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Chronic Obstructive Pulmonary Disease

  • Tilluckdharry

For the Monitor
Published: 2/8/2021 10:16:53 AM

What is Chronic Obstructive Pulmonary Disease (COPD)?

COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. It is a progressive and systemic disease that causes significant impacts to a person’s quality of life robbing that person of energy, ease of breathing, and even shortening their life span.

Chronic bronchitis and emphysema are two common presentations of COPD. Symptoms include difficulty breathing, daily cough, and increased sputum or mucous production.

Who is at risk for developing COPD? What causes COPD?

Tobacco smoke remains the top cause of COPD. It is responsible for 80% of the cases. Besides smoking cigarettes and cigars, use of recreational drugs, such as cocaine and heroin can lead to emphysema.

Smoke from the burning of biomass fuels, such as wood, time spent cooking in poorly ventilated kitchens, occupational exposure to dust, smoke or fumes, poorly treated asthma, and air pollution all increased a person’s risk for developing COPD.

While we are not yet sure that vaping causes COPD, we have evidence to suggest that it can worsen the disease.

We have learned that women are more genetically susceptible to developing COPD and also present differently from men, which can lead to delayed diagnosis.

How is COPD more than just a lung disease?

The systemic effects of COPD can arise over decades. In fact, people are usually two decades into the disease process once a diagnosis is received. Some examples of these systemic effects include dramatic weight loss and muscle weakness; systemic inflammation predisposing patients to various infections; and the development of lung cancer, coronary artery disease, hypertension, metabolic syndrome, osteoporosis, stomach ulceration, and depression.

What can I do to manage my COPD?

COPD is treatable and with proper management people can achieve good symptom control, slow progression, and can reduce the chance of developing complications.

The most important recommendation remains absolute smoking cessation, which is very complicated and recognized as more than just battling a nicotine addiction. As we age, we lose 20-30 ml of our lung function per year; however, a smoker can lose 50-100 ml/year, with any respiratory tract infections potentially accelerating that decline further.

Other key management recommendations include keeping all vaccines up-to-date, getting the COVID-19 vaccine, avoiding sick contacts, ventilating homes better (focusing on kitchens and areas with wood burning furnaces), using OSHA approved personal protective equipment (PPE) as directed, minimizing dust exposure, limiting exposures that worsen symptoms, and monitoring the air quality in the environs at des.nh.gov/home-and-recreation/air-quality.

What does COPD treatment involve?

Management is individualized and often requires a multidisciplinary and personalized approach based on medical history, symptoms, lung function, and frequency and severity of prior exacerbations.

Supportive management should include patient education about the disease and optimal inhaler use, creation of an at-home COPD action plan, and monitoring of symptoms.

Treatment includes a combination of pharmacologic agents, pulmonary rehabilitation and for a subset of patients with emphysema of a certain pattern, bronchoscopic or surgical lung volume reduction procedures.

There are endobronchial valves which can be placed in the airways to reduce hyperinflation and allow patients to breathe more comfortably. Pharmacologic therapy involves medications from a number of categories; ones which open the airways, ones which reduce inflammation, ones which treat infection and those which help with mucus clearance.

The best COPD management involves a coordinated, multidisciplinary approach to care; one that places the patient at the center of the informed decision making, anticipates and addresses problems and works with the individual to achieve their personal best.

Dr. Lisa Tilluckdharry of Concord Hospital Pulmonary and Critical Care Medicine is board-certified physician in internal, pulmonary, and critical care medicine. Dr. Tilluckdharry presented on COPD at the December Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Tilluckdharry’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.



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