Know the Warning Signs of COPD
In the beginning stages of chronic obstructive pulmonary disease (COPD), patients may have no symptoms – or have only mild ones. But as the disease progresses, symptoms may include chest tightness, a cough with mucus, low fever, shortness of breath and wheezing. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) no longer emphasizes distinguishing chronic bronchitis from emphysema, the two main types of COPD. It instead focuses on the airflow-limited state.
That said, COPD is a disease that includes persistent respiratory symptoms accompanied by airflow limitation that is secondary to airway and/or alveolar abnormalities, often caused by significant exposure to noxious gases or particles. Chronic bronchitis is defined as the presence of cough and sputum production for at least three months a year in each of two consecutive years, according to GOLD’s 2019 report.
Patients with chronic bronchitis and emphysema may be differentiated by their presentation, including associated cardiac and lung assessment findings, sitting position in the office, type of cough and weight. Those with chronic bronchitis may be obese and experience frequent coughing with expectorant, coarse rhonchi and wheezing on lung exam, and edema and cyanosis that can be associated with right-sided heart failure. They also may be thin and have barrel chests.
Hyper-resonant lung sounds and wheezing may be heard, or they may have pursed lip-breathing accompanied by a tripod position and use of accessory muscles and little or no cough or expectorant reported.
COPD diagnosis is made with spirometry, when the ratio of forced expiratory volume in one second is less than 70 percent of a match control, signifies an obstructive defect. A high-resolution computed tomography can help diagnose emphysema, given that it has better sensitivity then a chest radiograph.
The six-minute walk test is part of the BODE index (Body-mass index, airflow Obstruction, Dyspnea, and Exercise) to predict mortality for patients with COPD. There are other tests, of course. Differential diagnosis of COPD can include asthma, bronchiectasis, congestive heart failure, diffuse pan bronchiolitis, and obliterative borchiolitis.
The key to managing COPD is a thorough assessment that includes spirometry testing, the nature and magnitude of the symptoms, history of moderate and severe exacerbations and future risk, and presence of comorbidities, such as diabetes, gastroesophageal reflux disease, heart failure and osteoporosis.
The GOLD (2019) refined ABCD assessment tool can then be used to guide treatment, the goals of which include improving exercise tolerance and health status, preventing disease progression, preventing and treating exacerbations, reducing mortality and relieving symptoms. Smoking cessation is key to managing chronic bronchitis and COPD.
Treatment includes medications, such as inhaled or oral corticosteroids, short- and long-acting bronchodilators, phosphodiesterase, inhibitors, respiratory anticholinergics and a combination medication and corticosteroids or anticholinergic inhalations. Treatment may also include improved diet, infection control, management of sputum viscosity and clearance, oxygen therapy, pulmonary rehab, smoking cessation, vaccinations and anti-trypsin deficiency treatment to aid the patient’s functional status and quality of life.
Chronic bronchitis is the beginning point of the progression of COPD. Research is being done to analyze mucin concentration and phlegm samples, as well as clinical trials for patients with chronic bronchitis by attempting to kill cells that produce mucus with low-level energy.
