Tuesday, 26 November 2013

Chronic obstructive pulmonary disease (COPD) – The Symptoms

Chronic obstructive pulmonary disease (COPD))is the third leading cause of death in the United State.
 1. Emphysema, a type of Chronic obstructive pulmonary disease (COPD), is defined as a long term and progressive condition cause of shortness of breath but depending to the stage of lung function as a result of damage to tissues of the air sacs (alveoli) in the lungs. In the study of 63 patients with stable COPD (spirometric GOLD stages 2–4) and 17 age- and comorbidity-matched controls, researchers found that in contrast to asthma, COPD is characterised by elevated concentrations of both BDNF and TGF-beta1 in serum. The stage-dependent association with lung function supports the hypothesis that these platelet mediators may play a role in the pathogenesis of COPD(1). In some cases, but rarely, Emphysema is caused by Alpha-1 antitrypsin deficiency emphysema.
2. Chronic bronchitis
Chronic bronchitis is a chronic inflammation of the lung’s bronchi cause of the increased production of mucus in the lung of that leading to difficult breathing.
A. Symptoms
1. Shortness of Breath
Shortness of Breath is a The main symptoms of the disease. There is a report of There is a report of 27-year-old man who had been a smoker since 14 years of age presented with exertional dyspnea. Spirometry and high-resolution computed tomography scans suggested a diagnosis of chronic obstructive pulmonary disease (COPD). High susceptibility, smoking from an early age and organic solvent exposure may have caused early-onset COPD in this case(2). Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life(2a).
2. Functional impairment the upper and lower limb exercises
In comparison with lower limb exercises, upper limb exercises result in higher metabolic and ventilatory demands, as well as in a more intense sensation of dyspnea and greater fatigue. Because there are differences between the upper and lower limb muscles in terms of the morphological and functional adaptations in COPD patients, specific protocols for strength training and endurance should be developed and tested for the corresponding muscle groups(3).
3.  Chronic Cough (With or Without Sputum)
Cough reflex hypersensitivity is thought to underlie the chronic dry cough out of proportion to other symptoms that can occur in association with airways disease. Structural changes associated with airway disease (damage) include bronchial wall thickening, airway smooth muscle hypertrophy, bronchiectasis and emphysema(4).
4. Reduced Exercise Tolerance
Dyspnea and reduced exercise tolerance are common consequences of chronic obstructive pulmonary disease (COPD) and contribute importantly to poor perceived health status(5).
5. Sleep disturbance
An expert panel meeting was convened in Barcelona, Spain, in March 2011 to discuss the aetiology, evolution, burden, long-term clinical consequences and optimal management of night-time symptoms in COPD, showed that epidemiological data suggests that the prevalence of nocturnal symptoms and symptomatic sleep disturbance may exceed 75% in patients with COPD(6).
6. Loss of Appetite Leading to Weight Loss
Body weight loss, often observed in patients with COPD, is related to lack of appetite. Inflammatory cytokines are known to be involved in anorexia and to be correlated to arterial partial pressure of oxygen(7).
7. Hemoptysis and long-term fever 
Chronic obstructive pulmonary disease (COPD) is associated with symptoms of episodes of dyspnea, hemoptysis and long-term fever(8).
8. Wheezing
Patients with COPD are most likely to wheeze during an acute exacerbation, especially at the night time as a result of air pass through a narrow airway.
9. Other symptoms
In the study to  to investigate the accuracy of clinical variables in the diagnosis of COPD of 98 patients  (mean age, 62.3+/- 12.3 years; mean FEV1, 48.3 +/- 21.6%) and 102 controls, found that the likelihood ratios (95% CIs) for the diagnosis of COPD were as follows: 4.75 (2.29-9.82; p < 0.0001) for accessory muscle recruitment; 5.05 (2.72-9.39; p < 0.0001) for pursed-lip breathing; 2.58 (1.45-4.57; p < 0.001) for barrel chest; 3.65 (2.01-6.62; p < 0.0001) for decreased chest expansion; 7.17 (3.75-13.73; p < 0.0001) for reduced breath sounds; 2.17 (1.01-4.67; p < 0.05) for a thoracic index > or = 0.9; 2.36 (1.22-4.58; p < 0.05) for laryngeal height < or = 5.5 cm; 3.44 (1.92-6.16; p < 0.0001) for forced expiratory time > or = 4 s; and 4.78 (2.13-10.70; p < 0.0001) for lower liver edge > or = 4 cm from lower costal edge. Inter-rater reliability for those same variables was, respectively, 0.57, 0.45, 0.62, 0.32, 0.53, 0.32, 0.59, 0.52 and 0.44 (p < 0.0001 for all)(9).
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(1) http://respiratory-research.com/content/13/1/116/abstract
(2) http://www.ncbi.nlm.nih.gov/pubmed/23257530
(2a) http://www.ncbi.nlm.nih.gov/pubmed/21499589
(3) http://www.ncbi.nlm.nih.gov/pubmed/21755195
(4) http://www.ncbi.nlm.nih.gov/pubmed/23181785
(5) http://www.ncbi.nlm.nih.gov/pubmed/23234451
(6) http://www.ncbi.nlm.nih.gov/pubmed/21881146
(7) http://www.ncbi.nlm.nih.gov/pubmed/21145207
(8) http://www.ncbi.nlm.nih.gov/pubmed/22523845
(9) http://www.ncbi.nlm.nih.gov/pubmed/19547847

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