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.
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Chronic Bronchitis
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Emphysema
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Inflammation of the airways occurs and leads
to scarring of the bronchial tubes in the lungs
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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
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It is typically diagnosed when other causes of
lung dysfunction have been excluded
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Caused by damage to the alveoli (air sacs) in
the lungs
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Results in destruction to the walls of the
alveoli
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Destruction leads to a reduction in gas
exchange in the lungs
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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.
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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.
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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.
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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.
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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.
