What Is COPD? by Stephen Trevathan, Achieve Clinical Patient Education

Achieve Clinical Research What Is COPD?

Did you know that COPD is the third leading cause of death in the United States and causes about 25,000 deaths a year in the UK? In fact, according to the World Health Organization (WHO), COPD is the fifth leading cause of death worldwide! Millions of people around the world have been diagnosed with COPD, but perhaps even more frightening is the number of people who have gone undiagnosed. Doctors estimate that there could be millions of people who have this disease, but are not even aware of it. You may be asking yourself, “Exactly how could someone have this disease and not know it?” In order to understand this problem, we need to understand the disease itself.

So, what exactly is this deadly lung disease? In order to fully understand COPD, it is helpful to start out by realizing that this is actually not one single disease. Chronic Obstructive Pulmonary Disease (COPD) refers to a group of lung diseases that start to inhibit a patient’s airflow as they exhale. COPD is primarily made up of three related conditions: emphysema, chronic bronchitis, and chronic asthma.

Over time, these conditions make it increasingly more and more difficult to breathe. As any doctor would note, COPD can be a progressive disease, so it is very important to catch it at an early stage. In fact, this is exactly why this disease can be so deadly. Many patients are not diagnosed until they have reached a more advanced stage of the disease, and any damage to the lungs is irreversible.

Common Symptoms of COPD
There are a number of symptoms that have been associated with COPD. Some people may develop a chronic cough, frequent respiratory infections, and shortness of breath (this is also referred to as dyspnea). In fact, breathlessness, or dyspnea, tends to be one of the biggest red flags for COPD. It will be the major symptom if the patient is predominantly affected by emphysema. Initially, the shortness of breath will be more apparent during physical activity, but as the disease progresses to a more advanced stage, dyspnea can even occur while at rest.

For those COPD patients that have been affected primarily by chronic bronchitis, their major symptoms will be excess sputum production and a chronic cough. One should keep an eye out for sputum that appears to be clear and thick. Patients that experience periodic chest infections should also be wary of purulent (meaning discolored or cloudy) sputum, fever, breathlessness, or wheezing. As the chronic bronchitis starts to get worse, these chest infections will become more frequent.

Symptoms of Advanced Stage COPD
As COPD progresses, the symptoms will become more severe, and hospitalization may be required. Patients could develop morning headaches, which can occur if their body is not able to remove the carbon dioxide from the blood. If the disease has advanced far enough, patients may develop cyanosis (their lips and nail beds may turn bluish) from the overall lack of oxygen in available in the blood.

During the more advanced stages of COPD, the small blood vessels in the lungs are gradually destroyed. As they go, the flow of blood through the patient’s lungs gets blocked, which causes the heart to pump with more force and pressure in order to send blood through the lungs. In some cases, the patient’s heart is not able to cope with the additional strain. This can cause Cor pulmonale, or failure of the right side of the heart, resulting in swollen ankles and feet. Additionally, if the damage done to the inner lining of the airways is bad enough, it can cause some COPD patients to cough up blood. In any case, immediate medical attention should be sought if any of these advanced symptoms are experienced.

What Causes COPD? 

Cigarette Smoke: The number one cause of COPD around the world is smoking. Simply put, smoking causes ninety percent of the COPD cases identified in the United States and at least four out of five people in the UK who develop COPD are or have been smokers. According to current estimates, about fifteen percent of all cigarette smokers will eventually develop COPD. Additionally, the death toll among COPD patients that were (or still are) smokers is much higher than for COPD patients who were not smokers. COPD patients who smoke will experience a much faster rate of deterioration in their lungs. However, doctors have noted that if they quit, their rate of deterioration will slow down to about the same rate as a non-smoker with COPD.

Air Pollution: According to recent studies, in the non-industrialized world, the most common cause of COPD is actually indoor air pollution. Things like indoor stoves, dust, household chemical products, and poor ventilation can all be contributing factors. Outdoor air pollution can trigger the symptoms of COPD; however, it is still unclear whether it contributes to the development of COPD.

Workplace Exposure: Some jobs put people in contact with a variety of occupational pollutants. Over a long period of time, this sustained exposure can increase their risk of COPD. People who work as coal miners, metal workers, construction workers, or cotton workers need to take extra precautions while on the job.

Alpha-1 Antitrypsin (AAT) Deficiency: Despite only accounting for less than one percent of the COPD in the United States, the deficiency of alpha -1 antitrypsin (AAT) has become a well-established cause of COPD. AAT helps to block the damaging effect of elastase (this is an enzyme found in the lungs, which can cause damage to the airways and the alveoli). If a person is AAT deficient, they could develop emphysema by the time they are in their 40’s. Additionally, smoking will actually increase the amount of elastase in the lungs.

Medical Research on COPD
Unfortunately, there is no cure for COPD. However, medical researchers have been making excellent strides forward in recent years. For the better part of the last four decades, clinical research for COPD focused on learning more about the pathogenesis of the disease. This has led to a number of very promising discoveries. In particular, medical researchers have been learning incredible things about the primary cellular pathways which are involved in the development of COPD. Data that supports a number of new and innovative procedures and therapies has been presented, and could prove to be very beneficial for COPD patients all over the world. A comprehensive cure is still far from being discovered, but we can certainly expect to see the development and utilization of more effective diagnostic tests for COPD in the near future.

Stephen Trevathan,
Achieve Clinical Patient Education


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