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Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a devastating disorder that causes a huge degree of human suffering throughout the world. COPD is currently the fourth leading cause of death in the United States and sixth leading cause of death globally. It is a major public health threat throughout the world and afflicts millions. COPD is a disease where airflow obstruction due to chronic bronchitis or emphysema makes breathing difficult. When COPD occurs, it decreases the ability of the lungs to take in oxygen and remove excess carbon dioxide.

COPD is progressive and not fully reversible despite available treatments. COPD can be caused by chronic bronchitis, emphysema, small airways disease, or a combination. As COPD progresses, the smaller airways and alveoli within the walls of the lungs lose their innate elasticity and collapse. This closes some of the smaller air passages and narrows larger ones. Most of the air passageways fill with mucus, and as air continues to reach the alveoli when the lungs expand during breathing, it becomes trapped and cannot leave the lungs upon exhalation. This is a disease that reduces lung capacity. A main contributing factor to COPD is environmental exposure to inhaled toxins, smoking, and secondhand smoke.

Chronic bronchitis is described as the presence of an ongoing productive cough for many months during a two-year period. Emphysema is an abnormal, permanent enlargement of the air spaces in the lungs with destruction of these cell walls that makes them no longer function. COPD is present only if chronic airflow obstruction occurs in the lungs; chronic bronchitis without chronic airflow obstruction is not included within COPD.

History

In the early 19th century, the Scottish physician Charles Badham and the great French physician and inventor of the stethoscope René Laënnec made the classic description of chronic bronchitis and emphysema. Later that century, a British textbook described the familiar clinical picture of chronic bronchitis as an advanced disease with repeated bronchial infections that ended in right heart failure. At that time, the described disease caused more than 5 percent of all deaths. Their work and disease descriptions led to our understanding of what COPD is today.

The 20th century brought many advances that aid in the efficient diagnosis, sufficient treatment, and overall reduced morbidity for those with COPD. Specifically, accurate X-ray technology, sputum tests positive for microflora, arterial blood gas values, cardiac monitoring (ECG), and lung capacity testing such as spirometry for observation of airflow obstruction all enable the physician to paint the picture of COPD and in turn properly treat the patient.

Unfortunately, many of the above-mentioned diagnostic tools are not available where they are needed most: in developing nations. Areas that have big industry and poor market regulations and lack any smoking cessation treatments have more citizens exposed to terrible environmental conditions and COPD risk factors. The disability resulting from lack of diagnosis or poor treatment is significant and leads to death.

Global Epidemiology

In the United States, 12 to 16 million people currently suffer from COPD and about 10 to 13 million have chronic bronchitis. Approximately 1.5 to 2.3 million suffer from emphysema. In the past 25 years, new cases of COPD have increased by half. Further estimates gauge the prevalence (new cases/patients per a year) of chronic airflow obstruction in the United States at 8 to 17 percent for men and 10 to 19 percent for women. The most significant increase in prevalence has been a 30 percent jump among women in the past 10 years.

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