Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that usually refers to chronic bronchitis and emphysema. Patients have difficulty breathing, and over time, the symptoms get worse. The main cause of COPD is smoking, but environmental toxins like pollution, chemical fumes, or exposure to asbestos and other toxic workplace dust can also trigger the disease.

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People who have asbestosis, a lung disease caused by asbestos, may develop COPD as a complication. Asbestos is also a known cause of pleural mesothelioma, a cancer that affects the lining of the lungs, and it is not uncommon for mesothelioma patients to also have COPD.

According to the U.S. Department of Health and Human Services, about 12 million Americans are diagnosed with COPD each year, and an additional 12 million remain undiagnosed. This disease is the 4th leading cause of death in the U.S.

Generally, the disease is diagnosed in people older than 40. Studies show that patients can expect to live 12-18 years after a COPD diagnosis, depending on the severity of the disease.

Typically, COPD develops slowly, and symptoms such as cough, increased mucus production, difficulty sleeping, shortness of breath, tightness in the chest and wheezing gradually worsen as the illness progresses. COPD affects the lungs' elasticity, which makes it difficult for a patient to exhale properly.

Complications include high blood pressure, heart attack and a higher risk of respiratory infections – including pneumonia, which can cause severe problems for COPD sufferers.

Correlation Between Asbestos and COPD

COPD can be caused by the inhalation of foreign fumes or substances. Often, these irritants are inhaled at the workplace. Because asbestos was widely used at many industrial jobsites, workers may have inhaled these fibers and later developed COPD. Lungs that are weakened by COPD also may be much more susceptible to additional lung damage caused by asbestos.

Various scientific studies have reported a statistically significant incidence of COPD among those exposed to toxic materials such as asbestos and silica.

A Swedish study of 316,729 construction workers found the mortality rate from COPD was more than two and a half times higher in participants who had been exposed to airborne toxins, including asbestos, than in patients who had not been exposed to toxic dust on the job. Exposure to inorganic dust even affected participants who had never smoked and were therefore at a considerably low risk of developing COPD.

Another study published in the Environmental Health journal in 2011 found that COPD caused by occupational exposure to dust or fumes caused about 375,000 deaths and 3,804,000 years of healthy life lost globally in one year.

Symptoms

When someone first gets the disease, there may be few symptoms. Because COPD is a progressive disease, meaning it gets worse over time, symptoms typically worsen the longer someone has the disease.

Some symptoms of COPD include:

  • A cough that produces a lot of mucus
  • Tightness in the chest
  • Difficulty breathing or shortness of breath during physical activity
  • Wheezing
  • Getting sick often with colds or the flu
  • Swelling in ankles, feet or legs (edema)
  • Weight loss
  • Lower muscle endurance

As the disease progresses, the air sacs in the lungs will expand less, and there may be more fluid and mucus in the lungs. This makes it more and more difficult to breathe and get enough oxygen.

Severe symptoms of COPD that require emergency treatment include:

  • Blue or gray lips or fingernails (signs of low blood oxygen)
  • Lack of mental alertness
  • Rapid heartbeat
  • Difficulty breathing and talking
  • Symptoms get worse

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Diagnosing COPD

To diagnose COPD, doctors look at the symptoms, family history, medical history, and the results of special tests to measure lung health and function. The main test used to diagnose COPD is called spirometry. Spirometry uses a machine called a spirometer to measure the amount of air the patient can blow out and how fast it is blown out. The test is painless and non-invasive, and the patient blows into a tube connected to the spirometer. The doctor may also take another reading after giving the patient some medicine to help open the airways in the lungs to see how well the medicine is working.

Using this test, a doctor can even detect COPD before symptoms show up. It also can help doctors rule out other causes of symptoms such as heart failure or asthma.

Image tests are also useful for diagnosing COPD. Using chest X-rays or CT scans, doctors can check on the amount of damage in the lungs and can also rule out heart failure or other conditions.

Low blood oxygen is another sign of COPD. Doctors order an arterial blood gas test to measure the amount of oxygen in the blood. If it is too low, the patient may need oxygen therapy.

Doctors will stage COPD based on the severity of the damage in the lungs. This helps them decide on an appropriate treatment plan.

Treatment

Unfortunately, there is not yet a cure for COPD. However, there are a number of treatments that can improve a patient's quality of life and slow down lung damage. COPD symptoms are typically treated with one or more of the following treatments:

  • Lifestyle Changes. Quitting smoking, avoiding second-hand smoke or toxic fumes, eating a healthy diet with adequate nutrients, and getting safe levels of physical activity can improve symptoms and keep lungs from degrading.
  • Medications. Bronchodilators are medicines that relax the muscles in the airways, allowing more oxygen into the body by making it easier to breathe. These are usually delivered through an inhaler. If the COPD is more severe, bronchodilators may be mixed with steroids in an inhaler to reduce inflammation. Doctors may also prescribe antibiotics to fight respiratory infections or steroids to reduce inflammation during flare-ups. Because people with COPD can have severe complications from respiratory infections, doctors recommend vaccines for the flu and pneumonia.
  • Oxygen Therapy. This type of therapy increases the oxygen in the blood. Oxygen is delivered through nasal prongs or a face mask. Depending on the severity of the symptoms, oxygen may be used at certain times throughout the day or all day.
  • Surgery. Many times, the air sac walls in the lungs are destroyed and create large spaces in the lungs called bullae. A bullectomy is a surgery that removes some of these spaces to reduce difficulty in breathing. Other surgeries involve removing damaged parts of the lung to help the lung work better. Lung transplants may also be an option.

Adjustments can be made to a patient's home environment to make it easier to breathe. Patients should avoid cold or smoke-polluted air, and smokers are strongly urged to quit. Those with COPD may also benefit from joining a rehabilitation program or support group.

Additional Resources

  1. Pruss-Ustun, A., Vickers, C., Haefliger, P. & Bertolli, R. (2011). Known and unknowns on burden of disease due to chemicals: a systematic review. Retrieved from http://www.biomedcentral.com/content/pdf/1476-069X-10-9.pdf
  2. Bergdahl, I.A., Toren, K., Eriksson, K., Hedlund, U., Nilsson, Flodin, R. & Jarvholm, B. (2004). Retrieved from http://erj.ersjournals.com/content/23/3/402.long
  3. National Heart, Lung and Blood Institute. (2013). What is COPD? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/copd/
  4. National Heart, Lung and Blood Institute. (2013). Take the first step to breathing better. Learn more about COPD. Retrieved from http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm
  5. U.S. Department of Health and Human Services. (2009). COPD essentials for health professionals. Retrieved from http://www.cdc.gov/copd/pdfs/reference_card-copd_essentials_for_health_professionals.pdf
  6. National Institutes of Health (NIH). (2014). Asbestosis. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000118.htm
  7. Shavelle, R.M., Paculdo, D.R., Kush, S.J., Mannino, D.M. & Strauss, D.J. (2009). Life expectancy and years of life lost in chronic obstructive pulmonary disease: Findings from the NHANES III follow-up study. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672796/

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