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respiratory

COPD... cigarette smoking leads the list!
This airflow limitation is usually progressive and is associated with an irritation or inflammation of the airway linings in response to noxious gases, primarily caused by cigarette smoking.

The initials COPD stand for Chronic Obstructive Pulmonary Disease that, to many people, sounds ominous. The American Thoracic Society defines this chronic disease as “a preventable and treatable disease state characterized by airflow obstruction that is not fully reversible. This airflow limitation is usually progressive and is associated with an irritation or inflammation of the airway linings in response to noxious gases, primarily caused by cigarette smoking. The key words to keep in mind are “preventable” and “treatable.” Chronic obstructive pulmonary disease is complex and may have components of chronic bronchitis, emphysema, and even asthma.”

The death rate from COPD has risen significantly over the years whereas the death rates from heart disease and strokes have decreased. There are over 100,000 deaths per year resulting from the complications of COPD.

What are the risk factors? You guessed it; cigarette smoking leads the list! However, even being exposed to passive cigarette smoke may be a factor as well as family history of chronic lung disease (since there is a genetic link), air pollution, occupational exposures, allergic respiratory reactions, and recurrent respiratory infections.

If you have COPD and fail to seek specialist care, you can expect the disease to become progressive from airway flow limitation, to breathlessness, to reduced exercise capacity, to failing quality of life, to DEATH.

Stages
How is the disease classified? The GOLD classification (Global initiative for Obstructive Lung Disease) of disease severity classifies COPD into four stages. Stage one is classified as MILD and refers to specific lung function values which are close to normal but show some obstruction although the patient may not be complaining of symptoms. Stage two refers to MODERATE, stage three is SEVERE, and stage four is VERY SEVERE.

As the severity increases, so do the symptoms of cough, shortness of breath, and sputum production. In addition, as the severity increases, the lung function decreases with levels approaching only 30% of normal.

Treatment and Prevention
At the beginning of this article, I mentioned two words, preventable and treatable. Yes, COPD can be prevented. If there is a family history of COPD and you are young and a smoker, STOP SMOKING! Obviously, there are no guarantees because there is a sub-set of the population who develops COPD that has never smoked. But, there is significant evidence that cessation of smoking reduces the decline in lung function. Controlling ones’ work environment is also important. Occupational exposures to minerals (coal, oil mist, Portland cement, silica and quartz), metals (vanadium, welding fumes, and cadmium), organic dusts (cotton, grain, wood, and sawdust), and solvents are contributing factors. The treatment of COPD follows the GOLD stages. Before any treatment is prescribed, lung function studies should be done to determine your present stage. And remember, symptoms may be minimal, such as just a nagging cough. Your physician may prescribe a short-acting lung dilator, which is usually a metered dose inhaler (Proventil HFA, Ventolin HFA, and ProAir HFA) to use as needed for acute episodes of shortness of breath. However, as your lung function deteriorates other inhalers may be suggested such as “long-acting” lung dilators (Salmeterol = Serevent, Fomoterol = Foradil). Then, combination drugs may be used which contain a long-acting lung dilator with an inhaled steroid (Advair, Symbicort.) Another drug, which is being used for COPD to decrease the irritability of the airways, is Tiotropium bromide (Spiriva.) Remember, if you are concerned that you or a family member may be developing COPD, you must be pro-active. Genetics and family history are determining factors. Seeing a physician who utilizes pulmonary functions is important. If your physician is unable to monitor lung functions, then seeking a specialist such as a pulmonologist is mandatory. If there is a family history of COPD and you are a smoker, stop smoking. If you are working in an industry where environmental factors have been incriminated as causing lung disease, follow the recommendations to prevent exposure. If you are a wood worker, wear protective masks and ventilate the environment adequately. When mediations are prescribed to take on a daily basis, take them daily. Get your flu shot every year. If you are over 50, a pneumonia vaccine may be recommended and then repeated every 10 years or so. As we age, I feel that vitamins are important but not to be over- done. A once-a-day vitamin like Centrum Silver should be adequate.

Living with COPD is better now than it was years ago. Modern medications have reduced the complications of COPD, allowing patients to live more comfortably and longer.

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"COPD... cigarette smoking leads the list!"
   authored by:
ALLERGY
Thom F. Rosenberg, M.D., a graduate of The Chicago Medical. Pediatric internship and residency @ The Childrens' Hospital of Pittsburgh. Allergy & Immunology Fellowship @ The University of Pittsburgh Hospitals and The Childrens' Hospital of Pittsburgh...



COPD... cigarette sm...

Asthma Defined