What is COPD and How is it Treated?
My name's John Kinross-Wright. I'm a hospitalist physician, so I'm internal medicine trained and then I just do exclusively inpatient medicine.
What is COPD?
In the U.S it's almost exclusively a disease of smokers or long-term asthmatics who eventually transition into a COPD type. The mechanism that's causing the damage in your lungs is basically chronic inflammation. So you know, the smoke inhalation in your lungs, this is bad. So it does what your body does when it has stuff that's bad, it sends an inflammatory response. That chronic inflammation, the inflammatory cells, while good for fighting infection and a short-term thing, not good to be happening 24/7 every day. You lose your elasticity, your ability to push air out quickly, and then you're always inflamed so you're producing mucus and that's why you have a chronic cough and increased mucus production.
What complications arise from COPD?
Respiratory infections are probably the most common complication you're going to see. So, you're more susceptible to viral infections as well as pneumonias. I guess COPD exacerbations could be considered a complication where you have an acute worsening of your COPD and either need to go to the ER or be hospitalized. Longer-term complications, you can experience heart failure from the increased pressure that the heart has to use to pump through the damaged lungs. There's also some correlation with hypertension and some memory impairment.
What are the symptoms of COPD?
The cardinal symptoms of COPD are shortness of breath, most noticeable with activity, that's when people tend to notice it first. Chronic cough and then increased sputum production, so people have a junky cough.
When should you talk to your doctor about COPD?
If you're having a chronic cough, which is like a daily cough for more than three months or you're noticing that you're getting short of breath with activity, those are times to go see your primary care because it might not be COPD. You could have asthma or something. Even if you're not a smoker, those symptoms should be something that you should seek medical attention for.
How is COPD diagnosed?
COPD is diagnosed very specifically with pulmonary function tests. So the two numbers that we look for most often on that are you're forced vital capacity, so how much air you can breathe out after taking a full inhalation. And then the ratio of that with how much air you can breathe out in one second.
How is COPD prevented?
The best way to prevent COPD, since it's almost predominantly a disease of smokers, is to quit smoking or to not ever start smoking. You're never going to get back to prime lung function before you started smoking or had whatever exposure started you down the path of COPD, but you can get some back, so you can have improved lung function.
How is COPD treated?
The first thing to do is stop the progression of COPD. So you know, in the vast majority of cases that's either quitting smoking. So if you haven't quit smoking, that is the goal number one, two and three. Until you've quit smoking, the COPD is going to continue to progress. The second goal is symptom management. So that's when we use our broncodilators, our inhaler. So when you're doing something and you're getting short of breath, you can have something to alleviate that. So the Albuterol inhalers are probably the most common. And then we have pulmonary rehab, which we have good results with. So you can actually restore some lung function with that.
Why is Brookings Health System a good choice for COPD treatment?
I treat a lot of COPD both here and in my other hospitals that I work in. It's something that I am very comfortable with, we have all the facilities here you need to be treated. We do BiPAP here. Obviously we do the steroids and the nebulizers. We have respiratory therapy here, which is one of the mainstays of COPD treatment. You know, and if worst case scenario comes to it, we also can intubate patients here and we have ICU beds that we can manage that at. You're going to get all the care at Brookings hospital that you can get at a bigger facility.