Chronic Obstructive Lung Disease
Chronic Obstructive Pulmonary Disease (COPD) is a general
category that points to an increasing population of aging patients who have
chronic cough and trouble breathing. I recall as an intern at the Toronto General hospital my month’s
assignment to the respiratory ward which housed about 20 patients, all men older
than 60, all smokers who had chronic lung disease. The coughed all day and night and their sputum was
collected every morning. They all received oxygen by nasal catheter which they
removed to leave the ward for a cigarette break out in the hall. The futility of
the hospital experience was obvious.
Chronic obstructive pulmonary disease (COPD) is estimated
to affect 32 million persons in the United States and is the third leading cause
of death. COPD is obstruction to air flow in the lungs that is not reversible.
The air flow obstruction is usually progressive and associated with an
inflammatory response of the lungs to inhaled particles or gases. The term COPD
includes other diagnoses such as chronic bronchitis, asthma and emphysema. Heavy
smokers develop COPD even after they quit smoking. Symptoms develop after age 40
in people who have smoked a pack a day for 10 years or more. The single most
important preventive measure for COPD is not to smoke at any age in any amount.
COPD also develops in family members of smokers and in people exposed to heavy
doses of air pollution.
Chronic bronchitis is low grade inflammation of the tubes
in the lung associated with increased mucous production and cough that is
productive of sputum. The term “chronic” refer to duration of more than two
years. Chronic bronchitis occurs in 85% of COPD patients, but many patients have
chronic bronchitis commonly without airway obstruction.
Emphysema refers to
damaged alveoli that lose their elasticity and fail to empty during expiration. Air remains in these air sacks and
gradually the lungs become rigid and hyperinflated. Early in the process,
reduced air exchange is felt as shortness of breath with exertion. Smokers are
the most obvious group who accumulate lung damage over many years and eventually
are disabled. Smoking cessation is essential to reduce the progression of COPD.
Increased mucous production is a defensive mechanism in the
branching tubes of the airway. The mucous also provides food and shelter for
invading pathogens and may contribute to airway obstruction. Sputum is mucous that is coughed up and collected for analysis. Sputum
samples may contain numerous microorganisms, fungal spores, pollens, other
particles and chemicals there were inhaled. Air pollution is obviously not
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