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Chronic Obstructive Pulmonary Disease (COPD)
Introduction
Chronic Obstructive Pulmonary Disease (COPD) has emerged to be of great public health concern. COPD refers to a progressive lung disease that includes emphysema, refractory asthma, chronic bronchitis, and certain types of bronchiectasis. The disease is characterized by heterogeneous physiologic abnormalities that cannot be adequately represented by simple spirometry. Although increased breathlessness is the most common symptoms of COPD, it is often confused as a normal part of aging by many people (McCarthy et al. 3-4). The symptoms of the disease may be unnoticeable in the early stages of the disease. The disease can develop for years without the shortness of breath being noticed. Symptoms become more apparent in the advanced stages of the condition. The signs and symptoms of COPD include tightness of the chest, increased breathlessness, frequent coughing, and wheezing. It has been approximated that the disease affects about 30 million people in the United States of which more than half are not aware that they have symptoms of COPD (O’Donnell et al. 52). The risk factors associated with the development of the condition include environmental factors, smoking, and genetic factors.
COPD occurs due to chronic airflow limitation. The disease is considered to be heterogeneous, and a multi-component condition with a high degree of complexity. The severity of the disease can be exuberated in the presence of comorbidities like anemia, cardiovascular disease, diabetes, depression, and osteoporosis. Comorbidities affect functional performance, symptom burden, the health status of COPD patients, as well as the risk of hospitalization and mortality (Ford 990). Research studies examining the impact of other chronic conditions on COPD often use self-reported data which is associated with limited internal validity. The true prevalence of comorbidities may be underestimated due to the reliance on self-reported data. The extent to which other chronic conditions cluster in COPD largely remains unknown (Divo et al. 5-8). Few research studies examining the impact of different comorbidity profiles on disease severity, relevant clinical outcomes, and pharmacologic treatment have been done. COPD and comorbidities may be contributing to persistent low-grade systemic inflammation. Increased risk of comorbidities has been associated with elevated inflammatory markers. Chronic inflammation contributes to the development of comorbidities and systemic inflammation in COPD.
Case definition
COPD refers to a lung disease that occurs due to the chronic obstruction of airflow in the lungs thereby interfering with the normal breathing, and is irreversible. It has emerged to be a life-threatening disease that is highly under-diagnosed. The main risk factor of the diseases is smoking. A spirometry test can diagnose COPD. The test is crucial in measuring the depth of breathing and the rate at which air moves in and out of the lungs (O’Donnell et al. 55). The diagnostic test is recommended for patients who have symptoms of dyspnea, cough, production of sputum, and history of being exposed to the risk factor of the disease. Available tools can be used in the diagnosis of COPD incase spirometry is unavailable. The condition can also be diagnosed on the basis of clinical symptoms and signs such as increased forced expiratory symptoms and abnormal shortness of breath. Although low peak flow tends to be consistent with COPD, it may not be specific to the disease since it can also result from other diseases of the lungs or poor performance of a test. The development of airflow limitation is often preceded by a chronic cough and the production of sputum by many years (Huang et al. 2815). It is essential to note that not everybody with a cough and sputum production ends up developing COPD.
The main subtypes of COPD include chronic obstructive asthma, emphysema, and chronic bronchitis. The interrelationships between the subtypes causing airflow limitation are vital in providing a foundation for a concrete understanding of the spectrum of patient presentations. COPD patients tend to react differently to treatment and prognoses (Ford 994). It remains unclear whether the features of the disease reflect its severity. Evaluating these features is considered vital in clinical management, and classifying patients. Understanding the spectrum of COPD manifestation is useful in the diagnosis of the disease. The interrelationships among emphysema, asthma and chronic bronchitis are essential in the case definition of COPD (McCarthy et al. 7-9). Asthma patients experiencing a completely reversible airflow obstruction are not considered to have COPD while those whose airflow obstructions does not completely remit are said to have the disease, and they tend to have different pathogenesis and etiology as compared to the patients with emphysema and chronic bronchitis. Although emphysema and chronic bronchitis with airflow obstruction often occur together, some patients may also have asthma. Chronic productive cough may develop in patients with asthma spontaneously or due exposure to allergen or cigarette smoke. Unless they have airflow obstruction, individuals with emphysema, chronic bronchitis or both are not considered COPD patients. Individuals whose airflow obstruction is due to known etiology or specific pathologies such as obliterative bronchitis cystic fibrosis and bronchiectasis are usually excluded from the COPD case definition ((Huang et al. 2818-2820).
Descriptive epidemiology
According to Diaz-Guzman, Enrique, and David (2014), studies indicate that 8-10% of adult populations from various nations have COPD, and the main risk factor is cigarette smoking. Although tobacco smoking largely remains to be the risk factor associated with the development of the diseases in the developed world, other risk factors also contribute to the condition. Data from recent studies indicate the COPD burden is one decrease in certain parts of the world. Environmental and occupational exposure plays a key role in the development and progression of the disease, especially in the developing nations. COPD constitutes a great burden in terms of morbidity and mortality globally. Approximately 3 million lives are lost annually due to COPD (Diaz-Guzman, Enrique, and David 7-8). The disease has emerged to be the fourth leading cause of death globally. In the last two decades, deaths associated with cardiovascular disease has been decreasing trend, while COPD associated mortality has almost doubled. Over 15 million people in the U.S. and more than 210 million individuals globally are affected by the disease. According to the WHO, the disease is likely to become the third most leading cause of death globally by 2030. Prevalence estimates indicate that about a quarter of adults within the age of 40 years and over have airflow obstruction (O’Donnell et al. 59-60). Increased efforts have been taken with the aim of measuring the epidemiology of COPD due to the increasing prevalence of the disease.
Ospina et al. (2015) assert that the global prevalence estimate of COPD lies within the range of 5%-10% while the incidence varies between 2-6 cases per 1000 person-years based on the study population and case definition (Ospina et al. 1-2). Soriano and Samy (2016) attribute the increases cases of COPD to the big proportion of the aging population and tobacco exposure. Recent updates by the Global Burden of Disease indicate 328 million people are affected by COPD globally. Although airflow obstruction and COPD prevalence are associated with smoking, poverty largely contributes to the COPD mortality and vital capacity (Soriano and Samy 380).
COPD commonly occurs in the elderly. 25% of individuals who are 75 years old and over are affected by the disease (Soriano and Samy 381). The progression of the condition in the elderly tends to be complicated in the elderly due to co-morbid conditions. Drug-drug interactions further complicate the management of COPD. Intermittent worsening of symptoms is one of the key features of the disease. Research findings indicate that more than half of the acute exacerbations of COPD are caused by bacteria. There are several bacteria that cause exacerbations of COPD. They include Chlamydia pneumonia, non-typeable Haemophilus influenza, Streptococcus pneumonia, and Moraxella catarrhalis. The severity of exacerbation can be considered on the basis of three cardinal symptoms that include dyspnoea, sputum prevalence, and increased volume of sputum. Antibacterial therapy can be beneficial to patients with moderate and severe COPD. The rational choice of an antibacterial agent has to consider the underlying host factors. Three main considerations determine whether a patient has simple or complicated COPD. They include the presence of comorbid conditions, exacerbation frequency, and underlying lung disease (McCarthy et al. 11-13).
Risk factors
Tobacco smoking is considered to be the major risk factor for COPD. Other factors that may contribute to the development of the disease include indoor pollution; occupational dust and chemicals like fumes, vapors, and irritants; outdoor pollution; and frequent infection of the lower respiratory tract during childhood (Aghapour et al. 1-2). Approximately 75% of individuals with COPD smoke or used to smoke. Genetics also play a role in the development of the disease since individuals from families with COPD history are more likely to develop the condition if they are exposed to lung irritants such as tobacco smoke (Vestbo et al. 346-348). Research findings indicate that long-term exposure to lung irritants such as passive smoking, air pollution, dust and chemical fumes in workplaces and air pollution contribute to the development of COPD. Age is another risk factor that contributes to the disease burden. The condition is common in the elderly population. Symptoms begin in individuals of at least 40 years old. It is possible but rare for people who less than 40 years old to have COPD (Ospina et al. 3). A younger person may have the disease due to predisposing health issue like genetic condition that leads to alpha-1 antitrypsin deficiency.
Public health prevention
Public health programs have been established with the aim of preventing COPD. The disease can be prevented through the reduction or elimination of smoking initiation among teenagers and young adults, as well as encouraging current smokers to stop smoking. It is critical to enforce public health programs and policies that focus on the reduction of indoor and outdoor air pollution, prevention and cessation of tobacco use, and the reduction of occupational exposure to chemicals and dust. The development of COPD may also be prevented by early treatment and control of asthma (O’Donnell et al. 60).
Although the disease is treatable and preventable, the global epidemic of smoking contributes to the continuous rise in its prevalence. Enormous healthcare costs go into treatment and management of COPD. Systemic effects and common co-morbid conditions like osteoporosis, cardiovascular disease, and muscle wasting may be linked via a common inflammatory cascade. Malnutrition, depression, and anxiety tend to be common among the elderly COPD patients. These factors affect compliance with therapy and the quality of life. Malnutrition is considered to be an independent predictor of poor outcome and mortality. COPD is diagnosed using spirometry (Diaz-Guzman, Enrique, and David 10). Over-diagnosis is possible due to the lack of clarity on criteria of defining airflow limitation in elderly patients. The disease may also be under-diagnosed in patients since they perceive their symptoms differently. Acute exacerbations can worsen the symptoms necessitating the need for additional treatment. It may also contribute to quality of life and lung function. A multidisciplinary approach should be employed in managing elderly patients with COPD. Evidence-based practices indicate that it is important to assess the nutritional and mental status of patients. The assessment of functional impairment and lung function is also important. Several treatment options have been proposed for patients with COPD. They include lifestyle changes such smoking cessation; management of complications; physical activity training; oxygen supplementation; medications such as anti-inflammatory agents, bronchodilators, and inhaled steroids; and surgery (Vestbo et al. 363-365).
Treatment and management of the disease should begin immediately after successful diagnosis. The goals of treating and managing COPD include preventing exacerbations, disease progression, and complications; improving health status, exercise tolerance and daily activity; relieving symptoms; reducing premature mortality; and monitoring nutritional needs. Management focuses on smoking cessation and abstinence; limiting exposure to lung irritants such as gases, fumes, dust and secondhand smoke; surgery; supplemental oxygen therapy; pulmonary rehabilitation; pharmacological intervention using corticosteroids and bronchodilators; and collaborative self-management (Vestbo et al. 364). The promotion of treatment modalities targeting COPD patients and individuals at risk of developing the disease can be done through patient and professional education. Enhancing public health education on COPD in the future can assist in its elimination.