COPD is a chronic disorder characterized by obstruction in the airflow, occurring over a prolonged period of time. The leading cause of the disease is cigarette smoking. The obstruction in the airway occurs due to damage to the parenchymal tissues and the damage to the airway passage. The symptoms may respond to the medicinal treatment but the damage to the airways cannot be reverted back to the normal.
One single test may not be sufficient to diagnose the illness. It will require a series of tests to reach to the diagnosis. Following are the required tests according to the COPD guidelines:
Physical Examination: physical examination may not be conclusive in most of the cases in the early stages. In later stages there can be widening of the anteroposterior diameter of the chest, there can be hyperresonating notes on percussion and decreasing breath sounds.
Medical History: Cigarette smoking can be a prime cause of the disease. in the medical history, occupational history should also be elucidated. Exposure to smoke in various occupational fields predisposes to the disease. in family history it is important to determine the absence of alpha- 1 antitrypsin enzyme which is associated with chromosome 14. The absence of this enzyme increases the chances of lung or liver diseases.
Spirometry: FEV1/FVC ratio lesser than 0.7, along with FEV lesser than 80% is confirmed diagnostic of the disease.
Chest X- ray: Chest X- rays may be required to observe any nodular formations in the lungs, presence of any mass or any fibrotic damage (Stephens & Yew, 2008).
Other tests those may be required depending in the case are:
Arterial blood gas analysis
Tests those are rarely required:
Alpha- 1 antitrypsin
CT scan (WebMD, 2015).
Management of all the stages of COPD will require bronchodilators. The bronchodilators may consist of beta- adrenergic receptor agonists, methylxanthines and anticholinergics. The bronchodilators help in relaxing the smooth muscles. This helps in increasing FEV1 by increasing lung emptying and decreasing dyspnea. These bronchodilators can be administered both orally and by inhalation, however, inhalers are the preferred mode of administeration.
The patients of COPD must take influenza vaccines every year. Also pulmonary rehabilitation or oxygen therapy may be of great help in order to improve the quality of life of the patient. It is very important to educate the patient about the disease COPD. Proper education of the patient will increase the patient’s adherence to the medications. For acute exacerbations of the COPD, the management at home and hospital will be different. The management at home consists of increasing the dosage of the medicines the patient is already taking at that time, SABA or short acting beta agonists are the most preferred pharmacological management. In the hospitals, combination of bronchodialtors may be administered to ameliorate the symptoms (Fromer & Cooper, 2008).
COPD PREVENTION GUIDELINES
The best way to prevent COPD is quitting on smoking. It is the commonest cause of the disease. hence, eliminating the cause will reduce the risk of the disease to a great extent. Also avoidance of other pollutants like smoke, chemical fumes, dust and air pollution can decrease the chances of the disease (National Heart Lung and Blood Institute, 2013).
USING THESE GUIDELINES IN CLINICAL SETTING
In case of a probable diagnosis of COPD, the patient must be asked to undergo the laboratory tests in order to confirm or refute the diagnosis. Spirometry is the most important and confirmatory test of the disease. the patients must be educated about the disease. they should be encouraged to quit smoking. If it is difficult for them to quit smoking by themselves, they must take the help of the rehabilitation centers. The patients must be administered the correct dosage and medicine as required in the individual cases. They should be explained the importance of adherence to the medications.
A female of 52 years presented with respiratory symptoms. She suffers from early morning cough and excessive sputum production. She was a smoker for about 10 years, she used to have one pack every day. Currently she smokes only socially. She has positive family history for asthma and emphysema. On auscultation, decreased breath sounds and scattered end respiratory wheezes were audible. On undergoing spirometry, the results were conclusive of COPD. Her FEV1/FVC ratio was low. However her post bronchodilator FVC was found to be near normal, but suggestive of some airway obstruction. The treatment for this patient would consist of twice a day dosage of inhalation aerosol. These inhalers have beta adrenergic compounds in them. The dosage per inhalation should be limited to 45mcg up to 230mcg. For general management, the patient should be advised to quit smoking even at social levels. She should do breathing exercises. The patient must be advised to stay away from smoke and pollution of any kind. She should maintain general well being in order to prolong the life expectancy.
Fromer, L., & Cooper, C. (2008). A review of the GOLD guidelines for the diagnosis and treatment of patients with COPD. International Journal Of Clinical Practice, 62(8), 1219-1236. doi:10.1111/j.1742-1241.2008.01807.x
National Heart Lung and Blood Institute,. (2013). How Can COPD Be Prevented? - NHLBI, NIH. Retrieved 28 June 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/copd/prevention
Stephens, M., & Yew, K. (2008). Diagnosis of Chronic Obstructive Pulmonary Disease. American Academy Of Family Physicians, 78(1), 87-92.
WebMD,. (2015). COPD (Chronic Obstructive Pulmonary Disease)-Exams and Tests. Retrieved 28 June 2015, from http://www.webmd.com/lung/copd/tc/chronic-obstructive-pulmonary-disease-copd-exams-and-tests