Introduction to chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common respiratory

condition characterised by airflow limitation. It affects more than 5% of the
population worldwide and is associated with high morbidity and mortality. It
is the third ranked cause of death in the United States, killing more than
120000 individuals each year. In Malaysia as of 2013, diseases of the
respiratory system which includes COPD is ranked as second in causes of
hospitalisation and ranked as second in the principal causes of death.

As a consequence of its high prevalence and chronicity, COPD causes high

resource utilisation with frequent clinician office visits, frequent
hospitalisations due to acute exacerbations, and the need for chronic
therapy such as supplemental oxygen therapy and medication. Hence
establishing a correct diagnosis of COPD and appropriate management are
fundamental because these can decrease symptoms, reduce the frequency
and severity of exacerbations, improve health status, improve exercise
capacity and prolong survival

Despite its debilitating clinical outcome, COPD can be prevented to a great

extend through the avoidance of its risk factors. The biggest risk factor for
COPD is smoking whereby a cohort study shows that subjects who smoked
cigarettes throughout 25 year observation period were more likely than
never smokers to develop COPD (36 vs 8 percent) (1). Other than smoking,
numerous studies indicate that environmental exposure to pollutions such
as dusts, gases and fumes is a risk factor for COPD. Mild to moderate
persistent asthma is also a risk factor for the development of COPD due to
the chronic inflammation of the airway thus causing fibrosis. Some other
minor avoidable risk factors for COPD includes antioxidant deficiency
(vitamin C and E deficiency) and tuberculosis.

Most of the clinical risk factors for COPD can be modified. For primary
prevention, smoking cessation, exposure avoidance and engaging in
sustained physical fitness activities and exercises can help in great length to
prevent COPD. As for secondary prevention, screening using peak expiratory
flow rate (PEFR) can be done for adults who have features suggestive of
COPD or high risks of developing COPD. Last but not least, for those already
diagnosed with COPD, various efforts should be done to prevent or minimise
the severity of exacerbations, complications and comorbid diseases. The
patient should be educated about the nature of the disease, exacerbating
factor for COPD, ways to avoid exacerbations and what to do during an
episode of exacerbation. COPD is also linked to various comorbid conditions
such as cardiovascular disease, diabetes mellitus and cognitive dysfunction
(Alzheimer’s disease etc)

1. Løkke, A., Lange, P., Scharling, H., Fabricius, P., & Vestbo, J.
(2006). Developing COPD: a 25 year follow up study of the
general population. Thorax, 61(11), 935-939.