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What |s CCD?

Chronlc obsLrucLlve pulmonary dlsease (CCu) ls comprlsed prlmarlly of Lhree relaLed condlLlons chronlc
bronchlLls chronlc asLhma and emphysema ln each condlLlon Lhere ls chronlc obsLrucLlon of Lhe flow of alr
Lhrough Lhe alrways and ouL of Lhe lungs and Lhe obsLrucLlon generally ls permanenL and may be progresslve
over Llme
Whlle asLhma feaLures obsLrucLlon Lo Lhe flow of alr ouL of Lhe lungs usually Lhe obsLrucLlon ls
reverslble 8eLween aLLacks of asLhma Lhe flow of alr Lhrough Lhe alrways Lyplcally ls normal 1hese paLlenLs
do noL have CCu Powever lf asLhma ls lefL unLreaLed Lhe chronlc lnflammaLlon assoclaLed wlLh Lhls dlsease
can cause Lhe alrway obsLrucLlon Lo become flxed 1haL ls beLween aLLacks Lhe asLhmaLlc paLlenL may Lhen
have abnormal alr flow 1hls process ls referred Lo as lung remodellng 1hese asLhma paLlenLs wlLh a flxed
componenL of alrway obsLrucLlon are also consldered Lo have CCu
CfLen paLlenLs wlLh CCu are labeled by Lhe sympLoms Lhey are havlng aL Lhe Llme of an exacerbaLlon
of Lhelr dlsease lor lnsLance lf Lhey presenL wlLh mosLly shorLness of breaLh Lhey may be referred Lo as
emphysema paLlenLs Whlle lf Lhey have mosLly cough and mucus producLlon Lhey are referred Lo as havlng
chronlc bronchlLls ln reallLy lL ls beLLer Lo refer Lo Lhese paLlenLs as havlng CCu slnce Lhey can presenL wlLh
a varleLy of lung sympLoms
1here ls frequenL overlap among CCu paLlenLs 1hus paLlenLs wlLh emphysema may have some of
Lhe characLerlsLlcs of chronlc bronchlLls and chronlc asLhma and vlce a versa

What causes CCD?

C|garette smok|ng and secondhand smoke
Smoklng ls responslble for 90 of CCu ln Lhe unlLed SLaLes AlLhough noL all clgareLLe smokers wlll
develop CCu lL ls esLlmaLed LhaL 13 wlll Smokers wlLh CCu have hlgher deaLh raLes Lhan nonsmokers
wlLh CCu 1hey also have more frequenL resplraLory sympLoms (coughlng shorLness of breaLh eLc) and a
more rapld deLerloraLlon ln lung funcLlon Lhan nonsmokers lL ls lmporLanL Lo noLe LhaL when a CCu paLlenL
sLops smoklng Lhelr decllne ln lung funcLlon slows Lo Lhe same raLe as a nonsmoker 1herefore lL ls never Loo
laLe Lo qulL
LffecLs of passlve smoklng or secondhand smoke on Lhe lungs are noL wellknown however
evldence suggesLs LhaL resplraLory lnfecLlons asLhma and sympLoms are more common ln chlldren who llve
ln households where adulLs smoke
ClgareLLe smoklng damages Lhe lungs ln many ways lor example Lhe lrrlLaLlng effecL of clgareLLe
smoke aLLracLs cells Lo Lhe lungs LhaL promoLe lnflammaLlon ClgareLLe smoke also sLlmulaLes Lhese
lnflammaLory cells Lo release elasLase an enzyme LhaL breaks down Lhe elasLlc flbers ln lung Llssue

A|r po||ut|on
Alr polluLlon can cause problems for persons wlLh lung dlsease buL lL ls unclear wheLher ouLdoor alr
polluLlon conLrlbuLes Lo Lhe developmenL of CCu Powever ln Lhe nonlndusLrlallzed world Lhe mosL
common cause of CCu ls lndoor alr polluLlon 1hls ls usually due Lo lndoor sLoves used for cooklng
Cccupat|ona| po||utants

Some occupaLlonal polluLanLs such as cadmlum and slllca do lncrease Lhe rlsk of CCu ersons aL rlsk for Lhls
Lype of occupaLlonal polluLlon lnclude coal mlners consLrucLlon workers meLal workers coLLon workers eLc
(MosL of Lhls rlsk ls assoclaLed wlLh clgareLLe smoklng and Lhese occupaLlons an lssue noL well conLrolled for
1hese occupaLlons are more ofLen assoclaLed wlLh lnLersLlLlal lung dlseases especlally Lhe pneumoconloses)
neverLheless Lhe adverse effecLs of smoklng clgareLLes on lung funcLlon are far greaLer Lhan occupaLlonal

A|pha1 ant|tryps|n def|c|ency
AnoLher wellesLabllshed cause of CCu ls a deflclency of alpha1 anLlLrypsln (AA1) AA1 deflclency ls a
rare geneLlc (lnherlLed) dlsorder LhaL accounLs for less Lhan 1 of Lhe CCu ln Lhe unlLed SLaLes
As dlscussed prevlously normal funcLlon of Lhe lung ls dependenL on elasLlc flbers surroundlng Lhe
alrways and ln Lhe alveolar walls LlasLlc flbers are composed of a proLeln called elasLln An enzyme called
elasLase LhaL ls found even ln normal lungs (and ls lncreased ln clgareLLe smokers) can break down Lhe elasLln
and damage Lhe alrways and alveoll AnoLher proLeln called alpha1 anLlLrypsln (AA1) (produced by Lhe llver
and released lnLo Lhe blood) ls presenL ln normal lungs and can block Lhe damaglng effecLs of elasLase on

now |s CCD d|agnosed?
CCu usually ls flrsL dlagnosed on Lhe basls of a medlcal hlsLory whlch dlscloses many of Lhe sympLoms
of CCu and a physlcal examlnaLlon whlch dlscloses slgns of CCu CLher LesLs Lo dlagnose CCu lnclude
chesL xray compuLerlzed Lomography (CA1 or C1 scan) of Lhe chesL LesLs of lung funcLlon (pulmonary
funcLlon LesLs) and Lhe measuremenL of carbon dloxlde and oxygen levels ln Lhe blood
CCu ls ofLen suspecLed ln chronlc smokers who develop shorLness of breaLh wlLh or wlLhouL exerLlon
have chronlc perslsLenL cough wlLh spuLum producLlon and frequenL lnfecLlons of Lhe lungs such as bronchlLls
or pneumonla SomeLlmes CCu ls flrsL dlagnosed afLer a paLlenL develops a resplraLory lllness necesslLaLlng
hosplLallzaLlon ln reallLy CCu should be suspecLed ln all chronlc smokers because ofLen Lhey wlll only
develop sympLoms afLer slgnlflcanL lung damage occurs Some physlcal flndlngs of CCu lnclude enlarged
chesL cavlLy and wheezlng lalnL and dlsLanL breaLh sounds are heard when llsLenlng Lo Lhe chesL wlLh a
sLeLhoscope Alr ls Lrapped ln Lhe lungs from Lhe paLlenLs lnablllLy Lo empLy Lhelr lungs wlLh exhalaLlon 1hls
exLra alr dampens Lhe sounds heard and resulLs ln Lhe overlnflaLed chesL cavlLy

ln paLlenLs affecLed predomlnanLly wlLh emphysema Lhe chesL xray may show an enlarged chesL
cavlLy and decreased lung marklngs reflecLlng desLrucLlon of lung Llssue and enlargemenL of alrspaces

ln paLlenLs wlLh predomlnanLly chronlc bronchlLls Lhe chesL xray may show lncreased lung marklngs whlch
represenL Lhe Lhlckened lnflamed and scarred alrways CompuLerlzed Lomography (C1 or CA1 scan) of Lhe
chesL ls a speclallzed xray LhaL can accuraLely demonsLraLe Lhe abnormal lung Llssue and alrways ln CCu

ChesL xrays and C1 scans of Lhe chesL also are useful ln excludlng lung lnfecLlons (pneumonla) and cancers C1
scan of Lhe chesL usually ls noL necessary for Lhe rouLlne dlagnosls and managemenL of CCu buL can be
helpful ln evaluaLlng Lhe exLenL of emphysemaLous change as well as deLecLlng early lung cancers

1he mosL commonly used pulmonary funcLlon LesL ls splromeLry a LesL whlch quanLlLaLes Lhe amounL of
alrway obsLrucLlon uurlng splromeLry Lhe paLlenL Lakes a full breaLh and Lhen exhales fasL and forcefully lnLo
a Lube connecLed Lo a machlne LhaL measures Lhe volume of explred alr 1he lLv1 (Lhe volume of alr explred
ln 1 second) ls a rellable and useful measure of alrflow obsLrucLlon 1hls ls compared Lo Lhe LoLal amounL of alr
blown ouL of Lhe lungs Lhe forced vlLal capaclLy (lvC) 1he raLlo of Lhe lLv1 Lo Lhe lvC ls usually 70 When
obsLrucLlon ls presenL Lhls raLlo ls reduced Lhe lower Lhe 8A1lC Lhe greaLer Lhe alrway obsLrucLlon 1he lLv1
can be deLermlned agaln afLer LreaLmenL wlLh bronchodllaLors lmprovemenL ln lLv1 afLer bronchodllaLor
LreaLmenL means LhaL alrway obsLrucLlon ls reverslble uemonsLraLlng lmprovemenL ln lLv1 also helps
docLors selecL Lhe proper bronchodllaLors for paLlenLs MeasuremenLs of lLv1 and lvC can be repeaLed over
Llme Lo deLermlne how rapldly alrway obsLrucLlon ls progresslng

Cxygen and carbon dloxlde levels can be measured ln samples of blood obLalned from an arLery buL Lhls
requlres lnserLlng a needle lnLo an arLery A less lnvaslve meLhod Lo measure oxygen levels ln Lhe blood ls
called pulse oxlmeLry ulse oxlmeLry works on Lhe prlnclple LhaL Lhe degree of redness of hemoglobln (Lhe
proLeln ln blood LhaL carrles oxygen) ls proporLlonal Lo Lhe amounL of oxygen LhaL ls Lhe more oxygen Lhere ls
ln blood Lhe redder Lhe blood A probe (oxlmeLer) ls placed around a flngerLlp Cn one slde of Lhe flnger Lhe
probe shlnes a llghL Some of Lhe llghL ls LransmlLLed Lhrough Lhe flngerLlp and Lhe LransmlLLed llghL ls
measured on Lhe opposlLe slde of Lhe flnger by Lhe probe uependlng on Lhe redness of Lhe blood wlLhln Lhe
flngerLlp (LhaL ls Lhe amounL of oxygen ln Lhe blood) dlfferenL shades of red are LransmlLLed Lhrough Lhe
flngerLlp 1hus by measurlng Lhese dlfferences ln Lhe red llghL lL ls posslble Lo deLermlne Lhe amounL of
oxygen ln Lhe blood

AnoLher very effecLlve and slmple LesL used Lo monlLor CCu ls called Lhe slx mlnuLe walklng LesL (6MW1) 1he
paLlenL ls asked Lo walk on a level surface aL Lhelr own pace for slx mlnuLes 1here ls a very prescrlbed scrlpL
LhaL ls uLlllzed when performlng Lhls LesL 1he paLlenL ls lnformed abouL Lhe Llme lefL Lo compleLe Lhe LesL buL
no encouragemenL ls offered 1he paLlenL may sLop and resL aL any Llme durlng Lhe sLudy 1he dlsLance
Lraveled ls measured and ls a very accuraLe lndex of Lhe sLaLe of healLh and effecLlveness of Lherapy

What treatment |s ava||ab|e for CCD?

1he goals of CCu LreaLmenL are
Lo prevenL furLher deLerloraLlon ln lung funcLlon

Lo allevlaLe sympLoms

Lo lmprove performance of dally acLlvlLles and quallLy of llfe

1he LreaLmenL sLraLegles lnclude
qulLLlng clgareLLe smoklng

Laklng medlcaLlons Lo dllaLe alrways (bronchodllaLors) and decrease alrway lnflammaLlon

vacclnaLlon agalnsL flu lnfluenza and pneumonla

regular oxygen supplemenLaLlon and

pulmonary rehablllLaLlon
CulLLlng clgareLLe smoklng

1he mosL lmporLanL LreaLmenL for CCu ls qulLLlng clgareLLe smoklng aLlenLs who conLlnue Lo smoke have a
more rapld deLerloraLlon ln lung funcLlon when compared Lo oLhers who qulL Aglng lLself can cause a very
slow decllne ln lung funcLlon ln suscepLlble lndlvlduals clgareLLe smoklng can resulL ln a much more dramaLlc
loss of lung funcLlon lL ls lmporLanL Lo noLe LhaL when one sLops smoklng Lhe decllne ln lung funcLlon
evenLually reverLs Lo LhaL of a nonsmoker

unforLunaLely only abouL one Lhlrd of Lhe paLlenLs can absLaln from smoklng longLerm 8easons for dlfflculLy
ln qulLLlng lnclude nlcoLlne addlcLlon sLress ln Lhe workplace and aL home depresslon peer pressure and
adverLlslng from clgareLLe companles

nlcoLlne ln clgareLLes ls addlcLlve and Lherefore cessaLlon of smoklng can cause sympLoms of nlcoLlne
wlLhdrawal lncludlng anxleLy lrrlLablllLy anger depresslon faLlgue dlfflculLy concenLraLlng or sleeplng and
lnLense cravlng for clgareLLes aLlenLs llkely Lo develop wlLhdrawal sympLoms Lyplcally smoke more Lhan 20
clgareLLes a day need Lo smoke shorLly afLer waklng up ln Lhe mornlng and have dlfflculLy refralnlng from
smoklng ln nonsmoklng areas Powever some 23 of smokers can sLop smoklng wlLhouL developlng Lhese
sympLoms Lven ln Lhose smokers who develop sympLoms of wlLhdrawal Lhe sympLoms wlll decrease afLer
several weeks of absLlnence

1o help Lhose paLlenLs wlLh sympLoms of wlLhdrawal durlng Lhe early weeks of smoklng cessaLlon nlcoLlne
chewlng gum (nlcoreLLe Cum) nlcoLlne lnhalers and nlcoLlne skln paLches (PablLrol nlcoderm CC nlcoLrol)
are avallable ln Lhe unlLed SLaLes nlcoLlne replacemenL Lherapy can dellver enough nlcoLlne lnLo Lhe blood Lo
reduce buL noL LoLally ellmlnaLe wlLhdrawal sympLoms nlcoLlne replacemenL meLhods ln con[uncLlon wlLh
lnLense paLlenL educaLlon and behavloral modlflcaLlon programs have lmproved Lhe raLes aL whlch lndlvlduals
qulL smoklng nlcoLlne skln paLches are easy Lo use 1hey generally are used for four Lo slx weeks someLlmes
wlLh a Laperlng perlod of several addlLlonal weeks 1he addlcLlon poLenLlal of nlcoLlne skln paLches ls low
SomeLlmes a comblnaLlon of several nlcoLlne replacemenL Lheraples are uLlllzed lL ls lmporLanL Lo noLe LhaL
paLlenLs LhaL conLlnue Lo smoke whlle on replacemenL Lherapy are aL lncreased rlsk for hearL compllcaLlons

8uproplon (Zyban WellbuLrln) ls an anLldepressanL LhaL has been found Lo decrease cravlngs for clgareLLes lL
has been shown Lo be of beneflL Lo paLlenLs who wanL Lo qulL smoklng

varenlcllne (ChanLlx) ls a medlcaLlon ls Lo ald ln smoklng cessaLlon and has been approved for use ln Lhe uS
varenlcllne works ln Lwo ways by cuLLlng Lhe pleasure of smoklng and reduclng Lhe wlLhdrawal sympLoms
LhaL lead smokers Lo llghL up agaln and agaln 1hls medlclne ls Laken over a 12 week course and can work ln
ways LhaL buproplon does noL

Ant|cho||nerg|c Agents

Lxamples of lnhaled corLlcosLerolds lnclude
beclomeLhasone dlproplonaLe (8eclovenL Cvar and vancerll)

Lrlamclnolone aceLonlde (AzmacorL)

fluLlcasone (llovenL)

budesonlde (ulmlcorL)

momeLasone furoaLe (Asmanex) and

flunlsollde (Aerobld)

lnhaled corLlcosLerolds have been useful ln LreaLlng paLlenLs wlLh asLhma buL ln paLlenLs wlLh CCu lL
ls noL clear wheLher lnhaled corLlcosLerolds have Lhe same beneflL as oral corLlcosLerolds
neverLheless docLors are less concerned abouL uslng lnhaled corLlcosLerolds because of Lhelr safeLy
1he slde effecLs of lnhaled corLlcosLerolds lnclude hoarseness loss of volce and oral yeasL lnfecLlons

SubmlLLed Lo Mrs Corazon Morada
SubmlLLed by Labordo Ana Mae
!urldlco Aprll uexan 8elle