Resources: Senior Health Issues at Hebrew SeniorLife

What is Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, or COPD, is an umbrella term used to describe lung disease associated with airflow obstruction. While it is considered a chronic, debilitating and sometimes fatal disease--in fact, it's the fourth leading cause of death in the country--COPD can be managed, controlled and slowed down.

"Patients with COPD often don't go to the doctor until they're short of breath," says Jerome Slate, M.D., a pulmonologist at Hebrew SeniorLife. "They gradually decline over the years. When their activities of daily living are compromised, they seek medical attention. At that point, unfortunately, they are pretty far along in the disease process."

COPD is composed of two conditions: chronic bronchitis and emphysema. Chronic bronchitis is the inflammation of the lining of the bronchial tubes, a process that impairs airflow in and out of the lungs. Emphysema is characterized by the destruction of the air sacs in the lungs, called alveoli, where oxygen from the air is exchanged for carbon dioxide in the blood. As the alveoli are destroyed, they lose their elasticity, resulting in increased work of breathing and shortness of breath. The disease is characterized by long-term, persistent shortness of breath, wheezing, decreased exercise tolerance, and cough.

Smoking is the cause of nearly all COPD cases. Prolonged use of tobacco products--cigarettes, cigars, pipes--causes bronchial inflammation and destruction of the alveoli, making breathing difficult. About 15 percent to 20 percent of smokers develop COPD. Other causes of chronic bronchitis, a component of COPD, include exposure to second-hand smoke and air pollution. A rare enzyme abnormality, alpha-1 anti-trypsin deficiency, can cause emphysema in non-smokers.

People with COPD are at increased risk of pneumonia, respiratory insufficiency, carbon dioxide retention, right heart failure associated with lung disease, and end-stage lung disease. In terms of quality of life, many COPD patients are chronically dependent on oxygen therapy and mechanical ventilation, says Dr. Slate.

Because there is no cure for COPD, therapy focuses on treating symptoms to maximize function and improve quality of life. The most common medical treatments include bronchodilators to relax bronchial muscles and decrease airflow obstruction; steroids to treat inflamed airways; early and aggressive treatment of respiratory infections; supplemental oxygen; and rehabilitation and exercise conditioning. Smoking cessation is a must.

Lung volume reduction surgery, in which the diseased portion of the lung is removed, is an effective treatment in only a select group of patients, about 10 percent of COPD sufferers. Lung transplantations, on the other hand, are not a viable option because of high transplant rejection rates. 

"COPD is a progressive disease, with no stability to it," says Dr. Slate. "That is, the disease gets progressively worse over time, even with therapeutic interventions. Once the damage to the lungs has been done, it cannot be reversed. Early recognition and treatment of this disease in smokers, combined with smoking cessation, can slow disease progression."

A key component of COPD treatment is pulmonary rehabilitation, which focuses on physical conditioning and energy conservation so that patients can function more independently after discharge. The goal is to maximize function to get patients back, at least, to where they were prior to their acute illness and allow them to live independently at home with an improved quality of life. 

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