Chronic Obstructive Lung Disease (COLD)

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Chronic Obstructive Lung Disease is a preventable and treatable disease, with significant extrapulmonary effects that may contribute to disease severity. This disease, whose evolution is painless, as the main risk factor tobacco smoke and is often misdiagnosed.

Every patient deserves a particular therapeutic approach, with significant respiratory functional rehabilitation in many cases. Drug therapy should be maintained where there is indication for such discontinuation may lead to worsening of the disease and the onset of complications.

Nonspecific and Progressive Symptoms
Patients with Chronic Obstructive Lung Disease is a typical adult over the age of 40 who has risk factors (such as history of smoking or dust exposure) and symptoms of productive cough and exertional dyspnea (shortness of breath). The diagnosis is confirmed by studies that show a functional respiratory pattern of limitation of air speeds.

Often these patients are treated for the first time after the occurrence of an increased difficulty breathing, subsequently using medical care due to relapse or the presence of dyspnea, a symptom that is already associated with a significant deterioration of respiratory function. The characteristic painless evolution of the disease leads to a considerable number of patients presenting himself as a medical consultation with dyspnea on exertion that usually shows as a disability patent.

The presence of chronic inflammation is the basis of a slow and progressive reduction of the airflow that is not fully reversible in Chronic Obstructive Pulmonary Disease. The limitation of airflow is associated with an abnormal inflammatory response of the lung to noxious particles and gases.

Initially most of these patients reported shortness of breath and an abnormal fatigue in the performance of certain tasks. That is, they start to get tired going up stairs and start to ride in the elevator when you do sport, they fail to do so, but always blame tobacco. Tobacco is indeed largely responsible for the symptoms but the disease is already owned!
Patients develop a chronic productive cough (sputum) and varying degrees of difficulty breathing (dyspnea or) that will worsen with disease progression. This induces a progressive loss of capacity to develop the activities of daily living.

A 2003 report from the National Institute of Statistics identifies the Chronic Obstructive Pulmonary Disease as the fifth leading cause of death in Portugal. This disease represents 2.5% of the total number of deaths, 3.2% in men and 1.7% in women and is the second leading cause of hospitalization for respiratory disease. The number of hospitalizations increased 110% between 1994 and 2007 (from 4,333 to 9,143 hospitalizations).

Moreover, periodically, there is a worsening of respiratory distress (or exacerbations). These events are responsible for most of the costs of treatment due, in particular, the use of unscheduled visits and the use of emergency services involving often intensive treatment and prolonged hospitalization.

The Early Diagnosis Stop Disease Progression
The diagnosis of Chronic Obstructive Lung Disease involves a clinical trial based on a combination of personal and family history, physical examination and confirmation of the presence of airway obstruction. The presence of airway obstruction is identified by respiratory function tests, particularly by spirometry.

Chronic Obstructive Lung Disease is a heterogeneous disease and no action by itself can provide an adequate assessment of its severity in an individual patient. For example, a slight bronchial obstruction may be associated with a significant disability. A true assessment of severity should include determining the degree of bronchial obstruction, disability, history of exacerbations, and the presence of complications (respiratory failure, right heart failure, weight loss and arterial hypoxemia).

The disease can be mild, moderate, severe and very severe. But many of the diagnoses are made already in the later stages, when there are already many symptoms, especially when the patient goes to the doctor for a cold or a respiratory infection. If their diagnosis and therapeutic intervention is made effectively in mild stage, is much better for the patient who may not even need medication. All you need is no longer exposed to the disease-causing agents and here is crucial to quit smoking. The patient stabilizes and the disease does not evolve.

The Evolution of the Disease and its Treatment
The chronic and progressive course of Chronic Obstructive Pulmonary Disease is often aggravated by exacerbations.Exacerbations are periods where there worsening of symptoms, particularly cough, dyspnea and sputum production and can be defined as an increase in respiratory symptoms over the basic situation that usually requires changes in therapy.

These exacerbations of Chronic Obstructive Pulmonary Disease is an important measure of disease severity and have a negative impact on disease progression, duration of recovery, relapse rate and morbidity and mortality.

Exacerbations have a significant effect on the patient and society including worsening of health status and quality of life and increased hospitalizations and costs to the patient and mortality. Given these consequences, prevention of exacerbations is recommended as one of the key objectives of the treatment of Chronic Obstructive Pulmonary Disease.

Treatment of Chronic Obstructive Pulmonary Disease includes pharmacological and nonpharmacological interventions. Smoking cessation is the most important in treating this disease by reducing its rate of progression. Once the lung lesions that occur are only partially reversible, its goal is not cure the disease but to improve the quality of life and functional capacity. The pharmacological treatment of Chronic Obstructive Lung Disease is usually characterized by a stepwise increase in order to follow the evolution of the disease presented by the patient's symptoms and clinical presentation.

All clinical guidelines recommend bronchodilators as essential medicines for the treatment of Chronic Obstructive Pulmonary Disease. Work by reducing bronchial obstruction by relaxing bronchial smooth muscle. Are administered according to the need for immediate relief of symptoms or so maintained to prevent or reduce symptoms. Most bronchodilators are preferably administered by inhalation.

Methylxanthines are bronchodilators that are used in long-acting oral formulations in the maintenance treatment of Chronic Obstructive Pulmonary Disease and are not available for administration by inhalation. Given the frequency of side effects and drug interactions, their role in the treatment of Chronic Obstructive Pulmonary Disease is questionable, it is not first-line drugs in the treatment of this pathology. Since each class of bronchodilators act by a different mechanism, the combination of different classes of drugs can increase the bronchodilator effect and decrease the likelihood of adverse effects.

Corticosteroids are potent anti-inflammatory drugs used as first-line drugs in bronchial asthma. However, in Chronic Obstructive Pulmonary Disease, these drugs are not recommended routinely because, according to several studies, only 5 to 27% of patients with this disease respond to treatment. However, regular use of inhaled corticosteroids in combination with long-acting bronchodilators can reduce the frequency of exacerbations and improve health status in patients with symptomatic Chronic Obstructive Pulmonary Disease severe and very severe.

A major problem with the treatment of patients with Chronic Obstructive Lung Disease, as many other chronic diseases, is adherence to therapy. The membership is of increased importance in this disease, since the pharmacological approach is the key element in controlling the symptoms. Most studies point to poor treatment adherence by 25 to 50% of patients.

Find out! If you are alert to this disease you can arrest is development.

Miguel Ezaguy Manaças
Professor, at University of Lisbon - Faculty of Medicine 
Pulmonologist in Lifeclinic® - Health care

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