Introduction
Chronic obstructive pulmonary disease (COPD) is a disease of the lungs which is characterized by the narrowing of the airways. The narrowing of the airway leads to the limitation and reduced flow of air to the lungs and from the lungs hence causing shortness in breath. It affects the inflow and the outflow of air the lungs. COPD is more like Asthma but in contrast to Asthma the chronic obstruction (the limitation in the airflow) is not fully reversible and it gets worse gradually over time, while Asthma with good timely diagnosis is completely reversible in most people either spontaneously or with adequate treated.(Petty 1985)
Chronic obstruction pulmonary disease (COPD) leads to chronic airflow obstruction, this is defined as persistent decrease in the rate of airflow from the lungs when the person breathes out (exhales). This airflow obstruction is partially reversible in most people, either spontaneously or with treatment. The diagnosis of COPD includes chronic obstructive bronchitis and emphysema, which are experienced by many people. Chronic bronchitis is defined as cough that produces sputum repeatedly during two successive years. When this chronic bronchitis involves airflow obstruction, it qualifies as chronic obstructive bronchitis. Emphysema is defined as widespread and irreversible destruction of the alveolar walls (the cells that support the air sacs, or alveoli, that make up the lungs) and enlargement of many of the alveoli. (Warrel and Etal 2003)
Warrel and Etal further explains that the small airways (bronchioles) of the lungs contain smooth muscles and are normally held open by their attachments to alveolar walls. This is normally being affected by two conditions that are emphysema and chronic bronchitis. (Nguyen and Carrieri 2005) In emphysema, the destruction of alveolar wall attachments results in collapse of the bronchioles, causing permanent airflow obstruction. In chronic bronchitis, the glands lining the larger airways (bronchi) of the lungs enlarge and increase their secretion of mucus. Inflammation of the bronchioles develops and causes smooth muscle to contract (spasm), causing further obstructing of airflow. Inflammation also causes airflow to be blocked by secretions. (Nguyen and Carrieri 2005)
During infection it the inflow of air in the lungs it leads to the decrease in oxygen flow in the blood which as a result stimulates the red bone marrow to send more blood cells into the bloodstream, this condition is medically known as secondary polycythemia. The decrease in oxygen levels in the bloodstream also increases the pressure in the artery through which blood flows from the heart to the lungs (pulmonary artery). Because of this increased pressure, pulmonary hypertension and cor pulmonale can occur. People with COPD also have an increased risk of developing heart rhythm abnormalities (arrhythmias).( Warrel and Etal 2003)
The airflow obstruction of COPD causes air to become trapped in the lungs after a full exhalation, increasing the effort required to breathe. Also in COPD, the number of capillaries in the walls of the alveoli decreases. These abnormalities impair the exchange of oxygen and carbon dioxide between the alveoli and the blood. In the earlier stages of COPD, oxygen levels in the blood may be decreased, but carbon dioxide levels remain normal. In the later stages, carbon dioxide levels increase and oxygen levels fall.(Hough 2006)
The disease has been diagnosed and included among the top five killer diseases in both the US and other countries. It is second disease only to heart diseases as a course of disability at an early age and causes of disability that forces people to stop working. From record in US alone about 12 million people suffer from chronic obstructive pulmonary disease (COPD). It is the fourth most common cause of death, and deaths mostly occur in people with over 55 years and above and it is more common to men as compared to women, although it is common to men as compared to women the death rates is equal., but men and women die as a result of COPD at about equal rates. COPD is more often fatal in whites than in nonwhites(Loscalzo and Et al 2008)
This deadly condition is major causes are man made and inflated by the environmental impacts. The main causes of the disease are smoking. Smoking is the greatest curse of this condition, it has been detected that not all smokers develop the disease but only about 15% to 20% of smokers develop the disease. When categorized, pipe and cigar smokers develop COPD more than non smokers but this is more intense and often to cigarette smokers, as the ages increases the susceptible cigarette smokers lose lung functions more rapidly that nonsmokers. The function of the lung increases only to some little percentage if the victims stop smoking. The correction of the condition to return to that of nonsmokers only becomes possible if people stop smoking, this will delay the development and progression of the symptom.(Hinzdo and Vallythan 2003)
A lot of exposure to polluted air and smoke from nearby cigarette smokers (second hand or the passive smokers) increases and worsens COPD and may lead to COPD. Intense and prolonged exposure to workplace dusts found in coal mining, gold mining, and the cotton textile industry and chemicals such as cadium, isocyanates, and fumes from welding have been implicated in the development of airflow obstruction, even in nonsmokers. Workers who smoke and are exposed to these particles and gases are even more likely to develop COPD. Intense silica dust exposure causes silicosis, a restrictive lung disease distinct from COPD however less intense silica dust exposures have been linked to a COPD-like condition. The effect of occupational pollutants on the lungs appears to be substantially less important than the effect of cigarette smoking which is direct and intense. (Hinzdo and Vallythan 2003)
The third cause of the disease is attributed to a rare cause; this is hereditary condition in which the body produces a markedly decreased amount of the protein alpha1-antitrypsin. This protein prevents neutrophil elastase (an enzyme in certain white blood cells) from damaging the alveoli. Consequently, emphysema develops by early middle age in people with severe alpha1-antitrypsin deficiency (also called alpha1-antiprotease inhibitor deficiency), it is more common in people who smoke.Only about half of all long-term smokers will ever develop COPD. Some factor in addition to heavy smoke exposure is required for a person to develop COPD. This factor is probably genetics susceptibility. COPD is more common among relatives of COPD patients who smoke than unrelated smokers.(Hensley and Saunders 1989)
The disease has different signs and symptoms that are usually seen and indicate its presence in a person, one of the symptoms that are clearly seen in people that are infected with COPD is that there is production of a mild cough that produces sputum that mostly develops when one reaches about the age of 45 years. The cough is too common in the mornings when one wakes up from bed. The coughing and the production of sputum persist for along time and at times is sometimes accompanied the shortness of breath. Sometimes, shortness of breath first occurs only with a lung infection, during which time the person coughs more and has an increased amount of sputum. The color of the sputum changes from clear or white to yellow or green. This is one of the main signs.(Hinzdo and Vallythan 2003)
Since it has been indicated that COPD commonly affects people who are old and above 40 years ,it is more common to people when they reach around 60 years , especially when continue smoking. The symptom of shortness of breath with exertion becomes more troublesome. They also experience pneumonia and other lung infections attacks more often. They may result in severe shortness of breath even when the person is at rest and may require hospitalization. Shortness of breath during activities of daily living, such as toileting, washing, dressing, and sexual activity, may persist after the person has recovered from the lung infection.
A very big percentage of the people with severe COPD experience severe weight loss, in part because shortness of breath makes eating difficult and in part because of increased levels in the blood of a substance called tumor necrosis factor. Swelling of the legs often develops, which may be due to corpulmonale.
The infected People may intermittently cough up blood, which is usually due to inflammation of the bronchi, but which always raises the concern of lung cancer. Morning headaches may occur because breathing decreases during sleep, which causes increased retention of carbon dioxide.
It has also been discussed that as the infection of COPD progresses, some people, especially those who have emphysema, develop unusual breathing patterns. Some people even breathe out through pursed lips. Others find it more comfortable to stand over a table with their arms outstretched and weight on their palms, a maneuver that improves the function of the respiratory muscles. Over time, many people develop a barrel chest as the size of the lungs increases because of trapped air. Low oxygen levels in the blood can give a blue tint to the skin (cyanosis). Clubbing of the fingers is rare and raises the suspicion of lung cancer.( http://www.merch.com/mmhe/sec04/) Fragile areas in the lungs may rupture, permitting air to leak from the lung into the pleural space, a condition called pneumothorax. This condition often causes sudden pain and shortness of breath and requires immediate intervention by a doctor to remove the air from the pleural space. (http://www.merch.com/mmhe/sec04/)
A flare-up of COPD is a worsening of symptoms, usually cough, increased sputum, and shortness of breath. Sputum color often changes to yellow or green, and fever and body aches sometimes occur. Shortness of breath may be present when the person is at rest and may be severe enough to require hospitalization. Severe air pollution, common allergens, and viral or bacterial infections may cause flare-ups. During severe flare-ups, people may develop a life-threatening condition called acute respiratory failure. Among the possible symptoms are severe shortness of breath (a feeling likened to being drowned), severe anxiety, sweating, cyanosis, and confusion
The people infected with COPD need some special attention and treatment. They need physical attention, psychological attention and primary health care, the attention and treatment has to start with the diagnosis of the disease. Chronic bronchitis is diagnosed by the history of a prolonged productive cough. People with chronic obstructive bronchitis have chronic bronchitis and evidence of airflow obstruction on pulmonary function tests. Emphysema is diagnosed on the basis of findings observed during a physical examination and on pulmonary function test results. However, by the time the doctor notices these abnormalities, emphysema is moderately severe. It is not important for doctors to differentiate between chronic obstructive bronchitis and emphysema. The most important determinant of how the person feels and functions is the severity of the airflow obstruction.( Petty 1985)
In mild COPD, a doctor may find nothing unusual during the physical examination. As the disease progresses, wheezes may be heard through the stethoscope, and prolonged expiration and decreased breath sounds become apparent. Chest movement diminishes during breathing, and use of the neck and shoulder muscles in breathing may occur. As the patience undergo the primary and secondary stages of COPD there are quite a number of factors that one needs to adhere to, both psychologically and medically. These are;
The patient should be given oxygen therapy: it has been diagnosed that long that COPD patience should be under oxygen therapy so as to prolong their lives and aid in the reduction of carbon dioxide levels in their blood systems. Although round-the-clock therapy is best, using oxygen 12 hours a day also has some benefits. This therapy reduces the excess of red blood cells caused by low blood oxygen levels and helps to relieve cor pulmonale caused by COPD. Oxygen therapy may also improve shortness of breath during exercise or other energy taking activities. The supply of oxygen can be provided in two different ways namely through the use of electrically driven oxygen concentrators or compressed oxygen it is advisable that people who use oxygen support must never use it next to open flames or while smoking.
Other people who are below the age usually younger that 60 years and have severe airflow obstruction they are recommended to have single lung transplantation. The main objective of lung transplantation is to improve quality of life, because survival time is rarely increased. Lifelong immunosuppressant is required, placing people at low risk of infections.(Similowski, Whilelaw and Derrenne 2002)
People can also have surgery that reduces the volume of the lungs; this can be carried out in people with severe emphysema in the upper portions of their lungs. In this operation, the most severely diseased portions of the lungs are removed, thus permitting the remaining portions of the lungs and the diaphragm to function better. It is not known how long the improvement lasts. People are required to stop smoking for at least 6 months before surgery. (Hough 2001)
Psychological assistance
Research has indicated a strong relationship between the degree of physical problems and quality of life in patients with chronic obstructive pulmonary disease (COPD). The importance of adaptive psychological functioning to maintain optimum quality of life has long been recognized and there is a lot of empirical evidence concerning the nature of psychological factors involved in adjustment to COPD( Haave and Mayland 2006)
The patience and their caretakers should consider the option of pulmonary rehabilitation which can help people with this condition, although this pulmonary rehabilitation does not improve pulmonary but it encompasses some educational trainings talking about the disease, some exercise, and nutritional and psychosocial counseling. These programs can improve independence and quality of life, decrease the frequency and length of hospital stays, and improve the ability to exercise. Exercise programs can be carried out in an outpatient setting or at home. Walking (sometimes on a treadmill) is usually used to exercise the legs. Sometimes stationary bicycling and stair climbing are also used. Weight lifting is used for the arms. Often, oxygen is recommended during exercise. As with any exercise program, gains in conditioning are quickly lost if the person stops exercising. Special techniques are taught for decreasing shortness of breath during activities, such as cooking, engaging in hobbies, and sexual activity. The patience more so should be involved in these programs so as to see the impotence of being positive at the steps taken in their treatment. (Wagena and Et al 2004)
In another research the results indicated that higher levels of catastrophic withdrawal coping strategies and lower levels of self-efficacy of symptom management were associated with higher levels of depression, anxiety and a reduced quality of life. Higher levels of positive social support were linked to lower levels of depression and anxiety, while higher levels of negative social support were linked to higher levels of depression and anxiety. Hence it has been concluded that to maximize quality of life in patients with chronic obstructive pulmonary disease, psychological factors need to be carefully assessed and addressed (Nguyen and Carrieri 2005)
Bibliography
Gerald David, Theodore Marcy and Seward Elizabeth (1999) Medical Management of Pulmonary Diseases. CRC Press
Haave E and Mayland M.E (2006). The relation between measures of health status and quality of life in
COPD. Chronic Respiratory Disease, November 1, 2006; 3(4): 195 – 199
Hensley Michael and Saunders Nicholas (1989) Clinical Epidemiology of Chronic Obstructive Pulmonary
Disease
Hough Alexandra (2001) Physiotherapy in Respiratory Care: An Evidence-Based
Approach to Respiratory .Nelson Thornes Press
Hnizdo E, Vallyathan V (April 2003). “Chronic Obstructive Pulmonary Disease due to
Occupational Exposure to Silica Dust: a review of epidemiological and pathological
Evidence”. Occup Environ Med 60 (4): 237–43. PMID 12660371.
Loscalzo Joseph and Et al (2008). Harrison Principles of Internal Medicine, 17th Edition,
McGraw-Hill Professional. ISBN 0-07-146633-9
Nguyen H. O and Carrieri-Kohlman V (2005). Dyspnea Self-Management in Patients with Chronic
Obstructive Pulmonary Disease: Moderating Effects of Depressed Mood
Psychosomatics, October 1, 2005; 46(5): 402 – 410.
Petty Thomas (1985) Chronic Obstructive Pulmonary Disease Informa Health Care
Similowski Thomas, Whitelaw William and Derenne Jean-Philippe (2002) Clinical management of
Chronic obstructive pulmonary disease
Wagena E. J and Et al (2004) Risk of Depression and Anxiety in Employees with Chronic Bronchitis:
The Modifying Effect of Cigarette Smoking .Psychosom Med, September 1, 2004; 66(5): 729 –
734.
Warrell D., Cox Timothy and Firth John (2003) Oxford Medical Dictionary Oxford
University Press
http://www.merch.com/mmhe/sec04/ Retrieved on the 6th July 2008
