Question

What is COPD and how should it be treated?

Answer

COPD stands for chronic obstructive pulmonary disease. It is the obstructive part of the title which is the major factor determining symptoms and prognosis. There is always some element of pulmonary disease, which means destruction of the usual anatomy of the lung with emphysema. This emphysema is defined as an increase beyond the normal in the size of the air spaces, accompanied by destruction of their walls, but there is no obvious fibrosis, and the emphysema itself causes obstruction to air flow.

COPD is a diagnosis of exclusion. The major risk factor in Westernised countries is cigarette smoking. Working in dusty occupations may exacerbate the problems, but has not been proven to lead to obstruction. Recurrent chest infections may also play a part.

The management depends on the individual, but everyone should stop smoking. Virtually all patients with COPD show some response to treatment with beta adrenergic agonists, muscarinic antagonists and theophylline. If people respond well to these treatments, there may be further improvement with corticosteroids. Recent research suggests that beta-agonists such as Ventolin should only be used in the short term, and not as continuous therapy. There may be better improvement with home nebulisers rather than metered dose inhalers. In the long term, oxygen therapy may be effective, obesity should be treated, and an organised trial of physical therapy and rehabilitation is often very helpful.

Links

• Treating COPD