Chronic Obstructive Lung Disease
Management of an Irreversible Lung Condition
Living with chronic obstructive pulmonary disease requires medications and other treatments to overcome its limitations.
Chronic obstructive pulmonary disease (COPD) involves impaired airflow throughout the lungs. It can lead to problems that involve lack of oxygenation and physical limitations. Although COPD is considered permanent, there are still ways to treat and live with this condition.
The Disease
COPD is a disease state caused by chronic bronchitis and/or emphysema. Chronic bronchitis is defined as frequent coughing and sputum production for at least three months duration over at least two consecutive years. Emphysema is the destruction of the lung's elastic tissue, which stretches during inhalation and automatically recoils during exhalation. A related condition is alpha-1 antitrypsin deficiency, a genetic disorder resulting in emphysema at an earlier age, even without smoking. In order to be considered as having COPD, one must have either chronic bronchitis or emphysema along with obstructed airflow determined by spirometry.
The disease process has two major components. One is the lack of elastic recoil; without elastic tissue that passively assists with exhaling, the patient would have to put extra effort into doing so. The other is airway inflammation, associated with swelling of the airway lining, secretion of mucus, and narrowing of the lung airways by contraction of its smooth muscle (bronchoconstriction). These processes occur when environmental exposures, especially cigarette smoke, destroy the normal lung architecture.
As a result, patients with COPD find it difficult to breathe. With mucus secretions in the airways and less elastic recoil, they may be able to breathe in but have to work just to breathe out. The chest, normally narrower from front to back than from side to side, may assume a more rounded barrel shape. Getting enough oxygen to the blood may become another issue.
The Treatment
Initial treatment directly addresses the processes of bronchoconstriction, which is partially reversible, and airway inflammation. They include inhaled bronchodilators that widen the airways (e.g., albuterol, Atrovent, and salmeterol) and inhaled steroids that suppress the inflammatory process (e.g., prednisone and Flovent). The number of medications needed depends on the frequency of difficulty breathing and the severity based on lung function tests. Even so, COPD can exacerbate with inadequate treatment or environmental exposures (e.g., pneumonia).
For some patients with COPD, supplemental oxygen from a tank is necessary to maintain adequate blood oxygenation. Pulmonary rehabilitation, which involves exercises and behavioral management, can help optimize one's physical function even with the limitations of COPD. Surgery to remove parts of the lung or transplant a new lung is reserved for selected patients.
Most importantly, smoking cessation can make a big difference. It prevents worsening of COPD in current smokers and new COPD in smokers without this chronic lung disease.
References
- eMedicine - Chronic Obstructive Pulmonary Disease
- Merck Manual - Chronic Obstructive Pulmonary Disease
