Chronic Obstructive Pulmonary Diseases (COPD)

DEFINITION
COPD is a lung disease in which the lungs are damaged, making it hard to breathe. People with COPD have also Chronic Bronchitis and Emphysema. For the worse, it can cause DEATH

 Most people with COPD will get less air gets and outs, because : The airways and air sacs/ alveoli lose their elasticity (like an old rubber band) The walls between many of the air sacs are destroyed The walls of the airways become thick and inflamed (swollen) Cells in the airways make more sputum than usual, which tends to clog the airways.

EPIDEMIOLOGY
In USA, 10% are suffering Chronic Bronchitis(especially for elderly men). Almost 65 % men and 25% women are suffering Emphysema In Indonesia, COPD stand in 26%, the second place for Pulmonary Disease after TBC(65%).

PATOLOGY(1)
CHRONIC BRONCHITIS Major complaint is chronic cough A lot of sputum production Chest is noisy and Rhonchi invariably present Usually patients are overweight and cyanotic, but looks comfortable at rest Peripheral Edema is common

PATOLOGY(2)
EMPHYSEMA Cough is rare Mucoid Sputum Chest is very quiet without adventitious sounds Patients are thin, with recent weight loss common, looks uncomfortable No Peripheral edema

PATHOGENESIS
Cigarette smoking (active or passive) Occupational Exposures

Bad Air Pollution

Hereditary factors (alpha-1-antitripsin)

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 Cigarette smoking (active or passive) Chronic tobacco smoking is the primary risk factor for COPD . Its responsible for 90% of COPD cases in the United States. Although not all cigarette smokers will develop COPD, it is estimated that 15% will. Smokers with COPD have higher death rates than nonsmokers with COPD.

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 Occupational exposures

Intense and prolonged exposure to workplace dusts found in coal mining, gold mining , and the cotton textile industry and chemicals such as cadmium , isocyanates, silica, 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.

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 Bad Air Pollution

In the non-industrialized world, the most common cause of COPD is indoor air pollution. This is usually due to indoor stoves used for cooking. Indoor stoves often use biomass fuels such as wood and animal dung, which is a common cause of COPD, especially for women. Urban air pollution may also be a contributing factor for COPD

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 Hereditary factors (alpha-1-antitripsin)

Alpha 1-antitrypsin deficiency is a genetic condition that is responsible for about 2% of cases of COPD. In this condition, the body does not make enough of a protein, alpha 1-antitrypsin.

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SYMPTOMATOLOGY
Cough A lots of sputum production Shortness of breath, especially with exercise Wheezing (a whistling or squeaky when you breath) Chest tightness

DIAGNOSIS
Radiologist examination Endoscopy Lungs Blood test Breathing test ( Spirometry )

PREVENTION
Stop your smoking habit! Look for informations about COPD in health seminars, books, and the internet. Make a better living environment by reducing air pollution productions from industries and vehicles, and stop using biomass fuels for indoor stove. Vaccination

TREATMENT
Smoking Cessation (gum, inhaler, etc) Oxygen therapy Antibiotics Pulmonary rehabilitation

If worse : Lungs Surgery

PROGNOSIS
If Patient < 50 years old come with abated shortness of breath, 5 years after, they can survive If Patient < 50 years old come with sufficient shortness of breath, 5 years after, 42% of them will get worse and die If Patient > 50 years old with serious shortness of breath, 5 years after, 50% of them will die

Reference
Hersh CP et al: Predictors of survival in severe, early onset COPD. Chest. 2004 May; 126(5): 1443-14476 Shapiro SD. COPD unwound. N Engl J Med. 2005 May 12; 352(19):2016-2019 Hogg JC et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004 Jun 24; 350(26):2645-2653