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Chronic Obstructive Pulmonary Disease

Introduction and epidemiology

Respiratory disease ranks as the most common cause of medical consultation and the fourth leading cause of hospital admission. COPD is a condition characterised by persistent airflow obstruction which is slowly progressive. It can also present with features of airway hyper reactivity.

It is a common cause in the community associated mainly with cigarette smoking. More common in men than women and increases with age. It is a progressive disease with high morbidity and mortality.

What are the signs and symptoms of COPD?

The signs and symptoms of COPD depend on the severity :

  • Shortness of breath at moderate activity or even at rest
  • Productive cough for long period of time
  • Prolonged phase of exhaling air by lung and wheezing (noisy breathing during exhaling) in moderate condition
  • Feature of respiratory failure and enlargement of heart with fluid retention in the lung and lower part of body in late stage.

What are the risk factors of COPD?

Risk factors :

  • Cigarette smoking – the most common cause, the greater number of cigarettes the higher is the risk
  • Passive smoking
  • Air pollution
  • Viral infection leading to airway hyper reactivity
  • Work in quarry and exposure to dust
  • Genetic factor – Alpha 1 – antitrypsin deficiency

Aim of treatment in COPD

The aims of management of COPD are to :

  • Improve quality of life- no breathlessness.
  • Reduce further damage to the lung.
  • Prevent and treat complications of heart failure.
  • Prolong survival.
  • Reduce the number of hospitalisation due to attacks of breathlessness.

Treatment available for COPD are :

Education

  • Stop smoking because it is an essential step in preventing further damage to the lung.
  • Even a heavy smoker for many years shows improved survival rate following smoking cessation.

Drug treatment

  • Drugs that relax bronchial smooth muscles and relieve bronchospasm available in inhalation form such as ipatropium bromide, salbutamol and terbutaline. Advantages of inholed therapy include direct delivery to the site, rapid onset of action and fewer systemic side effects. Oral preparartions available like Neulin SR, Theudor and Euphylline.
  • Costicosteroids in the form of inhalants, tablets and injections. Corticosteroids are beneficial during acute attack. Becotide, Beclofort and Beclomet are example of sinhaled costicosteroid.
  • Antibiotics- Broad spectrum antibiotics are usually used.
  • Mucolytic agent to make sputum less viscous and easily produced. Cough suppressants are undesirable for treatment.

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Last reviewed : 26 April 2012
Writer : Dr. A. Khalek Abd Rahman
Reviewed : Dr. Norhaya Mohd Razali

 

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