Cardiovascular and Thoracic Surgery

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Chronic Obstructive Pulmonary Disease (COPD)

About COPD

COPD is one of the most common lung diseases and the third leading cause of death in the United States. Nearly 12 million people are diagnosed with COPD and an additional 12 million are likely to have the disease but don't know it. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus; and Emphysema which occurs in the air sacs (alveoli) at the end of the smallest air passages in the lungs are gradually destroyed. Symptoms typically appear in men and women over age 40 (especially with a history of smoking) and include shortness of breath, cough, sputum (mucus) production, or an unusual decline in activity level.


  • Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe, cigar and marijuana smokers and people exposed to large amounts of secondhand smoke also are at risk; however, as many as 1 out of 6 people with COPD have never smoked..
  • People with asthma who smoke. The combination of asthma and smoking increases the risk of COPD.
  • Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
  • Age. COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin.
  • Genetics. An uncommon genetic disorder known as alpha-1-antitrypsin deficiency is the source of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

If any of the following indicators are present and you are over age 40, your docotor may recommend testing for COPD. These indicators are not diagnostic themselves, but the presence of multple key indicators increases the probability of a diagnosis of COPD.

  • Dyspnea (shortness of breath) that is:
    • Progressive (worsens over time)
    • Usually worse with exercise
    • Persistent (present every day)
    • Described by the patient as an "increased effort to breathe," "heaviness," "air hunger," or "gasping"
  • Chronic cough:
    • May be intermittent and may be unproductive
  • Chronic sputum (mucus) production:
    • Any pattern of chronic sputum production may indicate COPD
  • History of exposure to risk factors (listed above)

Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests.Tests used to diagnose COPD include simple, non-invasive, “breathe into a machine” tactics, performed by pulmononigist and are ordered by your primary care physician to determine cause of shortness of breath.

Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests.


STAGES of COPD:

Stage I: Mild COPD - mild airflow limitation and sometimes, but not always, chronic cough and sputum production. At this stage, the individual may not be aware that his or her lung function is abnormal.

Stage II: Moderate COPD - worsening airflow limitation with shortness of breath, typicall developing on exertion. This is the stage at which patients typically seek medical attnetion because of chronic respiratory symptoms or an exacerbation of their disease.

Stage III: Severe COPD - further worsening of airflow limitation, greater shorness of breath, reduced exercise capacity and repeated exacerbations which have an impact on the patient's quality of life.

Stage IV: Very Severe COPD - severe airflow limitation plus chronic respiratory failure.

For all stages of disease, effective therapy is available which can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. COPD is a disease that progresses slowly, and early detection is key. Once symptoms are identified and a diagnosis is made, providers must monitor and follow up with the patient on a regular basis to be sure that treatment is appropriate for the level of disease severity.

Smoking cessation
The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse — which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. It's also a good idea to avoid secondhand smoke exposure whenever possible.

Medications
Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

  • Bronchodilators. These medications — which usually come in an inhaler — relax the muscles around your 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.
  • Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD.
  • Combination inhalers. Some medications combine bronchodilators and inhaled steroids.
  • Oral steroids. For people who have a moderate or severe acute exacerbation, oral steroids prevent further worsening of COPD. However, these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.
  • Phosphodiesterase-4 inhibitors. A new type of medication approved for people with severe COPD is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss.
  • Theophylline. This very inexpensive medication helps improve breathing and prevents exacerbations. Side effects may include nausea, fast heartbeat and tremor.
  • Antibiotics. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help fight acute exacerbations. The antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties.

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

  • Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental 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 quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options.
  • Pulmonary rehabilitation program. These programs typically combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program.

Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone:

  • Bullectomy may be offered for patients with damaged air sacs (alveoli) in the lung. When these air sacs break down, larger airspaces known as bullae are formed. Bullae sometimes can become so large that they interfere with breathing and may cause complications, including bursting, which can lead to a collapsed lung (pneumothorax). Or an abscess in the lung that can spread to the pleural cavity (the space between the lung and the membrane that surrounds it). This condition (empyema) can be difficult to resolve and often requires extensive treatment with antibiotics. Few people are considered good candidates for a bullectomy.
  • Lung volume reduction surgery (LVRS). In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently. In some people, this surgery can improve quality of life and prolong survival. Minimally-invasive surgery for this procedure results in earlier recovery time, and the results of the minimally-invasive procedure can be long-lasting.