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Chronic Obstructive Pulmonary Disease (COPD) in the Elderly

What is COPD?

Chronic obstructive pulmonary disease (chronic obstructive lung disease, chronic obstructive airway disease) is a combination of two common lung disease – chronic bronchitis and emphysema. It is a permanent respiratory disease associated with long term exposure to cigarette smoking, gases and airborne dusts.  Chronic bronchitis is a condition marked by a persistent cough and sputum production. In order for it to be diagnosed as chronic bronchitis, these symptoms should persist for at least 3 months in 2 consecutive years. Emphysema is characterized by progressive destruction of tissue necessary for maintaining shape and function of lungs. Treatment options are lifestyle modification (smoking cessation), drugs, oxygen therapy and surgery (in some cases).

COPD Symptoms

Initial mild cases of COPD usually do not produce any symptom. Gradually with time the disease progresses and symptoms of COPD become prominent.

  • Respiratory distress (shortness of breath) which is triggered with activity. In advanced cases, breathing trouble may occur even at rest. Shortness of breathing is characterized by active participation of neck muscles, breathing through parted (pursed) lips. Usually expiration (breathing out) takes longer time in comparison to inspiration (breathing in).
  • Chronic persistent cough usually with sputum.
  • Chest tightness.
  • Wheezing (whistling sound produced during breathing).
  • Long term disease lead to change in shape of chest (barrel chest).

COPD patients frequently experience acute lung infections (cold, pneumonia). In the long run COPD may lead to heart diseases (heart failure due to inadequate oxygen supply and high blood pressure). Chronic progressive breathlessness may lead to depression in patients.

Causes of COPD

COPD is a combination of two lung conditions chronic bronchitis and emphysema.

Chronic bronchitis is characterized by cough and noisy breathing (wheezing). In this condition there is increased number and activity of mucous-producing cells (goblet cells) which leads to profuse sputum production. Inflammation of the walls of the airway leads to thickening and remodeling of the airways. All the above mentioned changes lead to narrowing of the airways and breathing trouble.

Emphysema causes distension or enlargement of air sacs and destruction of elastic tissue of the lung leading to progressive loss of lung tissue.

There are some factors which trigger the symptoms of COPD :

  • Tobacco smoking.
  • Air pollutants like sulfur dioxide.
  • Occupational hazards like silica and asbestos.
  • Genetic susceptibility is common in family members, deficiency of certain enzymes like alpha1 antitrypsin and protease enzymes.

Risk factors

  • History of long term smoking.
  • Occupational exposure to silica, asbestos, chemical fumes and dust.
  • Age although disease starts early but symptoms appear usually after 40 years.
  • Genetic abnormalities.

Treatment

COPD is not curable and the disease progresses gradually despite treatment. The aim of treatment is :

  • Symptomatic relief
  • Reduction of complications

Treatment options are :

  • Cessation of smoking, avoidance of irritant smokes, dust and noxious chemical fumes.
  • Drugs:
    – Bronchodialators (inhalation) are prescribed to counteract narrowing of the airways. Both short acting (salbutamol) and long acting (salmeterol) bronchodilators are used.
    – Inhalational steroids (beclomethasone, budesonide) are prescribed often in combination with long acting bronchodilators.
    – Oral antibiotics: prescribed during acute attack of respiratory infection
  • Oxygen therapy.
  • Breathing exercises.
  • Surgery :
    – Lung volume reduction surgery.
    – Lung transplantation

References :

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153/

http://www.mayoclinic.com/health/copd/DS00916

 


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