US, WHO embark on COPD initiative

The major public health problem caused by what is called Chronic Obstructive Pulmonary Disease (COPD) has prompted the US National Heart, Lung and Blood Institute and the World Health Organization (WHO) to develop the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

The endeavor brought together a group of health professionals from around the world to formulate a four-component strategy for the diagnosis, management and prevention of COPD to control the health problem and help the thousands suffering from it.

Now the fourth leading cause of death in the world, COPD has failed to receive adequate attention from the healthcare community, government officials and the general public.

It poses a global burden in terms of prevalence and mortality, and is the primary health threat to smokers who may already have the disease by ignoring its symptoms.

COPD is primarily caused by cigarette smoking, but can also be the result of other factors like pollution and occupational exposure to dust and chemicals.

It is most common in smokers over the age of 40 who experience chronic cough that produces phlegm, frequent upper respiratory tract infections, shortness of breath and wheezing.

The two underlying conditions of COPD are emphysema and chronic bronchitis, both of which entail reduction of lung function. Though the disease can be controlled, it currently has no known cure.

The GOLD guidelines are the following:

• Assessing and monitoring the disease

The effective diagnosis of COPD is key in accomplishing as much as possible in curtailing the extent of damage to the lungs. Patients who have persistent phlegm-producing cough and a history of exposure to risk factors (tobacco smoke, occupational dust and chemicals, indoor or outdoor pollution) should be tested.

For diagnosis and assessment, spirometry is the best standard for measuring airflow limitation. This is a test to measure how well the lungs take in air, the volume of air the lungs hold, and how well the lungs exhale air.

It is performed by breathing into an instrument called a spirometer that records the amount of air and the rate of air that is breathed in over a specified time. Some of the test measurements are obtained by normal breathing, and other tests require forced inhalation and/or exhalation.

Chronic cough is usually the first COPD symptom to develop. Though it may initially be intermittent, it later on becomes present everyday. Breathlessness becomes more pronounced, especially during exercise and respiratory infections.

COPD is usually a progressive disease, and lung function can be expected to worsen over time. Symptoms should be monitored for development of complications.

Follow-up visits to the doctor should include a discussion of new and worsening symptoms, dosages of various medications, inhaler technique, and side-effects of treatment in order to adjust therapy appropriately as needed.

• Reducing risk factors

Reducing personal exposure to tobacco smoke, occupational dusts and chemicals, and indoor and outdoor air pollutants are important goals to prevent COPD.

Quitting smoking, however, is the single most effective intervention to reduce the risk of developing COPD and stop its progress. It is never too late to stop smoking and put a stop to the decline of lung function.

Occupationally induced COPD can be reduced or controlled through strategies aimed at reducing inhaled particles and gases. Though we all experience diverse contaminants in indoor and outdoor environments throughout the day, reducing the risk from air pollution requires individual protective steps.

Those who are susceptible to lung disease based on family history should avoid exercising outdoors during heavy pollution. If fuels are used for cooking or heating, adequate ventilation should be ensured. Person with severe COPD should monitor public announcements of air quality and stay indoors when air quality is poor.

• Managing stable COPD

The overall approach to management of COPD involves a stepwise increase in treatment depending on the severity of the disease. None of the existing medications for COPD have been shown to modify long-term decline in lung function that is the hallmark of the disease, but are used to decrease symptoms or complications.

Bronchodilators (more commonly known as inhalers) are essential to managing COPD symptoms. Most patients are given inhalers, which have a rapid effect to keep airways as wide open as possible and relieve breathlessness.

An important non-medical intervention for patients is pulmonary rehabilitation. The principal goals of pulmonary rehab are to reduce symptoms and improve quality of life through patient education, and the teaching of breathing techniques and exercises to increase lung capability.

Another option for COPD patients is Lung Volume Reduction Surgery, which involves the removal of diseased lung tissue to create more room in the chest cavity for the good lung tissue to work.

It is essential for COPD patients and their physicians to coordinate closely for maximum effectiveness in providing recommendations based on individual cases.

• Managing exacerbations

The most common causes of COPD exacerbations or complications are infection and air pollution, but the cause of about one-third of severe exacerbations cannot be identified.

Patients experiencing COPD with clinical signs of airway infection (increased breathlessness, a change in the volume or color of phlegm, fever, etc.) may benefit from antibiotics. Adjustments in bronchodilator therapy through increased dosage or combinations of inhaler types may also be recommended.

• The future of COPD

Extensive research is essential in determining effective methods and new approaches to the management of the disease. There is a pressing need to develop drugs that control symptoms and prevent the progress of COPD.

Some advances have been made and there are several classes of drugs currently in development for COPD patients. But since COPD is not fully reversible and slowly progressive, it is important to identify early cases as more effective therapies emerge.

An important goal is to reduce the prevalence of smoking and prevent young people from starting the cigarette habit. — V. Foz