National COPD Awareness Month

November is National COPD Awareness Month

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is a common lung disease where airflow is limited making it difficult for a patient to breathe. COPD is chronic, irreversible, and worsens over time. Currently, there is no cure available but it is preventable and the symptoms are treatable.

How common is COPD in the US?

According to the Centers for Disease Control and Prevention (CDC), COPD is the 3rd leading cause of death in the United States. It is estimated that more than 12 million Americans are affected by COPD. In the past it was more common in men; however, since 2000, women have exceeded men in the number of deaths caused by COPD. According to the US Department of Health and Human Services, in 2010, COPD cost the nation $49.9 billion in direct and non-direct medical costs.

What is the difference between chronic bronchitis and emphysema?

COPD refers to two lung conditions, chronic bronchitis and emphysema. Chronic bronchitis and emphysema may both be present in a patient.

Chronic Bronchitis	Emphysema
§  Inflammation of the airways occurs and leads to scarring of the bronchial tubes in the lungs §  Mucus-producing cough is present that  occurs consistently for 3 months at a time for at least 3 months out of a year and seen in 2 consecutive years §  It is typically diagnosed when other causes of lung dysfunction have been excluded	§  Caused by damage to the alveoli (air sacs) in the lungs §  Results in destruction to the walls of the alveoli §  Destruction leads to a reduction in gas exchange in the lungs

What are the most common risk factors for developing COPD?

Major risk factors for COPD include cigarette smoking, air pollution, occupational exposures (dust or chemicals), or genetic disorders. Cigarette smoking is the most common cause of COPD. According to US Department of Health and Human Services, cigarette smoking accounts for 75% of deaths caused by COPD. A genetic disorder, α1-antitrypsin deficiency, may decline a patient’s lung function leading to increased risk of developing COPD.  Patients with α1-antitrypsin deficiency lack a protein that protects damage to the lungs. Overall, most risk factors may be modified and can be avoided, which will reduce the risk of developing COPD.

What are the signs and symptoms of COPD?

Various signs and symptoms are characteristic of COPD and may help distinguish the severity of the disease.  Typical symptoms include cough (with or without sputum), shortness of breath, and wheezing. On physical exam, certain signs are present but may not be seen until later in the disease or in more severe cases. Signs include cyanosis of mucosal membrane (bluish discoloration due to lack of oxygen), barrel-shape chest (deformity of chest wall) due to excess air trapped inside the lungs, increased respiratory rate and shallow breathing, and changes in normal breathing such as pursed (puckered) lips or use of accessory respiratory muscles. Patients may need to stand in a “tripod” position with their hands placed on their knees bending forward in order to breathe more effectively.

How is COPD diagnosed?

Several factors aid help to diagnose COPD. These factors include the patient’s age (> 40 years), constant and worsening shortness of breath, chronic cough with production of sputum, decline in normal activity, and being positive for risk factors of COPD. Typically, when COPD is suspected a patient will undergo spirometry testing. Spirometry is a common pulmonary function test, which measures a person’s breathing. Spirometry assesses a patient’s lung capacity and volume. It is typically done to confirm the presence of airflow limitation and it is very useful in determining a patient’s disease severity.

How do you treat COPD?

The goals of treatment include relieving symptoms, slowing disease progression, prevention and treatment of any complications or exacerbations, improvement of normal activity, and improvement of overall health status. However, since no cure exists, the major focus should be prevention.

·      Lifestyle Changes: Smoking cessation (quit smoking) is the most important step to take in order to prevent and slow the progress of COPD. Smoking cessation is the only confirmed intervention that has been proven to affect long-term decline in lung function. If you or someone you know is having trouble quitting, ask your local pharmacist about treatments available to help quit. Also, if possible, avoid any lung irritants such as air pollution, dusts, or chemicals because they are risk factors for developing COPD.

·      Pulmonary Rehabilitation: This is a wellness program that aims at improving a person’s overall health status. The program includes exercise training, behavioral modifications, nutritional and disease management education, and emotional support. It is a supervised program typically 3 days per week for a total of 6 to 12 weeks.

·      Oxygen Therapy: This may be an option for patients who have severe COPD and low levels of oxygen. Oxygen therapy has been shown to increase the ability to perform daily activities and exercise, improve quality of life, and increase survival. Oxygen is administered nasally typically through prongs or masks and given for > 15 hours per day.

·      Immunizations: The CDC recommends patients with COPD receive an annual influenza vaccine due to serious complications that may occur with the flu in a patient with COPD. Because patients with COPD are at an increased risk of pneumonia, it is also recommended for patients ages 2 to 64 years with a chronic lung disease to receive the pneumococcal vaccine once. In patients > 65 years, a second vaccination is recommended if it has been longer than 5 years since receiving the pneumococcal vaccine.  

Drug Therapy

Bronchodilators: used to relax and enlarge the airways, making breathing easier.

Typically, patients will begin treatment with a short-acting bronchodilator as needed; however, if the disease worsens patients may need a long-acting bronchodilator daily. Short-acting bronchodilators (e.g. albuterol, ipratropium) are only used for immediate relief of symptoms when needed. Short-acting bronchodilators begin working within 5 minutes and work for about 4 to 6 hours. Long-acting bronchodilators (e.g. salmeterol, formoterol, tiotropium) are used when short-acting agents do not provide enough relief and patients experience symptoms on a regular basis. Long-acting bronchodilators work for about 12 hours and are typically given twice a day. Both classes of bronchodilators are given by inhalation using an inhaler. Generally, they are well tolerated with minimal side effects.

Inhaled glucocorticoids (Steroids): used to help reduce inflammation in the airways.

Inhaled glucocorticoids (e.g. fluticasone, budesonide) are never used alone but are combined with bronchodilators; therefore, patients who begin taking a glucocorticosteroid must also be taking a bronchodilator. They are typically given to patients when symptoms or severity of disease worsens. Inhaled glucocorticoids may be limited to short-term therapy because they are associated with more side effects, such as headache, hoarseness, sore throat, and oral candidiasis (mouth infection).

What is the prognosis of COPD?

COPD prognosis is poor if symptoms are left untreated and patients do not make the necessary lifestyle changes such as smoking cessation. Decline in lung function may lead to disease progression, poor quality of life, and possible disability and death. The primary causes of death due to COPD are respiratory failure, cardiovascular events or diseases, and lung cancer. It is important to make lifestyle changes, stay up-to-date on immunizations, and adhere to medications in order to prevent and reduce any complications.

Where can I find more information?

Several resources are available that will provide patients with useful information about COPD. You may also discuss any questions or concerns about COPD with your local pharmacists.

American Lung Association

www.lung.org

Global Initiative for Chronic Obstructive Pulmonary Disease

www.goldcopd.org

National Heart Blood and Lung Institute

http://www.nhlbi.nih.gov/health/public/lung/index.htm#copd

World Health Organization

http://www.who.int/topics/chronic_obstructive_pulmonary_disease/en/

Written by:

Michelle Dudek, PharmD Candidate, 2013

Chicago State University

References:

1.            Chronic Obstructive Pulmonary Disease. National Heart, Lung, and Blood Institute.  http://www.nhlbi.nih.gov/health/health-topics/topics/copd/treatment.html; Updated June 2012. Accessed September 13, 2012.

2.            Chronic Obstructive Pulmonary Disease. American Lung Association. http://www.lung.org/lung-disease/copd/. Accessed September 12, 2012

3.            Chronic Obstructive Pulmonary Disease. Centers for Disease Control and Prevention. http://www.cdc.gov/copd/; updated March 2012. Accessed September 13, 2012.

4.            Williams DM, Bourdet SV. Chapter 34. Chronic Obstructive Pulmonary Disease. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7975888. Accessed September 13, 2012.