What is COPD?
COPD (Chronic Obstructive Pulmonary Disease) is defined as generally irreversible progressive chronic airflow obstruction. COPD is the 4th leading cause of death in the US. Some 14 million patients, 20% of adults, in the US have been diagnosed with one of the two subclassifications of COPD, chronic bronchitis or emphysema.
First aiders should be aware of COPD due to its increasing prevalence globally.
Risk factors include smoking and exposure to smoke, occupational pollutants, family history, recurrent respiratory infections, and protease deficiencies. However, smoking is responsible for 80-90% of COPD cases. Prevalence, incidence and mortality rates increase with age.
Chronic bronchitis is characterized by a productive cough, mucus overproduction, and inflammation of the bronchial tubes lasting 3 months or more in 2 consecutive years. Patients are usually diagnosed in their 30’s and 40’s. The overwhelming indicative factor is a history of smoking. Other sources of environmental pollution can cause chronic bronchitis as well. For more information, see e-Bronchitis.org.
Emphysema is characterized by alveolar distention and destruction due to the destruction of elastic fibers by elastase from white blood cells (neutrophils). Naturally occurring antitrypsin in the lung can be inactivated by oxygen radicals derived from cigarette smoke. Antitrypsin is a serine protease inhibitor and therefore a protectant against damage to elastic fibers in connective tissues.
Weight loss, dyspnea, hypoxia, tachypnea are symptoms of emphysema. Physical examination and history will suggest the possibility of COPD. Chest x-rays and pulmonary function tests help to confirm the diagnosis and exclude other possibilities such as tuberculosis or cancer. Treatments include lung reduction surgery, smoking cessation, and lung transplant. Symptomatic therapy is aimed as reducing bronchoconstriction and inflammation. Bronchdilators, anticholinergics, theophylline, corticosteroids, and antibiotics may be prescribed. Oxygen therapy and pulmonary rehabilitation are helpful in many patients. Influenza vaccine should be given yearly and the pneumococcal vaccine should be given once and again six years later.
Preventative measures include smoking cessation, pulmonary rehabilitation, exercise, influenza vaccine, pneumococcal vaccine, nutritional supplementation.