What is COPD? What is its etiology? According to authors Terry Des Jardins and George G. Burton in the seventh edition of Clinical Manifestations and Assessment of Respiratory Disease COPD, “Is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily cause by cigarette smoking”. (Jardins & Burton 2016) COPD is a combination of two diseases, emphysema and chronic bronchitis.
Chronic bronchitis is defined as, “chronic productive cough for 3 months in each of 2 successive years in a patient whom other causes of a productive cough have been excluded”. (Jardins & Burton 2016) The anatomic alterations of the lungs associated with chronic bronchitis outlined in Clinical Manifestations and Assessment of Respiratory Disease are
• Chronic inflammation and swelling of the peripheral airways
• Excessive mucus production and accumulation
• Partial or total mucus plugging of the airways
• Smooth muscle constriction of bronchial airways (Bronchospasm)
• Air trapping and hyperinflation of alveoli – occasionally in the late stages (Jardins & Burton 2016)
The signs and symptoms associated with chronic bronchitis outlined in Clinical Manifestations and Assessment of Respiratory Disease are
• A stocky, overweight body build
• Diminished respiratory drive
• Hypoventilation
• Cough
• Sputum
• Cyanosis
• Peripheral edema
• Neck vein distention
• Wheeze, crackles, rhonchi
• Congested lung fields
• Polycythemia secondary to hypoxemia
• Infections
• Pulmonary Hypertension
• Cor Pulmonale (Jardins & Burton 2016)
Emphysema is defined as, “presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis”. (Jardins & Burton 2016) The anatomic alterations of the lungs associated with emphysema outlined in Clinical Manifestations and Assessment of Respiratory Disease are
• Permanent enlargement and deterioration of air spaces distal to the terminal bronchioles
• Destruction of pulmonary capillaries
• Weakening of distal airways, primarily in the respiratory bronchioles
• Air trapping and hyperinflation of alveoli (Jardins & Burton 2016)
The signs and symptoms associated with emphysema outlined in Clinical Manifestations and Assessment of Respiratory Disease are
• Thin body build
• Barrel chested
• Hyperinflation & marked dyspnea, often occurs at rest
• Late stage diminished drive & hypoventilation
• Pursed lip breathing
• Use of accessory muscles
• Decreased breath sounds
• Decreased heart sounds
• Prolonged expiration
• Hyper resonance (Jardins & Burton 2016)
Classic signs and symptoms for COPD in anyone over the age of 40 excluding patients with alpha1 antitrypsin deficiency according to Terry Des Jardins and George G. Burton authors of the seventh edition of Clinical Manifestations and Assessment of Respiratory Disease are
• Dyspnea
• Chronic cough
• Chronic sputum production
• History of exposure to risk factors
• Family History of COPD (Jardins & Burton 2016)
The three main diagnostic studies used to diagnose COPD are FVC, FEV1, and FEV1/FVC. Other diagnostic tests include bronchodilator reversibility testing, chest x-ray, ABG, or screening for alpha1 antitrypsin deficiency a genetic abnormality that can lead to COPD. According to the Gold reports for global initiative for COPD pocket guide, “Spirometry is required to make the diagnosis in this clinical context12; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD in patients with appropriate symptoms and significant exposures to noxious stimuli. Spirometry is the most reproducible and objective measurement of airflow limitation. It is a noninvasive and readily available test.”
As said before, “COPD is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.” (Jardins & Burton 2016) If the disease is not reversible but is treatable, how do we treat it? The Clinical Manifestations and Assessment of Respiratory Disease textbook does a great job of illustrating how each anatomic lung alteration can be treated. The different tables and charts in Chapter 9 of the book tell us that excessive bronchial secretions (eg., chronic bronchitis) should be treated with mucolytics, breaking down the mucus, bronchospasm (inflammation of the airways), should be treated with aerosolized medication, and distal airway and alveolar weakening (emphysema), should be treated with breathing exercises, such as pursed lip breathing.