 Chronic Obstructive Pulmonary Disease (COPD) is a progressively disabling illness that is composed of two entities: emphysema and chronic bronchitis. Emphysema is characterized by the destruction and enlargement of the air sacs. Clinically the disease is manifested as worsening of shortness of breath. Chronic bronchitis is a condition seen in patients with productive cough of 3 month duration for a period of at least 2 years. Pathologically, it shows a number of changes in the bronchus and bronchioles like hypertrophy/ hyperplasia of mucous glands, inflammation and mucous secretions.
COPD affects over 600 million people worldwide. In the Philippines, it is ranked as the 7th leading cause of mortality. Ironically, as much as 50% people affected are not aware that they have the disease. The disease is often misdiagnosed as asthma.
COPD is most often caused by cigarette smoking and will develop in about one fifth of smokers. Because of the increasing number of both male and female smokers, morbidity and death secondary to this disease has dramatically increased in the last several years.
Among the many diagnostic tools available, pulmonary function testing is considered the most important. This study can document presence of significant airflow obstruction and can determine disease severity through recommended cut off scores. Recommended treatment depends on disease severity.
Notable advances in pharmacotherapy (bronchodilators, vaccines, antibiotics, inhaled corticosteroids etc.) have been achieved in the last few decades. Despite these drugs, patients often present clinically with recurrent cough, wheezing and breathlessness. Because of the permanent pathologic changes, medical therapy in many cases achieve only temporary relief of symptoms. This is perhaps the major reason for the establishment of pulmonary rehabilitation programs. The concept of restoring patients with debilitating diseases to their fullest medical, mental and emotional potential is not new. What is relatively new is its application to patients suffering from chronic lung diseases.
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