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Prepared by:

KOPP,MELANIE P.

SALCEDO,MARK ANTHONY

Submitted to:

MS KAREN ANN MABAO

01 September 2010

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when you breathe in, it becomes trapped, making it difficult and uncomfortable to breathe

out.

Risk factors include exposure to a wide variety of inhaled particles and gases, but in the

Western world, inhaled cigarette smoke is the most important known causative factor. COPD

is more than a pulmonary disorder with a known effect on cardiovascular function and on the

risks of lung cancer, the metabolic syndrome, osteoporosis, and depression. (Information forhealth care professionals and patients with COPD is available on the Web site of the National

Heart, Lung, and Blood Institute, at www.nhlbi.nih.gov/health/public/lung/copd).

There are four stages of COPD, and it is summarized in Table 1.2 below .

COPD Key Points

Patients with COPD die mainly from extra-pulmonary diseases, and COPD-related

mortality is probably underestimated because identifying the precise cause of death is difficult

in elderly patients with this disease, in whom cardiac arrhythmias, ischemia and chronic

pulmonary heart disease (cor pulmonale) or pulmonary embolism, or both could be suspected.

A recent global survey has cited Metro Manila as one of the most polluted cities in the

world, as bad as Mexico City, New Delhi, Shanghai, and other polluted cities in Eastern Europe.

Add to this the fact that half of the entire Filipino male population are smokers and you get a

society that is on the brink of a COPD epidemic.COPD is chronic obstructive pulmonary disease, also known as the "smoker's disease."

It is the fourth major cause of death throughout the world. In the Philippines, it is the seventh

leading killer, while it is third in the U.S.

Medical researchers are projecting that if the trend continues, COPD will become one

of the top diseases causing illness and death in the Philippines by the year 2020. Yet, a lot of

people know little about this dreaded disease because its recognition as a public health

problem has been evolving slowly despite the rising mortality rate.

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Some Worldwide Alarming Statistics

p The World Health Organization (WHO) estimates that COPD as a single cause of deathshares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebro-vascular

disease and acute respiratory infection).

p The WHO estimates that in 2000, 2.74 million people died of COPD worldwide.p In 1990, a study by the World Bank and WHO ranked COPD 12th as a burden of disease;

by 2020, it is estimated that COPD will be ranked 5th.

p According to the WHO, passive smoking carries serious risks, especially for children andthose chronically exposed. The WHO estimates that passive smoking is associated with

a 10 to 43 percent increase in risk of COPD in adults.

p Although cigarette smoking is the primary cause of COPD, the WHO estimates thatthere are 400,000 deaths per year from exposure to biomass fuels.

p In Algeria, the prevalence of tuberculosis and acute respiratory infection has decreasedsince 1965, but an increase in chronic respiratory diseases (asthma and COPD) has been

observed in the last decade.p COPD is estimated to be 6.2 percent in 11 Asian countries surveyed by the Asian Pacific

Society of Respiratory Diseases.

p The use of biomass fuels, especially in the rural areas, contributes towards a higherprevalence of COPD in some of these countries and suggests that COPD may be

significantly greater in this region of the world than previously estimated.

p In China, where it is estimated that over 50 percent of the men smoke, chronicrespiratory diseases are the 4th leading cause of death in large urban areas, but the first

leading cause of death in rural areas.

p In China, smoking rates among women remain low (estimated at 6 percent), althoughthe prevalence of COPD in men and women is about the same. This points to theimportance of risk factors other than smoking as a cause for COPD in Chinese women.

p In Malaysia, respiratory illness is the primary cause of visits to health clinics andoutpatient hospital clinics. It is estimated that 50 percent of the male population

smokes, with higher rates in the rural areas than the urban areas.

PATHOLOGY

The pathological hallmarks of COPD are destruction of the lung parenchyma, which

characterizes emphysema, inflammation of the peripheral airways, which characterizes

bronchitis, and inflammation of the central airways, which characterizes chronic bronchitis.

The functional consequence of these abnormalities is expiratory airflow limitation. Technically,this flow is the result of a driving pressure (elastic recoil of the lung) and of an opposing

resistance (airway obstruction). It is best to refer to the changes in flow seen in smokers as

airflow limitation, rather than airflow obstruction, since both loss of elastic recoil and increase

in airway resistance play an important role in the observed decrease in flow. Emphysema will

contribute to the airflow limitation by reducing the elastic recoil of the lung through

parenchymal destruction, as well as by reducing the elastic load applied to the airways through

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destruction of alveolar attachments. On the other hand, bronchitis will contribute to the

airflow limitation by narrowing and obliterating the lumen and by actively constricting the

airways. The role of symptoms of chronic bronchitis in the development of chronic airflow

limitation is still controversial. In fact, chronic sputum production has traditionally been

considered to be irrelevant to the development of chronic airflow limitation (Turato, Zuin, and

Saetta, 2001).In sum, in the peripheral airways of patients with COPD, there is airflow limitation due

to loss of alveolar attachments, as well as inflammation, fibrosis, and mucus secretion, which

result in the obstruction of airway. The contributions to airflow limitation from this process

vary from individual to individual.

S IGNS AND SYMPTOMS

Smokers often overlook COPD symptoms thinking smokers cough and general

breathlessness are just par for the course the natural side-effects of smoking, or normal

signs of getting older. In many cases, however, they could be the earliest signs of COPD.

Common symptoms of COPD include:

p wet cough, usually accompanied by a lot of phlegmp tightness in the chestp shortness of breath (particularly in cold weather and in the mornings)p wheezing with mild exertions, like climbing stairsp frequent clearing of the throatp chest infections with phlegm becoming yellow or green.

A cough can occur quite a long time before breathlessness occurs. The breathlessness

of COPD can cause panic. Some people describe it as like drowning on land.

DIAGNOSIS AND DIAGNOSTIC TOOLS

If one has any of the symptoms listed earlier, let him seek advice from a health

professional as soon as possible. The condition may not be caused by COPD, so it will need to

be properly assessed by a GP, practice nurse, or occupational health nurse (if the victim works

and has an occupational health service). If COPD is suspected, they will need to check the lung

function using a spirometer, which tests how much puff you have in your lungs.

Practice nurses and occupational health nurses usually carry out the spirometry test,

and all the patient has to do is blow into a machine, which measures the breathing over a

specified time.Spirometry (meaning the measuring of breath), is the most common of the Pulmonary

Function Tests (PFTs), measuring lung function, specifically the measurement of the amount

(volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important

tool used for generating pneumotachographs (lung photos), which are helpful in assessing

conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD.

Aside from spirometry is a chest x-ray. A chest X-ray can show emphysema one of

the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.

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Another is the arterial blood gas analysis. This blood test measures how well your lungs

are bringing oxygen into your blood and removing carbon dioxide.

Next is a sputum examination. Analysis of the cells in your sputum can help identify the

cause of your lung problems and help rule out some lung cancers.

Then the computerized tomography (CT) scan. A CT scan is an X-ray technique that

produces more-detailed images of your internal organs than those produced by conventionalX-rays. A CT scan of your lungs can help detect emphysema and help determine if you might

benefit from surgery for COPD.

Victims are advised not to be shy; smokers sometimes feel guilty or embarrassed about

seeking help for a condition they think they might have brought upon themselves by

smoking, but doctors would much rather they get help early and there is a lot surgery that can

do to help the patient manage the condition.

COPD TREATMENTS

There is no cure for COPD, and one cannot undo the damage to the lungs. But, COPD

treatments can control symptoms, reduce the risk of complications and exacerbations, and

improve ones ability to lead an active life.

Smoking cessation

The most essential step in any treatment plan for smokers with COPD is to stop all

smoking. It is the only way to keep COPD from getting worse, which can eventually result in

losing the patients ability to breathe. But, quitting smoking is never easy. The victim, then, is

advised to talk to the doctor about nicotine replacement products and medications that might

help, as well as how he might handle relapses. It is not known what role exposure to

secondhand smoke plays in COPD, but one should avoid it whenever possible.

Medications

Doctors use several basic groups of medications to treat the symptoms and

complications of COPD. The patient may take some medications on a regular basis and others

as needed:

y Bronchodilators. These medications, which usually come in an inhaler, relax themuscles around the airways. This can help relieve coughing and shortness of breath and

make breathing easier. Depending on the severity of your disease, you may need a

short-acting bronchodilator before activities, a long-acting bronchodilator that you use

every day, or both.

yInhaled steroids. Inhaled corticosteroid medications can reduce airway inflammationand help you breathe better. But prolonged use of these medications can weaken your

bones and increase your risk of high blood pressure, cataracts and diabetes. They're

usually reserved for people with moderate or severe COPD.

y Antibiotics. Respiratory infections, such as acute bronchitis, pneumonia and influenza,can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are

only recommended when necessary.

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Surgery

Surgery is an option for some people with some forms of severe emphysema who aren't

helped sufficiently by medications alone:

y Lung volume reduction surgery. In this surgery, your surgeon removes small wedges ofdamaged lung tissue. This creates extra space in your chest cavity so that the remaining

lung tissue and the diaphragm work more efficiently. The surgery has a number of risks,and long-term results may be no better than for nonsurgical approaches.

y Lung transplant. Single-lung transplantation may be an option for certain people withsevere emphysema who meet specific criteria. Transplantation can improve your ability

to breathe and be active, but it doesn't appear to prolong life and you may have to wait

for a long time to receive a donated organ. So the decision to undergo lung

transplantation is complicated.

Other therapies

Doctors often use these additional therapies for people with moderate or severe COPD:

yOxygen therapy. If there isn't enough oxygen in your blood, you may needsupplemental oxygen. There are several devices to deliver oxygen to your lungs,

including lightweight, portable units that you can take with you to run errands and get

around town. Some people with COPD use oxygen only during activities or while

sleeping. Others use oxygen all the time. Oxygen therapy can improve heart function,

exercise capacity, depression, mental clarity and quality of life. In some people, it may

also extend life. Talk to your doctor about your needs and options.

y Pulmonary rehabilitation program. Comprehensive pulmonary rehabilitation may beable to decrease the length of any hospitalizations you require, increase your ability to

participate in everyday activities and improve your quality of life. These programs

typically combine education, exercise training, nutrition advice and counseling. If you

are referred to a program, you'll probably work with a range of health care

professionals, including physical therapists, respiratory therapists, exercise specialists

and dietitians. These specialists can tailor your rehabilitation program to meet your

needs.

Managing exacerbations

Even with ongoing treatment, one may experience times when symptoms suddenly get

worse. This is called an acute exacerbation, and it may cause lung failure if the patient do not

receive prompt treatment. Exacerbations may be caused by a respiratory infection or a change

in temperature or air pollution. Whatever the cause, it's important to seek prompt medical help

if one notice more coughing, a change in the mucus or if he has a harder time breathing.When exacerbations occur, you may need additional medications, supplemental

oxygen or treatment in the hospital. Once symptoms improve, you'll want to take measures to

prevent future exacerbations. This may include quitting smoking, avoiding indoor and outdoor

pollutants as much as possible, exercise and treatment for GERD.

References:

http://www.nhlbi.nih.gov http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf

http://www.copdinamerica.org/background.html http://gsk.ibreathe.com/ibreathe_pages/3_0_copd/3_1_2_statistics.htm

http://www.hosppract.com/issues/1998/04/dmmferg.htm http://www.lungusa.org/data/lae_02/lae_index02.html