPD and asthma are both obstructive lung diseases marked by shortness of breath but asthma is by definition reversible while with COPD the airflow obstruction is either irreversible or only partly reversible. The mainstay of therapy in asthma is inhaled corticosteroids while in COPD it is long acting bronchodilators. Over time some asthmatics may develop an irreversible component, a variant of COPD. Because both are common diseases they can occur together. Estimates suggest that as many as 20% of COPD patients have ACOS, the asthma/COPD overlap.
Treating and preventing exacerbations—or flares of disease—are critical factors in managing COPD. People with frequent exacerbations (2 or more a year), have a more rapid deterioration in lung function, more frequent hospitalizations, and higher mortality.
There are many medical options for treating emphysema/COPD.
- The primary recommendation for preventing and treating COPD is to stop smoking.
- Bronchodilators relax the muscles of the bronchi, the major air passageway in the lungs. This allows air to get in and out easier. These medications are available in pill or liquid form (taken orally), or as an aerosol spray (inhaled).
- Steroids are powerful anti-inflammatory medications. The only role for systemic steroid therapy in COPD is for 5-10 days during an acute exacerbation. Longer term treatment with systemic steroids in COPD has not been shown to have any benefit and can carry significant risks. The potential side effects of long term systemic steroid use include osteoporosis, diabetes, weight gain, cataracts, muscle weakness, cataracts, and hypertension.
- Antibiotics are frequently used during acute bronchitis to fight bacterial infections. Flu and pneumonia vaccinations are recommended for all patients with COPD. The influenza shot is administered yearly while the pneumonia shot is administered every five years.
- Oxygen therapy in patients with a resting O2 saturations less than or equal to 88% has been shown to improve quality of life and survival.
- Proper nutrition is critical for emphysema patients. Weight loss, which is common in patients with advanced emphysema, can be caused by inadequate food intake in individuals too short of breath to eat. However, most weight loss in COPD patients is due to the increased metabolic demand of respiratory muscles that are overworked because of emphysema damage.
Pulmonary rehabilitation has clear benefits for patients with COPD. Exercise increases endurance, improves shortness of breath, increases maximal oxygen consumption, and improves quality of life. Numerous studies have documented improvement in symptoms, maximum oxygen consumption, and quality-of-life measures. A decrease in the number of hospitalizations has also been shown in patients who participate in pulmonary rehabilitation programs.
Benefits do vary among individuals, however, and consistent participation in an exercise regimen is necessary to maintain improvements. In addition, it has not been shown that pulmonary rehabilitation produces any change in pulmonary function tests (PFTs) or overall oxygen requirements for individuals.
If medical treatment does not alleviate the symptoms of COPD, or symptoms and exacerbations increase, surgery may be an option. However, in order to be a candidate for surgery, there are specific criteria. These include not being a current smoker, participating in a pulmonary rehabilitation program, and being strong enough to receive surgery.
There are two types of surgery performed for COPD, Lung Volume Reduction Surgery and Bullectomy.
- Lung Volume Reduction Surgery involves removing parts of the lung that are most affected by COPD. Removal of lung tissue seems counterintuitive, but it allows the remaining, healthy parts of the lung function more efficiently.
- Bullectomy involves the removal of bullae from the lungs. Bullae are large air sacs in the lungs that form when a large number of alveoli are destroyed by COPD. These air sacs interfere with breathing.
If damage to the lungs is too severe or surgery does not alleviate symptoms, a doctor may recommend a lung transplant.
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