ChronicObstructive Pulmonary Disease (COPD)
ChronicObstructive Pulmonary Disease (COPD)
Humanbeings are exposed to different factors that subject them to the riskof suffering from respiratory diseases. The chronic obstructivepulmonary disease (COPD) is among the most common types ofrespiratory illnesses that are reported in the health carefacilities. The COPD is a medical condition that results fromprogressive destruction of different airways, a process that ischaracterized by a gradual loss of the functionality of the lungs(Bhandari & Sharma, 2012). This loss of ability to function isattributed to a combination of emphysema and chronic bronchitis. Thefact that COPD is a highly prevalent disease that kills millions ofpeople globally makes it a medical condition worth studying. It isestimated that the global prevalence rate of COPD is 10-20 % of thetotal population of people aged 40 years and above, and it killsabout 3 million patients annually (Bhandari & Sharma, 2012). Thispaper will address COPD, with a focus on its natural history,etiology, incidence rate, diagnosis, prevention strategies, andpolicy recommendations.
TheNatural History of COPD
Thestudy of COPD and related components (including chronic bronchitis,emphysema, and asthmatic bronchitis) has taken place for more thantwo centuries. Some of the key symptoms (such as voluminous as wellas turgid lungs) were reported as early as 1679 and 1769 by scholarsBonet Geneva and Morgagni, respectively (Petty, 2006). A discoverythat the disease is chronic was made in 1814 by Badham, while itsemphysema component was revealed by Laennec in 1821 (Petty, 2006).These early scholars referred to COPD as a disease of the chest dueto location of the lungs and the breathing system. In 1944, RonaldChristie recognized the fact that the medical history of the patientand individual components of the disease are significant aspects thatneeds to be considered when diagnosing COPD. Some of the key scholarswho made a significant contribution towards the development of themethods (such as flow volume patterns and spirometry) used todiagnose COPD in the 1950s include Dayman and Dickerson Richards.
Thefoundation of the key components that are used to diagnose COPD todaywas laid down in 1962 by the American Thoracic Society Committee onDiagnostic Standards (Petty, 2006). The disease was given manyacronyms (such as non-specific chronic pulmonary disease and chronicobstructive lung disease) in the early 1960s as different scholarstried to study its severity and the number of components that shouldbe considered when diagnosing COPD (Petty, 2006). However, the termCOPD was first used by a researcher, William Briscoe in 1965. Theidea of organizing a series of conferences that could bring togetherdifferent stakeholders was coined by Roger Mitchell in 1958. Theseconferences were held in Aspen, Colorado, and their objective was tocreate a platform on which scholars could share their knowledgeregarding the diagnosis as well as the treatment of COPD (Petty,2006).
Therelationship between smoking and the risk of contracting COPD wasdiscovered by Chares Fletcher in the 1970s. This scholar determinedthat a decision to stop smoking would reduce the rate at which FEV1declines, which would in turn minimize the risk of getting COPD(Petty, 2006). Major studies focusing on prognosis of COPD started inthe late 1960s. A study of prognosis of COPD, which was conducted byBurows and Earle between 1969 and 1987, indicated that patients whohad a low FEV1/FVC percentage experienced a higher rate of FEV1decline (Petty, 2006). This was an indication of poor prognosis.
Thecourse of the disease was determined between 1980s and 2000 bydifferent scholars. It was discovered that the structure of thebreathing system is damaged early in the course, which leads to theloss of its elastic recoil. The initial damage to the lungs takesplace in the small air passages and around alveoli. The elasticity ofthe structure that supports the lungs is lost when alveoli aredamaged. This results in an increase in resistance of airways and adecrease in elastic recoil (Petty, 2006). This is followed by anincrease in the size of the lungs and FVC. The physioloc alterationof the lungs then takes place and it can be discovered using thespirometry method. Its symptoms appear when it reaches the moderateor advanced stages (Petty, 2006). The length of the course variesfrom patient to another, depending on the level of exposure to therisk factors.
Etiologyand COPD’s Risk Factors
Thereare many factors that contribute towards the occurrence of COPD. Theleading cause of the disease is smoking, which is estimated toaccount for between 80 and 90 % of all cases of COPD (American LungAssociation, 2016). A study conducted by Macnee & Rennard (2012)indicated that black smoke causes COPD-related mortality with oddsratio =1.182 95 % confidence interval. Cigarettes produce about7,000 chemicals where most of them are harmful. The harmful chemicalsare responsible for the occurrence of COPD. These chemicals lead tothe development of COPD by weakening the lung’s defense againstinfections, causing swelling in the air tubes, and the destruction ofair sacs.
Thesecond cause of COPD is individual’s exposure to environmentalfactors. Some of the key environmental factors that are responsiblefor the occurrence of COPD include the secondhand smoke, airpollutants, chemicals, and fumes (ALA, 2016). Studies haveestablished a positive association between the risk for theoccurrence of COPD and second hand smoking with OR = 1.12 and 95 CI(Koeverden, Blanc, Bowler & Arjomandi, 2015).
Thethird type of COPD’s cause is genetic predisposition. Alpha-1deficiency has been shown to cause emphysema, which is among the keycomponents that are considered when diagnosing COPD (ALA, 2016). Thelack of capacity to produce alpha-1, which is a protein that isresponsible for the protection of the lungs, is a heritablecondition. This has been confirmed by a study showing that a severedeficiency of genes that code for Alpha-1 leads to COPD with OR = 1.5and 95 % CI (Sorroche, Acquirier, Jove, Giugno, Pace, Livellara,Legal, Oyhamburu & Saez, 2015).
COPDis a serious disease that affects all members of the society,irrespective of their social as well as demographic features. Itsprevalence rate varies from one state to another. Some states (suchas Colorado and Hawaii) have a prevalence rate of less than 4 %,while others (including Kentucky, Alabama, and West Virginia) haveincidence rates of more than 9 % (Center for Disease Control andPrevention, 2016). On average, it is estimated that about 12 % of thetotal number of the U.S. adults are diagnosed with COPD, whichtranslates to about 30 million people (ALA, 2016). Scholars and thestakeholders in the health care sector hold that COPD is among themost under-diagnosed illnesses, which suggest that the prevalencerate could be higher.
Aconsideration of some risk factors (such as smoking) suggests thatmen could be at a higher risk than their counterpart female subjects.However, empirical studies indicate that COPD is more prevalent amongwomen than men. This trend is attributed to three key factors. First,the tobacco industry targeted women in the 1960s, which has beenconfirmed by studies showing that the prevalence rate of COPD amongthe female subjects increase with age (ALA, 2016). Secondly, womenare considered to be more vulnerable to lung damage that results frompollutants, including the cigarette smoke. This level ofvulnerability is attributed to the high concentration of estrogen andthe fact that the women’s lungs are smaller than those of men.Lastly, COPD has historically been misdiagnosed among women since itis believed to be a man’s disease.
Interms of death rate, COPD is classified as the third leading cause ofmortality in the U.S. after cancer and various heart diseases (ALA,2013). It is estimated that age-adjusted death rate as a result ofCOPD varies between 15.3 for every 100,000 people in Hawaii and 62for every 100,000 in Kentucky (ALA, 2013). The average age-adjusteddeath rate has declined from 57 for every 100,000 persons in the year1999 to 44.3 for every 100,000 people in 2014, but there is nosignificant change that has been reported among women (CDC, 2016).The gender difference in incidence rate is confirmed by studiesshowing that about 52.3 % of all people who die of COPD are women(ALA, 2013). Some racial differences have also been reported on theprevalence of COPD. About 80 % of the all deaths affect non-Hispanicwhites, where the least number of cases of mortality is reportedamong Hispanic citizens (ALA, 2013). Therefore, COPD can affect allpeople, but women and non-Hispanic whites are more vulnerable.
Thereare many methods that can be used to test and diagnose COPD, but fiveof them are more important. The first and the most commonly usedmethod is spirometry. This method is preferred by many health careproviders because it is easy and quicker (COPD Foundation, 2016). Aspirometry test is recommended for all individuals with symptoms forCOPD, a history of smoking, exposure to smoke, and previous cases ofchronic lung diseases in the family.
Secondly,COPD can be diagnosed using bronchodilator reversibility method. Itis recommended that this reversal method should be conducted once onthe patient since it helps the health care providers establishsuitable lung function and exclude asthma (COPD Foundation, 2016). Inaddition, bronchodilator reversibility method enables the health careproviders to estimate the COPD prognosis.
Thethird method used to diagnose COPD is chest radiography. This methodis considered to be essential, but it has some limitations. Forexample, chest radiography fails to give the health careprofessionals an opportunity to reduce the possibility of otherillnesses, such as cancer, congestive heart failure, and pneumonia(COPD Foundation, 2016). This limitation implies that application ofchest radiography method could lead to a misdiagnosis.
Fourth,alpha-1 antitrypsin deficiency (AATD) testing is a diagnostic methodthat is recommended by credible organizations, such as WHO and ERS.The effectiveness of this diagnostic method is based on the fact thatAATD is a significant COPD’s genetic risk factor (COPD Foundation,2016). Therefore, the detection of deficiency of this protein canenable the health care providers to deliver a unique therapy to COPDpatients.
Thefifth method, computer tomography, is recommended when COPD diagnosisthat is performed using other strategies is unclear. One of the keybenefits of computer tomography is the high level of accuracy (COPDFoundation, 2016).
Thestrategies used to prevent the occurrence of COPD can be classifiedinto primary, secondary, and tertiary measures. The effectiveness ofthe primary strategies is achieved when the exposure of vulnerablepeople to the risk factors is minimized (WHO, 2016). For example, thereduction of a direct as well as indirect exposure to tobacco smokehas been confirmed to be an effective strategy that minimizes therisk of COPD. However, the application of the primary methods isbeyond the scope of the health care providers, which calls for thecollaboration among all stakeholders. For example, the members of thecommunity need to be enlightened about the sources of pollution (suchas smoke) that they need to avoid. This can help them to minimize therisk of suffering from COPD. Additionally, civic education programsthat focus on enlightening the population about healthy living can goa long way in helping the vulnerable individuals to limit theirexposure to the risk factors. In essence, the primary COPD preventionstrategies aim to empower the population.
Secondaryand tertiary methods of preventing COPD
Thesecondary methods of prevention involve the early detection of COPDin order to reduce its risk of progression to a more seriouscondition. Early detection of COPD ensures that the disease can bemanaged through the cost effective medication. For example, the earlydiagnosis of occupational asthma, which is one of the key riskfactors for COPD, can help the affected persons reduce theprobability of the diseases progressing to a stronger respiratoryillness (WHO, 2016). Although asthma has no cure, its early detectioncan give the patient a chance to avoid coming into contact withallergens, thus keeping it under manageable levels. In addition,diseases (including asthma) that increase the risk of contractingCOPD can be managed using pharmacological products (such asanti-inflammatory drugs), thus reducing the risk of the developmentof a more chronic illness. Apart from the reduction of allergens andthe early management of preliminary diseases, vaccination has beenproven to be an effective strategy for prevention of influenza, whichamong the key risk factors for COPD (WHO, 2016).
Thereare four specific policy recommendations that can be considered whendesigning strategies to reduce the prevalence of COPD. First, thegovernment should increase surveillance and evaluation of the datarelated to COPD. Currently, the government includes some informationthat is related to COPD in the population-based surveys. However, thedata need to be analyzed further and new questions included in orderto make the surveys more cost-effective, informative, and timely(CDC, 2011).
Secondly,the government should increase support for applied and epidemiologicprevention research that should explore the key risk factors,measures for COPD prevention, and treatment options. Currently, COPDis considered as an incurable disease, which implies that preventionis a vital (CDC, 2011). Therefore, new epidemiologic studies underthe support of the government could lead to the discovery ofeffective treatment modalities and prevention measures.
Third,the government should increase policy-related collaboration withpartner organizations. Currently, all levels of government havesurveillance and COPD prevention programs, but there are limitedplatforms on which they care share relevant data (CDC, 2011).Therefore, collaboration between the local, federal, and stateagencies can create synergy and lead to successful prevention ofCOPD. For example, the establishment of indoor quality air assuranceprograms in all workplaces requires the concerted efforts of allrelevant government and non-governmental agencies.
Fourth,the government should increase awareness among the vulnerable groups,including COPD patients, their relatives, health professionals, andindividuals who are exposed to environmental risk factors. Thisrecommendation is based on the fact that the current level ofawareness about COPD and prevention measures is quite low (CDC,2011). Specific actions that should be taken in order to enhanceawareness include meetings with relevant stakeholders to discussemerging trends and conducting civic education programs.
Thereare many diseases that affect the human respiratory system, but COPDis among the illnesses with the highest prevalence rates. Itsoccurrence is attributed to progressive destruction of the airways,which reduces the capacity of the lungs to function properly. COPDcan affect all people, but it is more prevalent among thenon-Hispanic whites and women. Its key risk factors can be classifiedas environmental (including an exposure to smoke) and geneticpredisposition. The most effective strategies used to prevent theoccurrence of COPD can be classified into primary, secondary andtertiary and they involve the reduction of exposure to the mostcommon risk factors and the management of preliminary disease (suchas asthma) that tend to enhance the level of vulnerability. Thegovernment should develop policies that will enhance collaborationamong the stakeholders, intensify epidemiologic research, andincrease public awareness about COPD.
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