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Chronic obstructive pulmonary disease

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VOL: 99, ISSUE: 47, PAGE NO: 37



- Chronic obstructive pulmonary disease (COPD) is a chronic, slowly progressive disease characterised by airflow obstruction.

- It is secondary to chronic bronchitis, emphysema and some cases of chronic asthma.

- Cigarette smoking is the major risk factor (Kanner, 1996), although it is likely that environmental or genetic factors may also be contributory.

- There were 32,155 deaths from COPD in 1999 (British Thoracic Society, 2002).

- History of smoking 10-20 cigarettes a day for 20 or more years prior to onset of symptoms.

- Usually presents in fifth decade.

- Productive cough or acute chest infection.

- Wheezing.

- Later, breathlessness on moderate exertion.

- In severe disease, breathlessness on mild exertion, pursed-lip breathing, use of accessory respiratory muscles, central cyanosis.

- Spirometry: forced expiratory volume in one second (FEV1). Obstructive impairment is shown by FEV1 <80 per cent of predicted value and FEV1/FVC (forced expiratory vital capacity) ratio <70 per cent.

- Chest X-ray may show hyperinflation, flat hemidiaphragm, reduced peripheral vascular markings and bullae.

- Full blood count to exclude chronic hypoxia.

- Serum alpha 1-antitrypsin deficiency should be excluded in the following cases:

- Chronic bronchitis and emphysema in a non-smoker;

- Premature onset of COPD;

- Family history of alpha 1-antitrypsin deficiency or COPD onset by age of 50.

- Stopping smoking reduces the rate of decline (BTS, 1997; Kanner, 1996).

- Patients need thorough instruction in the use of their medications, as compliance is poor in people with COPD. Many underuse maintenance medication while others overuse at times of exacerbation.

- Anxiety is common in patients with COPD experiencing breathlessness during exercise.

- Patients need to adapt their lifestyles to take account of their condition - they should try to keep generally fit, maintain a healthy weight and eat a balanced diet to slow the disease progress.

- Pulmonary rehabilitation programmes have been shown to improve exercise tolerance, relieve dyspnoea and fatigue and enhance patients’ sense of control over their condition (Lacasse et al, 2002).

- Inhaled bronchodilators - the patient’s inhaler technique should be reviewed regularly.

- Short courses of corticosteroids may reduce breathlessness.

- Antibiotics may be required to treat acute exacerbations of COPD.

- Oxygen therapy may be used to treat hypoxaemia after assessment:

- Long-term oxygen therapy at home is unsuitable for patients unwilling to stop smoking as it presents a fire hazard;

- Ambulatory oxygen therapy can be useful to make shopping, exercise and travel easier.

- Annual flu immunisation is recommended, as is a one-off pneumococcal vaccination.

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