COPD (‘chronic bronchitis’, emphysema) is a common lung disease in which there is irreversible airway obstruction and excess sputum production. Some symptoms are similar to asthma, but the obstruction in asthma is reversible.
COPD is usually progressive – there may be few symptoms in the ‘mild’ stage (shortness of breath on exercise, recurrent chest infections) but as the disease progresses to ‘moderate’ severity (increasing shortness of breath with only moderate exercise, chronic cough and sputum, more severe lung infections) and ‘severe’ COPD ( shortness of breath on minimal exertion, severe restriction of daily activities, chronic cough and sputum production) it becomes very debilitating.
Smoking is the predominant cause of COPD in our society – other medical problems which may also lead to COPD include chronic asthma, bronchiectasis and cystic fibrosis. Environmental exposure to noxious agents can also lead to COPD – historically an almost inevitable occupational hazard for coal miners.
DIAGNOSIS is usually based on a history of smoking or exposure to noxious agents and abnormal lung function testing – FEV1/FVC less than 70% after bronchodilator. Chest xray or CT scan is often performed as well.
The severity of COPD is based on lung function testing :
MILD FEV1 60-80 % of predicted
MODERATE FEV1 40-60 % of predicted
SEVERE FEV1 less than 40 % of predicted
(Comparing calculated ‘Lung Age’ with actual age may be a useful patient guide.)
MANAGEMENT of COPD should be based on:
1 Preventing Deterioration
*All current or ex-smokers over 35 years of age would benefit from lung function testing to identify those with early COPD.
COPD is usually progressive – there may be few symptoms in the ‘mild’ stage (shortness of breath on exercise, recurrent chest infections) but as the disease progresses to ‘moderate’ severity (increasing shortness of breath with only moderate exercise, chronic cough and sputum, more severe lung infections) and ‘severe’ COPD ( shortness of breath on minimal exertion, severe restriction of daily activities, chronic cough and sputum production) it becomes very debilitating.
Smoking is the predominant cause of COPD in our society – other medical problems which may also lead to COPD include chronic asthma, bronchiectasis and cystic fibrosis. Environmental exposure to noxious agents can also lead to COPD – historically an almost inevitable occupational hazard for coal miners.
DIAGNOSIS is usually based on a history of smoking or exposure to noxious agents and abnormal lung function testing – FEV1/FVC less than 70% after bronchodilator. Chest xray or CT scan is often performed as well.
The severity of COPD is based on lung function testing :
MILD FEV1 60-80 % of predicted
MODERATE FEV1 40-60 % of predicted
SEVERE FEV1 less than 40 % of predicted
(Comparing calculated ‘Lung Age’ with actual age may be a useful patient guide.)
MANAGEMENT of COPD should be based on:
1 Preventing Deterioration
- the most important is to CEASE SMOKING. Stopping smoking, in even quite advanced disease, slows the rate of deterioration.
- annual influenza immunisation
- pneumococcal pneumonia immunisation
- use of long term mucolytic medication can reduce flare-ups
- patients with severe disease and low oxygen levels benefit from long term oxygen therapy
- check for sleep apnoea
- active and aggressive treatment of acute flare-ups is important, even in the early stages of the disease
- in Mild COPD inhaled steroids, bronchodilators and antibiotics are useful in flare-ups
- those with Moderate COPD usually require oral steroids for exacerbations
- Pulmonary Rehabilitation programs have been shown to benefit those with moderate or severe disease
- ensuring correct use of inhaler devices is important for maximum benefit
- in general, amoxycillin or doxycycline are preferred antibiotics to macrolides (e.g. roxithromycin erythromycin) because of the bacteria involved in lung infection.
- when oral steroids are required, the usual dose is 30-50mg of prednisolone for 7 to 14 days and then cease
- assessment by a respiratory physician is likely to be of benefit in moderate and severe cases.
- maintaining a healthy weight will improve mobility
- excess alcohol use in those with more severe disease is detrimental
- monitoring and treating osteoporosis – the risk of which is increased by reduced activity and steroid treatment – is important
*All current or ex-smokers over 35 years of age would benefit from lung function testing to identify those with early COPD.
