User:WalshDay

Background - What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is defined by the Global Obstructive Lung Disease group as a disease state charachterised by airflow limitation that is not fully reversible The air flow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. COPD usually presents in mid-life (around 40 years and onwards) with slowly progressive symptoms

The Issue - Explanation of COPD

 * The World Health Organisation (WHO) estimates that there are presently 1.1 billions smokers worldwide and that this figure will increase to 1.6 billion by 2025 in low and middle-income countries.
 * In the year 2000 there was an estimated 2.74 millions deaths worldwide from COPD alone.
 * COPD currently affects over 2 million Australians.
 * COPD is the leading cause of death in the Australian population (4th for males, 6th for females) and was responsible for 5,152 deaths in 2007.
 * In 1990, COPD was ranked 12th as a burden of disease and this is projected to reach 5th by 2020.
 * In the US COPD has an estimated 15% prevalence in those aged over 65 years and accounts for 20% of hospitalisations of older people.

Forms of COPD
COPD can generally be classified into one of two groups:

Chronic Bronchitis
Chronic Bronchitis is a recurrent problem, defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. The condition reduces the diameter of the airways through a combination of airway inflammation and overproduction of mucus. Chronic bronchitis is more prevalent in women than in men.

Emphysema
Emphysema is defined as the abnormal and permanent enlargement of air spaces distal to the terminal bronchioles accompanied with destruction of their walls. In emphysema, the /alveoli/ are gradually destroyed so people have difficulty absorbing enough oxygen. The /bronchi/ become inelastic and narrow making it harder to breathe in and out. It is widely accepted that, smoking is the most common cause of emphysema. It is also most prevalent among men aged over 65 years.

COPD is usually classified by severity, from mild to moderate to severe.

Mild COPD
Symptoms may only include the need to cough up mucus each morning. Symptoms such as shortness of breath, coughing or coughing up mucus might only occur during winter or after a cold.

Moderate COPD
Symptoms are present in Mild COPD are observed almost every day, including feeling out of breath after exertion such as walking quickly, having trouble doing every day chores as a result of breathlessness, and it may take several weeks to recover from a cold or chest infection.

Severe COPD
All of the above symptoms will be present every day and shortness of breath will be present during normal daily activities such as taking a shower or getting the mail.

Who is at risk?

 * Smokers - Cigarette smoking is the main cause of COPD development. Smoking is thought to release enzyme that damage a protein called elastin, which makes the lungs less elastics when breathing in and out.
 * Individuals exposed to pollutants in the workplace - COPD can also occur in people who have had long-term exposure to things that irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Occupational exposure may be responsible for 20-30% of COPD cases. Heavy or long-term exposure to second-hand smoke or other air pollutants may also contribute to COPD.
 * AAT Deficiency - In some, COPD is caused by a genetic condition known as alpha-1 antitrypsin (AAT) deficiency. People with this condition can devleop COPD without ever having smoked or had long-term exposure to harmful pollutants. In these susceptible individuals, exposure to harmful gases or particles can result in chronic inflammation with tissue injury, ineffective repair and structural changes.
 * Females - Some studies have shown that women may be at a greater risk of developing COPD. This may due to smaller lungs and airways and more sensitive airways.

Diagnosis
Indicators of COPD include: Note: Please note that diagnosis should always be confirmed by /Spirometry/
 * Chronic Cough: Present intermittently or every day, throughout the day.
 * Chronic Sputum Production: Any pattern of chronic sputum production.
 * Acute Bronchitis: Repeated episodes.
 * /Dyspnea/ (shortness of breath) that is: Progressive, persistent, worse with exercise, and worse during respiratory infections.
 * History of Exposure to Risk Factors: Including tobacco smoke, occupational dusts and chemicals, smoke from home cooking and heating fuel e.g. coal.

Recommendations - How to Manage COPD
While there is no cure for COPD and the airway damage cannot be repaired, all the symptoms can be reduced by following certain management strategies. Including:


 * Prevent disease progression i.e. stop smoking - only smoking cessation and oxygen therapy (in significant /hypoxaemia/) have shown improved mortality in COPD.
 * Relieve symptoms
 * Improve exercise tolerance
 * Improve health status
 * Prevent and treat complications
 * Prevent and treat exacerbations - managing exacerbations involves a combination of /short-acting bronchodilators/, /systemic corticosteroids/, and when needed, antibiotics.
 * Reduce mortality, and
 * Prevent or minimize side effects from treatment

The Importance of Exercise for the COPD Patient
Weakness, shortness of breath, and even the fear of breathlessness can cause people with COPD to avoid physical activity. This cycle of weakness, shortness of breath, and inactivity contributes to a progressive decline in muscle strength and inefficient oxygen use, making it difficult for some patients to perform day-to-day activities, such as showering and dressing. As such, exercise is now recognised as an integral part of managing COPD and while it won't change the underlying structural problems in the lungs, it noes have a number of important benefits.

Exercise Increases:
 * Energy levels
 * Muscle strength, endurance and efficiency
 * /Cardiopulmonary endurance/
 * Restful sleep, and
 * Bone density
 * Independence
 * Quality of Life
 * Assist in weight control

Exercise Decreases: - Exercise appears to be an effective non-pharmacological method of reducing cigarette cravings and desire to smoke during temporary abstinence from smoking
 * Shortness of breath
 * Risk factors of heart disease
 * Blood pressure
 * Anxiety and depression
 * Blood sugar levels, and
 * Desire to smoke

How Often Should I Exercise?
Those with COPD should aim to exercise for a minimum of 3 sessions per week, for at least 20 to 30 minutes per session. It has been found that patients with COPD who exericse for more than 2 hours per week can improve their health

What Intensity of exercise should I be Doing?
The Australian Lung Foundation recommends that COPD sufferers should exercise between levels three and four on the /Modified Borg Dyspnea Scale/, somewhere between 'Moderate' and 'Somewhat severe'. Exercise should be undertaken at 60% of your maximal heart rate. You DO need to push yourself into minor breathlessness in order to adapt and increase exercise tolerance.

- Moderate exercise was shown to have a delayed effect on reducing the withdrawal symptoms of restlessness, stress, tension and poor concentration, relative to light exercise, at 5 min or 10 min post-exercise

- A program of supervised vigorous exercise is associated with long-term maintenance of smoking cessation in females.

What Type of Exercise Should I be Doing?
Those with COPD should be looking to undertake aerobic activity to build endurance and resistance training to strengthen muscles. Good aerobic activities include walking, cycling, stair climbing, and aquatic exercises. Resistance exercise involves the use of free weights, special resistance bands, or resistance machines.