Tuesday, 26 November 2013

Chronic obstructive pulmonary disease (COPD)– The Diagnosis and Misdiagnosis

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
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.
C. Diagnosis and tests
If you are smokers and have the above symptoms and your doctor may suspect that you have developed the chronic obstructive pulmonary disease (COPD). After a complete physical exam and recording the family history of the diseases, the tests which your doctor orders may include
1. Spirometry
Spirometryis one of the best test for patient who is suspected to have developed chronic obstructive pulmonary disease (COPD). In this test, you are asked to breath into a instrument connected to a spirometer for the evaluation of the function of your lung including the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. In the study Of the 12,491 patients with a primary or secondary COPD diagnosis between 1994 and 2006, with 1520 continuously enrolled patients, showed that among the 648 eligible records from patients with evidence of a pulmonary function test, 366 were identified by spirometry as having COPD of GOLD stage I or higher (average percentage of predicted forced expiratory volume in 1 second: 60%): 19% were diagnosed at the stage of mild disease (GOLD stage I); 50% at moderate disease (GOLD stage II); and 31% at severe or very severe disease (GOLD stage III or IV, respectively). The majority of patients in these groups were not receiving maintenance treatment(17).
2. Stethoscope  
Stethoscope is medical device used by tour doctor to listen to the internal sounds of your lung. According to the study by the University of Colorado Medical Center, the stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose(18).
3. Exercise intolerance tests
Walking tests, such as the “shuttle” incremental walking test (SWT) and the 6-min walking test (6′WT), are commonly utilized in evaluating exercise intolerance in patients with chronic obstructive pulmonary disease (COPD) and the distance covered is the variable usually considered. According to the study by University of Rome La Sapienza, the two walking protocols reveal substantial differences in pathophysiologic adaptations and provide evidence that SWT is more accurate than the 6′WT in the evaluation of maximal exercise tolerance in COPD patients(19).
4. Exercise for desaturation test 
In the study to to explore whether the rate of lung function decline differs between COPD patients with and without exertional desaturation, researchers found that for the first time, that exertional desaturation may be a predictor of rapid decline in lung function in patients with COPD. The 6MWT may be a useful test to predict a rapid lung function decline in COPD(20).
5. Arterial blood gases
The blood test is to measure the levels of oxygen and carbon dioxide in the blood.
6. Etc.
D. Misdiagnosis
Chronic obstructive pulmonary disease (COPD)  or Asthma
Chronic obstructive pulmonary disease (COPD) is often misdiagnosed as asthma, leading to inappropriate treatment and suboptimal patient outcomes. Despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment, according to the National Jewish Medical and Research Center(21).  
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(17) http://www.ncbi.nlm.nih.gov/pubmed/22135490
(18) http://www.ncbi.nlm.nih.gov/pubmed/18046898
(19) http://www.ncbi.nlm.nih.gov/pubmed/12736842
(20) http://www.ncbi.nlm.nih.gov/pubmed/23235126
(21) http://www.ncbi.nlm.nih.gov/pubmed/16448970

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