(Chronic Bronchitis and Emphysema)
COPD = chronic bronchitis and emphysema
--both characterized by obstruction to airflow
--does not include asthma
--fourth leading cause of death in America, claiming the lives of 122,283 Americans in 2003
--the number of women dying from the disease has surpassed the # of men, for four years now. In 2003, over 63,000 females died compared to 59,000 males.
--Primary risk factor: smoking
--other risk factors: air pollution, 2nd-hand smoke, industrial pollutants, heredity, Hx of childhood resp infx
--80 to 90% of COPD deaths are caused by smoking
--Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked.
--Male smokers are nearly 12 times as likely to die from COPD as men who have never smoked.
--the fraction of COPD attributed to work was estimated as 19.2% overall and 31.1% among never smokers.
--may be underdiagnosed as 11.4 million US adults estimated to have COPD ni 2004, but more like 24 million have evidence of impaired lung fx
--2004 cost to the nation for COPD was approximately $37.2 billion, including $20.9 billion in direct health care expenditures, $7.4 billion in indirect morbidity costs and $8.9 billion in indirect mortality costs.
--A recent American Lung Association survey revealed that half of all COPD patients (51%) say their condition limits their ability to work. It also limits them in normal physical exertion (70%), household chores (56%), social activities (53%), sleeping (50%) and family activities (46%).
--None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease. Therefore, the goal of pharmacotherapy for COPD is to provide relief of symptoms and prevent complications and/or progression of the disease with a minimum of side effects.
--Bronchodilators, inhaled or oral
--systemic glucocorticosteroids, inahled under study, short term benefit has been demostrated, serious side effects with long term.
--vaccines for Pneumonia and influenza
--healthy lifestyle by exercising, avoiding cigarette smoke and other air pollutants, and eating well.
--Pulmonary rehabilitation is a preventive health-care program provided by a team of health professionals to help people cope physically, psychologically, and socially with COPD.
--may require supplemental oxygen
--may have to rely on mechanical respiratory assistance
--lung volume reduction surgery (LVRS) is controversial and risky
--Treatments for AAT deficiency emphysema (lifelong AAT replacement therapy) and gene therapy are being tested
Chronic bronchitis =
--inflammation and eventual scarring of the lining of the bronchial tubes
--frequent throat clearing
--shortness of breath
--presence of a mucus-producing chronic cough most days of the month, three months of a year for two successive years without other underlying disease to explain the cough.
--chronic not acute, often ignored until it is life threatening
--In 2004, an estimated 9 million Americans reported a physician diagnosis of chronic bronchitis.
--higher in those over 45 years old
--Females more than twice as likely to be diagnosed
--begins with the destruction of air sacs (alveoli). Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.
--shortness of breath, cough
--lower exercise tolerance
--lungs also lose their elasticity
--chronic, not acute
--Of the estimated 3.6 million Americans ever diagnosed with emphysema, 91 percent were 45 or older, 54.8 percent are male and 45.2 percent are female. --- in the last year prevalence rate for women has seen a 20 percent increase where as men have seen a decreased of 19 percent.
--Diagnosis is made by pulmonary function tests
Alpha1 antitrypsin deficiency-related (AAT) emphysema
--caused by the inherited deficiency of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. AAT, produced by the liver, is a "lung protector." In the absence of AAT, emphysema is almost inevitable. It is responsible for 5% or less of the emphysema in the United States. An estimated 100,000 Americans, primarily of northern European descent, have AAT deficiency emphysema. Another 25 million Americans carry a single deficient gene that causes Alpha-1 and may pass the gene onto their children. Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age and include shortness of breath and decreased exercise capacity. Smoking significantly increases the severity of emphysema in AAT-deficient individuals. Blood screening is primarily used to diagnose whether a person is a carrier or AAT-deficient. If children are diagnosed as AAT-deficient through blood screening, they may undergo a liver transplant.20 In addition, a DNA-based cheek swab test has been recently developed for the diagnosis of AAT-deficiency. A recent study suggested that there are at least 116 million carriers among all racial groups, worldwide.