Evolving Definition of COPD

Challenges of a disease

Experts from around the world have been challenging the burden of COPD since a couple of decades ago. However, one of the most relevant challenges has been the education on the disease and what it really represents not only for the medical community but for the very patient.

The history

Years ago, scientists didn’t see light in the chronicity of the disease. It’s perpetuating agressive cycle was like a ghost that physicians didn’t want to deal with and so… the patient. The decline in lung fuction no matter the measures was deppressing and the pulmonologist was like a priest at the end of life.

Words

The word emphysema meant the worst thing a person could suffer (after cancer of course). Patients considered that it was their fault and didn’t want to see a doctor since the only solution would be smoking cessation and some unproductive support.

Advances

Recently, due to research and a careful assessment of sufferers, the definition of COPD has evolved. Traditionally it was considered relentless, lethal, no effective measures allowed… Now we define the disease in terms of airflow obstruction, chronic but partially reversible and, said this, treatable.

Armamentarium of opportunities

Bronchodilators, the corner stone for airflow obstruction management started to show their benefits. Pulmonary rehabilitation opened a window to better health related quality of life. Oxygen for advanced stages was found to help too. Antiinflamatory drugs started to be formulated in inhalers. The disease was reorganized according to spirometry measurements and evidence based recommendations.

And now: a treatable disease

These days we can now talk about a chronic treatable disease associated to cigarette smoking among other risk factors. More opportunities for the patient to find out what to do. More resources to understand their doctors (with their typical limited time). And more investigations on progress on the field.

Work in progress

Although there’s a long way to walk through, never it’s to late to understand that diseases may occur but our empowerment is fundamental to confront them with good will, appropriate medical support, and self education well controlled. Great that we all can deal with problems…

Who’s smoking this days?

COPD and its associations
Chronic Obstructive Pulmonary Disease is associated to cigarette smoking in more than 70% of cases. However, COPD is only one of the consequences of smoking. Everybody knows that this behavior is also associated to lung cancer, a wide spectrum of cardiovascular diseases, other cancers, and many other conditions.

Measures against smoking
Here in New York it has been adopted the measure of banning smoking in almost everywhere. Airports around the world understood that they are closed spaces and need clean air to breath. Buses, trains, planes, etc also need clean air (as well as apartments, corridors, stairs, sidewalks, etc).

Origins of smoking behavior
Many years ago smoking was a male behavior. Men were then affected by its related conditions in a higher rate than women or younger populations.
When it was announced that smoking was not the best choice for an off moment, the target of marketing changed to women and the youngest (just see the publicity from the 60s, 70s, and 80s).

The change
The nightmare just then started. This days it is known that COPD has changed its population too. COPD is currently affecting more and more women than ever. In 2000 the number of hospitalizations associated to COPD in women outnumbered those for men and women also started reporting more than half of cases by 2004. The sad part of the unnecessary tale is that COPD deaths almost tripled in women from 1980 to 2000. Of course this is another evidence that smoking incidence has increased in women.

More than a woman
COPD has started to create a burden for younger population. Patients with less than 65 years old are increasing in number at medical offices and hospitals. It has also seen that COPD is as common as diseases of younger crowds like asthma and diabetes in those between 45 and 54 years old.

Affecting the working population

The pain that this give to the society is aggravated by the reality that this age range is the working population. The bitter reality of all this is that 70% of patients with COPD are younger than 65 years old.
It’s then important to realize that everybody needs smoking cessation counseling as well as educational efforts should never stop being aggressive as they can.

Effort requested
Every minute accounts in the medical office to chat about smoking and its effects on the health and its related quality of life. Every effort at home to ban smoking and educating about cigarette smoking and illness may be so relevant that its results will provide with sense of feeling grateful for the years ahead. Parents talk frequently about candies, vicious snacks, hand washing, etc but they should talk openly about smoking and its associated decline in lung health and general well being.

Finally
So… women, girls, and boys: no smoking please. A condition called COPD is being reported more in all of you and it’s not by coincidence.

Behind the Best Treatment for COPD?

Many Components

COPD is a multifactorial disease. Thinking about its treatment requires to consider this reality. It’s not a knot in the hair that you can cut and nothing else happens. Since most of the cases are associated to cigarette smoking there’s no doubt that the best management starts with this measure. However, its several components need to be addressed when planning its follow up.

… cigarette-cigarette: stop doing that!

After taking into account the reality of cigarette smoking as the physical and chemical element responsible for the origin, it’s necessary to consider the response of the organism as a target for management. The classical response of the organism after a repetitive injury is the protection. In case of lungs what they can do (if we accept the similitude with an entire being) is to close the airways.

Closing the door to protect

Although there’s no doubt that the irritation leads to some type of inflammation, the persistent feature will be the airways closure (bronchoconstriction). If this is the situation, the most open we can keep the airways the most we help to ease breathe. Medications which mechanism of action implies the relaxation of the muscles around the lung airways are called bronchodilators.

Bronchodilators

It seems reasonable that as soon as a diagnosis of chronic airways obstruction in the lung is made, it should be initiated therapy with bronchodilators. The point of sensitivity with bronchodilators is that they should be inhaled to allow a most effective local action and less general consequences. Guidelines have been recommended to start with bronchodilators soon after diagnosis. Unfortunately, the scientific evidence has not been enough to support an early continuous therapy with bronchodilators and they are being suggested to be used as on a needed basis (as if there were not chronic disease).

Bronchodilators can be of short action or long acting. Short acting agents only help to relieve sudden symptoms while long acting point toward a prolonged relieve. Since the disease is chronic and progressive, all COPD patients will require long acting bronchodilators to maintain their symptoms under control.

Effects of Bronchodilators

Bronchodilators have shown to increase the airflow in and out of the lungs. This effect is seen in the improvement of FEV1 values. The improvement in FEV1 will eventually lead to reductions in the air trapped inside lungs that is said to be responsible for breathlessness. If the air trapping is reduced, dyspnea decreases and patients may tolerate more physical activities, which has been demonstrated in trials associating increases in airflow and exercise tolerance in the laboratory.

More than bronchodilators

However, it’s also relevant to mention that the complex nature of the disease may require adjustments of therapy according to patient responses, incidence of exacerbations, presence of other diseases (comorbidities), etc.

Said this, it should be consider that some patients may require more than one medication to cope with excess risk of exacerbations, infections, physical attiude, etc.

So..

So, let’s keep in mind: there’s no better treatment for COPD but key elements to cover followed by the consideration of the complexity of the illness and individual features that will help address the different aspects of the disease.