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Chronic obstructive pulmonary disease - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of COPD -- emphysema and/or chronic bronchitis.

Alternative Names

COPD; Alpha-1 antitrypsin deficiency; Bronchitis - chronic; Chronic bronchitis; Emphysema

Highlights:

Causes

A gene called ADAM33 is more common in smokers with COPD than in those without the disease. This gene may explain why only about 25% of smokers develop COPD. Other genetic variants linked to the disease have been discovered on chromosome 4, as well as in the gene for the a-nicotinic acetylcholine receptor, CHRNA 3/5 (a chemical messenger that has also been linked to smoking and lung cancer).

Complications

Researchers have discovered that a clot that blocks a lung artery (pulmonary embolus) is present in as many as a quarter of all COPD exacerbations. COPD patients are at higher risk for embolisms than the general public.
Having depression can worsen the outlook for COPD patients. It can increase the risk of exacerbations by more than 50%, and of hospitalization by more than 70%. Depression also increases the risk of death in both those with stable COPD and in those with uncontrolled disease. People with stable COPD are nearly twice as likely to die if they have moderate-to-severe depression.

Treatment

Pulmonary rehabilitation can help reduce hospitalizations in COPD patients. In one study, an 8-week pulmonary rehabilitation program reduced the number of COPD patients admitted to the hospital by 46%.

Medication

Recent studies suggest that anticholinergic medications taken for COPD may pose serious heart risks. In one study, patients who used an inhaled anticholinergic medication for more than a month had a nearly 60% increased risk of heart attack, stroke, or death. Another study found that the anticholinergic drug ipratropium (Atrovent) increased the risk of cardiovascular death by more than 30%, particularly in men who were recently diagnosed with COPD.
One study showed that combining the beta-agonist salmeterol and the inhaled corticosteroid fluticasone (Flonase) can slow the progression of COPD. This drug combination is the only intervention other than stopping smoking that has been shown to slow COPD progression.

Lifestyle Changes

A computer-controlled breathing training program may help COPD patients improve their exercise tolerance. The technique uses computer feedback to help patients learn to slow down their breathing. This helps prevent the over-inflation of the lungs that can lead to reduced exercise tolerance.

Resources

www.lungusa.org -- American Lung Association
www.nhlbi.nih.gov -- National Heart, Lung, and Blood Institute
www.aarc.org -- American Association for Respiratory Care
www.njc.org -- National Jewish Medical and Research Center
www.alpha1.org -- Alpha1 National Association
www.emphysemafoundation.org -- The National Emphysema Foundation
www.nlhep.org -- National Lung Health Education Program
www.thoracic.org -- American Thoracic Society
www.sts.org -- Society of Thoracic Surgeons
www.unos.org -- United Network for Organ Sharing
www.copd-international.com -- COPD International (patient support site)

References

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Anthonisen N. Chronic Obstructive Pulmonary Disease. In: Goldman L, Auseillo D. Goldman: Cecil Medicine. Philadelphia, PA: Saunders Elsevier; 2007:chap 88.

Calverly PM, Anderson JA, Celli B, et al, for the TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775-789.

Celli BR, Thomas NE, Anderson JA, Ferguson GT, Jenkins CR, Jones PW, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008;178:332-338.

De Jong Y, Uil SM, Grotjohan HP, Postma DS, Kerstjens HAM, Van den Berg JWK. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132:1741-1747.

De Voogd JN, Wempe JB, Koëter GH, Postema K, van Sonderen E, Ranchor AV, et al. Depressive symptoms as predictors of mortality in patients with COPD. Chest. 2009/135:619-625.

Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a meta-analysis of randomized controlled trials. Chest. 2007;132:447-455.

Fan VS, Ramsey SD, Giardino ND, Make BJ, Emery CF, Diaz PT, et al. Sex, depression, and risk of hospitalization and mortality in chronic obstructive pulmonary disease. Arch Intern Med. 2007;167:2345-2353.

Han MK, Postma D, Mannino DM, Giardino ND, Buist S, Curtis JL, et al. Gender and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:1179-1184.

Kang MJ, Lee CG, Lee JY, Dela Cruz CS, Chen ZJ, et al. Cigarette smoke selectively enhances viral PAMP- and virus-induced pulmonary innate immune and remodeling responses in mice. J Clin Invest. 2008;118:2771-2784.

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Lee TA, Pickard AS, Au DH, Bartle B, Weiss KB. Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med. 2008;149:380-390.

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Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131:4S-42S.

Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009;135:786-793.

Sadaghnejad A, Ohar JA, Zheng SL, Sterling DA, Hawkins GA, Meyers DA, et al. ADAM33 polymorphisms are associated with COPD and lung function in long term tobacco smokers. Respir Res. 2009;10:21. [Epub ahead of print]

Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. JAMA. 2008;300:1439-1450.

Soltz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin guidance with standard therapy. Chest. 2007;131:9-19.

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Thabut G, Christie JD, Ravaud P, Castier Y, Brugière O, Fournier M, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371:744-751.

Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA Jr. Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med. 2007;13(1):6-14.

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Reviewed last on: 4/20/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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