COPD includes emphysema, an anatomically defined condition characterized by destruction and enlargement of the lung alveoli; chronic bronchitis, a clinically defined condition with chronic cough and phlegm; and small airways disease, a condition in which small bronchioles are narrowed.

Epidemiology:

COPD is the fourth leading cause of death and affects more than 16 million persons in the United States. COPD is also a disease of increasing public health importance around the world.

Risk Factors

Cigarette Smoking

The causal relationship between cigarette smoking and the development of COPD has been absolutely proved, there is considerable variability in the response to smoking.

Respiratory Infections

These have been studied as potential risk factors for the development and progression of COPD in adults; childhood respiratory infections have also been assessed as potential predisposing factors for the eventual development of COPD.

Occupational Exposures

Increased respiratory symptoms and airflow obstruction have been suggested as resulting from general exposure to dust at work. Several specific occupational exposures, including coal mining, gold mining, and cotton textile dust, have been suggested as risk factors for chronic airflow obstruction. However, although nonsmokers in these occupations developed some reductions in FEV1, the importance of dust exposure as a risk factor for COPD, independent of cigarette smoking, is not certain.

Passive, or Second-Hand, Smoking Exposure

Exposure of children to maternal smoking results in significantly reduced lung growth. In utero tobacco smoke exposure also contributes to significant reductions in postnatal pulmonary function. Although passive smoke exposure has been associated with reductions in pulmonary function, the importance of this risk factor in the development of the severe pulmonary function reductions in COPD remains uncertain.

Genetic Considerations

Severe antitrypsin deficiency is a proven genetic risk factor for COPD; there is increasing evidence that other genetic determinants also exist.

Pathophysiology

Persistent reduction in forced expiratory flow rates is the most typical finding in COPD. Increases in the residual volume and the residual volume or total lung capacity ratio, non uniform distribution of ventilation, and ventilation-perfusion mismatching also occur.

Pathology

Cigarette smoke exposure may affect the large airways, small airways and alveolar space. Changes in large airways cause cough and sputum, while changes in small airways and alveoli are responsible for physiologic alterations. Emphysema and small airway pathology are both present in most persons with COPD, and their relative contributions to obstruction vary from one person to another.

Pathogenesis

Airflow limitation, the major physiologic change in COPD, can result from both small airway obstruction and emphysema, as discussed above. Pathologic findings that can contribute to small airway obstruction are described above, but their relative importance is unknown. Fibrosis surrounding the small airways appears to be a significant contributor.

Clinical features:

The three most common symptoms in COPD are cough, sputum production, and exertional dyspnea.

Many patients have such symptoms for months or years before seeking medical attention.

Although the development of airflow obstruction is a gradual process, many patients date the onset of their disease to an acute illness or exacerbation.

A careful history, however, usually reveals the presence of symptoms prior to the acute exacerbation.

The development of exertional dyspnea, often described as increased effort to breathe, heaviness, air hunger, or gasping, can be insidious.

Homoeopathic approach:

Senega:

It is indicated where the cough is irritating and the phlegm is especially adhesive and the patient complains of a pressing pain in the chest, when respiring, moving or coughing.

Scilla:

It suits obstinate chronic coughs with stitches in the chest, expectoration transparent or muco-purulent, easy at times, hard at others.

Dulcamara:

It is a valuable remedy for bronchial catarrhs of old people with a very free greenish expectoration, worse from change of weather to cold and wet.

Bacillinum:

It is a remedy highly spoken of by some competent observers; it seems to suit especially individuals who are constantly catching cold, one is hardly gotten rid of before another is contracted.

The irritation locates itself in the bronchial mucous membrane

leaving troublesome cough.

Mercurius :

The remedy in inflammatory bronchial catarrh; there is roughness and soreness from the fauces down through the middle of the chest, a dry, raw concussive cough, which is very exhausting ;sputum watery, saliva-like,or yellow and muco-purulent.

There is fever and alternation of hills and heat, desire for cold drinks, which aggravate the cough. and pasty sweat without relief.

steven is associated with medical coding training uae and icd-10 training

steven is associated with medical coding training uae and icd-10 training

Author Bio: steven is associated with medical coding training uae and icd-10 training

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