Chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling respiratory disease, but it is a condition that can be prevented and treated.
References +

1. World Health Organization. the Global Burden of disease www.who.int. visitado 29 abril 2020.

2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2020. http://www. goldcopd.org/ [visitado 29 abril 2020].

3. Fletcher MJ, Upton J, Taylor-Fishwick J, Buist SA, Jenkins C, Hutton J et al. COPD uncovered: an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population. BMC Public Health 2011;11:612.

4. Toy EL, Gallagher KF, Stanley EL, Swensen AR, Duh MS. The economic impact of exacerbations of chronic obstructive pulmonary disease and exacerbation definition: a review. COPD 2010;7(3):214-228.

5. World Health Organization. World Health Statistics 2008. http:// www.who.int/gho/publications/world_health_statistics/EN_ WHS08_Full.pdf.(visitado 29 abril 2020).2008

6. Decision Resources. Mosaic Study #3 - Chronic Obstructive Pulmonary Disease. 2007. Waltham, MA, Decision Resources, Inc. https://decisionresourcesgroup.com/ visitado a 8 de maio de 2020

7. Dockery DW, Speizer FE, Ferris BG, Jr., Ware JH, Louis TA, Spiro A, III. Cumulative and reversible effects of lifetime smoking on simple tests of lung function in adults. Am Rev Respir Dis 1988; 137(2):286-292.

8. Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet 2007; 370(9589):786-796.

9. Anecchino C, Rossi E, Fanizza C, De RM, Tognoni G, Romero M. Prevalence of chronic obstructive pulmonary disease and pattern of comorbidities in a general population. Int J Chron Obstruct Pulmon Dis 2007; 2(4):567-574.

10. Van der Molen T. Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences. Prim Care Respir J 2010; 19(4):326-334.

11. Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax 2010; 65(11):956-962.

12. Barr RG, Celli BR, Mannino DM, Petty T, Rennard SI, Sciurba FC et al. Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med 2009; 122(4):348-355.

13. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003; 107(11):1514-1519.

14. Boutin-Forzano S, Moreau D, Kalaboka S, Gay E, Bonnefoy X, Carrozzi L et al. Reported prevalence and co-morbidity of asthma, chronic bronchitis and emphysema: a pan-European estimation. Int J Tuberc Lung Dis 2007; 11(6):695-702.

15. Darkow T, Kadlubek PJ, Shah H, Phillips AL, Marton JP. A retrospective analysis of disability and its related costs among employees with chronic obstructive pulmonary disease. J Occup Environ Med 2007; 49(1):22-30.

16. El-Zein RA, Young RP, Hopkins RJ, Etzel CJ. Genetic predisposition to chronic obstructive pulmonary disease and/or lung cancer: important considerations when evaluating risk. Cancer Prev Res (Phila) 2012; 5(4):522-527.

17. Agusti A. Systemic effects of chronic obstructive pulmonary disease: what we know and what we don’t know (but should). Proc Am Thorac Soc 2007; 4(7):522-525.

18. Howard K, Berry P, Petrillo J, Wiklund I, Roberts L, Watkins M et al. Development of the Shortness of Breath with Daily Activities questionnaire (SOBDA). Value Health 2012; 15(8):1042-1050.

19. NORMA CLÍNICA: 005/2019. Diagnóstico e Tratamento da Doença Pulmonar Obstrutiva Crónica no Adulto. 26 agosto 2019. www.dgs.pt

Respiratory Area

According to WHO data, there are about 210 million people with COPD, 65 million with moderate to severe COPD, causing 3 million deaths globally. (1),(3),(19) It is estimated that by 2030, COPD will be the third cause of death in the world. (1)

COPD

COPD is defined as a frequent, preventable and treatable disease characterized by persistent respiratory symptoms and limitation of airway flow resulting from alveolar and/or airway changes caused by significant exposure to harmful particles and gases. (2)

COPD has a high impact on both individuals and society

In addition to being a disabling disease associated with premature mortality, COPD is also associated with increased health care needs and hospital stays due to exacerbations. (1),(3),(4) The cost of COPD is more than just financial, as it affects the quality of life of patients and has a detrimental impact on their mental health (1),(2),(3)The prevalence of COPD is expected to increase in the coming decades. (2),(5)

Risk Factors (2)

  • SMOKING
  • Exposure to polluting gases, dust or chemicals
  • Family History (rare and more frequent in individuals of European descent)
  • Poor lung development (decreased lung function)
  • Nutrition and Socioeconomic Status
  • Respiratory infections (in childhood)

How does COPD cause airflow limitation?

The typical airflow limitation of COPD is caused by narrowing and/or obstruction of the airways, loss of elastic retraction, or both (6).

Adapted from 6

Symptoms

  • Dyspnea is the distinctive symptom of COPD. It is usually persistent and progressive - also known as shortness of breath (7)
  • Chronic cough (7)
  • Wheezing (7)

What is an exacerbation? (8)

  • It is an acute worsening of symptoms
  • Increased shortness of breath during normal daily activities, with a consequent increase in the use of usual medication and/or need for medication.
  • Sputum production, which can become more frequent than is normal for the patient, or be viscous;
  • Cough that can occur due to increased sputum

Impact of exacerbations

  • Increased airway inflammation
  • Decreased quality of life (8)
  • Increased mortality rate (8)
  • Rapid decline in lung function (8)

Associated illnesses (9)

  • Cardiovascular diseases (10),(11)
  • Diabetes (12),(13)
  • Depression(14)
  • Osteoporosis(14),(15)
  • Lung cancer (16)
  • Weight loss (17)

Diagnosis (19)

The clinical diagnosis of COPD should be considered in any patient who has the following symptoms:

  • Dyspnea, chronic cough or sputum

Airflow measurement by spirometry is required (2)

  • presence of air flow obstruction due to spirometric changes (FEV1/FVC ratio below 0.70 after bronchodilation) (19)

Adapted from 19

How are symptoms assessed?

  • Medical Research Council (mMRC) modified dyspnea scale - assesses dyspnea intensity, ranging from zero to four.(2)
  • COPD (CAT) assessment test questionnaire - Measures the impact of COPD on quality of life.(2)
  • COPD clinical questionnaire (CCQ) - measures functional status, symptom and mental status), related to people with COPD.(2)
  • Questionnaire about shortness of breath with daily activities (SOBDA) (18)

Treatment objectives

1. Reduction of current symptoms (2):

  • Relief of symptoms;
  • Improved tolerance to physical exercise;
  • Improved health status.

2. Reducing future risks consists of (2):

  • Preventing disease progression;
  • Preventing and treating exacerbations;
  • Decreased mortality.

Treatment

The main therapeutic measures are (2):

  • Quit smoking
  • Medicines - Bronchodilators (used according to the severity of the disease and the presence or absence of exacerbation)
  • Respiratory rehabilitation
  • Oxygen therapy
  • Proper nutrition and lifestyle

Acronyms:
COPD - Chronic Obstructive Pulmonary Disease
WHO - World Health Organization
FEV1 - Forced expiratory volume in 1 second
FVC - Forced Vital Capacity
GOLD - Global Initiative for Chronic Obstructive Lung Disease
mMRC – Modified Medical Research Council dyspnea scale
CAT – Scores de COPD assessment test
CCQ – Clinical COPD Questionnaire
SOBDA – Shortness of Breath with Daily Activities Questionnaire

Medinfar-2020-05-FL-02 drafted in April 2020