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| ====== Chronic Obstructive Pulmonary Disease (COPD) ====== | ====== Chronic Obstructive Pulmonary Disease (COPD) ====== | ||
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| + | {{:4._copd-_presentation.pdf|}} | ||
| ===== Introduction ===== | ===== Introduction ===== | ||
| - | A Genetically Modified Organism is any organism created by gene splicing techniques and often involves merging DNA from different species (31). Scientists directly manipulate an organism’s genome to isolate traits or characteristics deemed of value. Currently, the safety of GMOs is under research as they are relatively recent developments (22). | ||
| **What is COPD** | **What is COPD** | ||
| + | Chronic obstructive pulmonary disease, denoted as COPD is a type of obstructive lung disease (n.d., 2013). It is characterized by long-term poor airflow and displays symptoms including cough with sputum production and shortness of breath. Figure 1 displays a visual representation of a lung tissue of a healthy individual and of an individual with COPD. From the beginning of its diagnosis, these symptoms from individuals with COPD tend to worsen over time. It is the fourth leading cause of death in the world as of 2013. | ||
| - | **Prevalence and Epidemiology of the Disease** | + | <box width classes round white centre|>{{:normal_and_copd_lung.png}}</box| Figure 1: Lung tissues of a normal individual and of an individual with COPD. Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/copd> |
| - | **Economic Burden of COPD** | + | **Epidemiology and Economic Burden of the Disease** |
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| + | As of 2010, 329 million people, approximately 4.8% of the population are affected by COPD (n.d. 2010). The primary cause of COPD is due to the rise in tobacco use among both men and women. The increase in the developing world since 1970 is believed to influence the increase in smoking within the region. The global numbers are expected to progressively increase as risk factors remain prevalent and the aging population continues to increase. As expected, COPD is more common in older people; on average, it affects 34-200 out of 1000 people older than 65 years. | ||
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| + | COPD is also considered one of the most expensive conditions to treat in U.S. hospitals in 2011, averaging to approximately $5.7 billion. The global estimated cost of treating COPD is $2.1 trillion; $1.9 trillion goes to direct medical care costs such as patient care and $0.2 trillion goes to indirect medical care costs such as sick pay for medical professionals. Costs are projected to more than double by 2030. | ||
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| **Mechanism of Disease** | **Mechanism of Disease** | ||
| + | COPD is an airway inflammation syndrome which consists of structural changes and mucociliary dysfunction. | ||
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| + | **Structural Changes** | ||
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| + | The pulmonary system undergoes structural changes as a direct result of the inflammatory response that is associated with COPD. Eventually, this leads to the narrowing of the airways, making it harder for the individual to breathe. Parenchymal destruction is associated with loss of lung tissue elasticity (Takeda, 2012), implicating that the small airways collapse during exhalation and impedes airflow. | ||
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| + | **Mucociliary Dysfunction** | ||
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| + | Chronic smoking and COPD inflammation forces mucous glands that line the airway lung walls to enlarge. This in turn, causes healthy cells to be replaced by excessive mucus-secreting cells. Over time, COPD also causes damage to the mucociliary transport system which is primarily responsible for clearing the mucus from airways. Figure 2 shows a visual representation of the mechanism in how the presence of mucus worsens airflow. | ||
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| + | <box width classes round white centre|>{{:untitled6.png}}</box| Figure 2: Mechanism of Mucociliary effects from COPD. Retrieved from: https://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease> | ||
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| - | <box width classes round white centre|>{{:summary_of_pathways_and_candidate_genes_involved_in_copd.png|}}</box| Figure : Summary of Pathways and Candidate Genes Involved in COPD. Retrieved from: | + | <box width classes round white centre|>{{:summary_of_pathways_and_candidate_genes_involved_in_copd.png|}}</box| Figure 3: Summary of Pathways and Candidate Genes Involved in COPD. Retrieved from: |
| http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.629.4676&rep=rep1&type=pdf> | http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.629.4676&rep=rep1&type=pdf> | ||
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| - | <box width classes round white centre|>{{:a._normal_small_airway_b._abnormal_small_airway_exhibiting_airway_remodeling_in_copd._berge_et_al._2011_.png|}}</box| Figure : A. Normal Small Airway, B. Abnormal Small Airway Exhibiting Airway Remodeling in COPD. Modified from: Berge et al. (2011)> | + | <box width classes round white centre|>{{:a._normal_small_airway_b._abnormal_small_airway_exhibiting_airway_remodeling_in_copd._berge_et_al._2011_.png|}}</box| Figure 5: A. Normal Small Airway, B. Abnormal Small Airway Exhibiting Airway Remodeling in COPD. Modified from: Berge et al. (2011)> |
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| - | <box width classes round white centre|>{{:spirometry_traces_representing_healthy_patients_and_copd_patients.png|}}</box| Figure : Spirometry Traces Representing Healthy Patients and COPD Patients. Retrieved from: http://www.thinkcopdifferently.com/en/About-COPD/Diagnosing-COPD/Spirometric-assessment> | + | <box width classes round white centre|>{{:spirometry_traces_representing_healthy_patients_and_copd_patients.png|}}</box| Figure 6: Spirometry Traces Representing Healthy Patients and COPD Patients. Retrieved from: http://www.thinkcopdifferently.com/en/About-COPD/Diagnosing-COPD/Spirometric-assessment> |
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| Across North America, pulmonary rehabilitation has become an extremely popular method for long-term management of COPD (Goldstein et al., 1994). It aims to manage and improve some of the disabilities that are associated with COPD, such as decreased motor function and weight loss (Goldstein et al., 1994). There are three facets of pulmonary rehabilitation are: the multidisciplinary nature of, individualized programs and attention to physical and social function (Ries & Squier, 1996). The collaboration between various kinds health care professionals makes pulmonary rehabilitation very successful because it encompasses a variety of health care fields. Individuals involved include: physicians, nurses, occupational therapists, psychologists, nutritionists and exercise specialists. (Ries & Squier, 1996). Additionally, the emphasis on an individualized rehabilitation plans leads to successful outcomes because patients are able to focus on the areas that they need to develop the most (Ries & Squier, 1996). Finally, by focusing on both the physical and social function of these individuals, pulmonary rehabilitation allows patients to work on emotional issues. This aspect has been correlated with better outcomes in physical symptoms, such as lung function and exercise tolerance (Ries & Squier, 1996). | Across North America, pulmonary rehabilitation has become an extremely popular method for long-term management of COPD (Goldstein et al., 1994). It aims to manage and improve some of the disabilities that are associated with COPD, such as decreased motor function and weight loss (Goldstein et al., 1994). There are three facets of pulmonary rehabilitation are: the multidisciplinary nature of, individualized programs and attention to physical and social function (Ries & Squier, 1996). The collaboration between various kinds health care professionals makes pulmonary rehabilitation very successful because it encompasses a variety of health care fields. Individuals involved include: physicians, nurses, occupational therapists, psychologists, nutritionists and exercise specialists. (Ries & Squier, 1996). Additionally, the emphasis on an individualized rehabilitation plans leads to successful outcomes because patients are able to focus on the areas that they need to develop the most (Ries & Squier, 1996). Finally, by focusing on both the physical and social function of these individuals, pulmonary rehabilitation allows patients to work on emotional issues. This aspect has been correlated with better outcomes in physical symptoms, such as lung function and exercise tolerance (Ries & Squier, 1996). | ||
| - | <box width classes round white centre|>{{:nutrition.png|}}</box| Retrieved from: http://blog.copdstore.com/the-official-guide-to-copd-nutrition> | + | <box width classes round white centre|>{{:nutrition.png|}}</box| Figure 7: Foods Full of Nutrition. Retrieved from: http://blog.copdstore.com/the-official-guide-to-copd-nutrition> |
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| - | <box width classes round white centre|>{{:pulmonary_rehabilitation_in_action.png|}}</box| Retrieved from: http://drvijaynair.8m.com/ > | + | <box width classes round white centre|>{{:pulmonary_rehabilitation_in_action.png|}}</box| Figure 8: Pulmonary Rehabilitation in Action. Retrieved from: http://drvijaynair.8m.com/ > |
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| - | <box width classes round white centre|>{{:significant_improvement_in_exercise_improvement.png|}}</box| Figure : Significant improvement in exercise endurance, for up to 3 months, in individuals who participated in 6 weeks of pulmonary rehabilitation. Modified from: Berry et al. (1999)> | + | <box width classes round white centre|>{{:significant_improvement_in_exercise_improvement.png|}}</box| Figure 9: Significant improvement in exercise endurance, for up to 3 months, in individuals who participated in 6 weeks of pulmonary rehabilitation. Modified from: Berry et al. (1999)> |
| Furthermore, a study done by Lacasse et al. (2006), showed significant improvements with the participation in pulmonary rehabilitation in other symptoms common to COPD patients as well. It was proven that pulmonary rehabilitation relieved symptoms of dyspnea (labored breathing) and fatigue, which is common found in COPD patients due to the muscle loss and increased energy expenditure of movement (Lacasse et al. 2006). Additionally, improvements to the emotional state of COPD patients were shown to enhance an individual’s sense of mastery and control over their condition (Lacasee et al., 2006). Results of this study are shown below. After much research, the significant yield of results illustrate why pulmonary rehabilitation is a crucial component in the long-term management of COPD. | Furthermore, a study done by Lacasse et al. (2006), showed significant improvements with the participation in pulmonary rehabilitation in other symptoms common to COPD patients as well. It was proven that pulmonary rehabilitation relieved symptoms of dyspnea (labored breathing) and fatigue, which is common found in COPD patients due to the muscle loss and increased energy expenditure of movement (Lacasse et al. 2006). Additionally, improvements to the emotional state of COPD patients were shown to enhance an individual’s sense of mastery and control over their condition (Lacasee et al., 2006). Results of this study are shown below. After much research, the significant yield of results illustrate why pulmonary rehabilitation is a crucial component in the long-term management of COPD. | ||
| - | <box width classes round white centre|>{{:improvement_of_symptoms.png|}}</box| Figure : Illustration of the improvement of symptoms, which are common in COPD patients, with the participation in pulmonary rehabilitation. Modified from: Lacasse et al. (2006)> | + | <box width classes round white centre|>{{:improvement_of_symptoms.png|}}</box| Figure 10: Illustration of the improvement of symptoms, which are common in COPD patients, with the participation in pulmonary rehabilitation. Modified from: Lacasse et al. (2006)> |
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| Bronchodilators are a class of medications that are widely used to treat COPD and aid in preventing airflow obstruction in COPD patients (Shim, 1989). These drugs provide relief of some symptoms commonly associated with COPD, such as dyspnea or decreased exercise tolerance, through the relaxation of smooth muscle that line airways (Barnes, 1995). Due to the increase build-up of smooth muscle in COPD patients and subsequent impairment of lung function, these bronchodilators are extremely important in the prevention/reduction of airway obstruction (Berge et al., 2011). The two main bronchodilators used in the treatment of COPD are beta-agonist’s and anti-cholinergic’s (Barnes, 1995). Beta-agonist’s are the most widely used bronchodilator typically used to treat COPD patients (Barnes, 1995). Beta-agonist’s act by binding to the adrenergic receptors on smooth muscle cells and cause an increase of cyclic-AMP (cAMP), a secondary messenger, within the smooth muscle cell. The increase in cAMP causes an intra-cellular cascade that ultimately leads to a relaxation of the smooth muscle surrounding the airway and thus causing bronchodilation (Tashkin & Fabbri, 2010). Long-acting beta-agonist’s in specific, such as formoterol or salmeterol, have been proven to more effectively than regular beta-agonist medications, primarily due to their rapid onset and long duration of action (Barnes, 1995). | Bronchodilators are a class of medications that are widely used to treat COPD and aid in preventing airflow obstruction in COPD patients (Shim, 1989). These drugs provide relief of some symptoms commonly associated with COPD, such as dyspnea or decreased exercise tolerance, through the relaxation of smooth muscle that line airways (Barnes, 1995). Due to the increase build-up of smooth muscle in COPD patients and subsequent impairment of lung function, these bronchodilators are extremely important in the prevention/reduction of airway obstruction (Berge et al., 2011). The two main bronchodilators used in the treatment of COPD are beta-agonist’s and anti-cholinergic’s (Barnes, 1995). Beta-agonist’s are the most widely used bronchodilator typically used to treat COPD patients (Barnes, 1995). Beta-agonist’s act by binding to the adrenergic receptors on smooth muscle cells and cause an increase of cyclic-AMP (cAMP), a secondary messenger, within the smooth muscle cell. The increase in cAMP causes an intra-cellular cascade that ultimately leads to a relaxation of the smooth muscle surrounding the airway and thus causing bronchodilation (Tashkin & Fabbri, 2010). Long-acting beta-agonist’s in specific, such as formoterol or salmeterol, have been proven to more effectively than regular beta-agonist medications, primarily due to their rapid onset and long duration of action (Barnes, 1995). | ||
| - | <box width classes round white centre|>{{:action_of_beta-agonists.png|}}</box| Figure : Mechanism of Action of Beta-Agonists> | + | <box width classes round white centre|>{{:action_of_beta-agonists.png|}}</box| Figure 13: Mechanism of Action of Beta-Agonists> |
| The other kind of bronchodilator used are anti-cholinergic’s, also known as muscarinic antagonists. These not used as often as beta-agonist’s but have been shown to aid in improvement of airway flow in COPD patients as well (Barnes, 1995). Anti-cholinergic’s act by blocking the binding of acetylcholine, which is released from the pre-synaptic cleft of a neuron, to the smooth muscle acetylcholine receptor. By blocking the binding, anti-cholinergic’s are able to prevent bronchoconstriction (Tashkin & Fabbri, 2010). | The other kind of bronchodilator used are anti-cholinergic’s, also known as muscarinic antagonists. These not used as often as beta-agonist’s but have been shown to aid in improvement of airway flow in COPD patients as well (Barnes, 1995). Anti-cholinergic’s act by blocking the binding of acetylcholine, which is released from the pre-synaptic cleft of a neuron, to the smooth muscle acetylcholine receptor. By blocking the binding, anti-cholinergic’s are able to prevent bronchoconstriction (Tashkin & Fabbri, 2010). | ||
| - | <box width classes round white centre|>{{:action_of_anti-cholinergics.png|}}</box| Figure : Action of Anti-Cholinergics> | + | <box width classes round white centre|>{{:action_of_anti-cholinergics.png|}}</box| Figure 14: Action of Anti-Cholinergics> |
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| Studies have shown the long-acting beta-agonist’s (LABAs), such as formoterol, are the best course of medical treatments for individuals with COPD (Rossi, Khirani & Cazzola, 2008). These LABAs are more effective due to their rapid onset and prolonged duration (Barnes, 1995). When used, COPD patients saw improvement with common symptoms, such as dyspnea and decreased exercise tolerance, within minutes-hours after ingestion. Additionally, these drugs also helped improved lung function, reduce exacerbations and overall improve the health status of symptomatic patients with moderate-severe COPD (Rossi, Khirani & Cazzola, 2008). In a clinical study done by Van Noord et al. (2005), results showed that the efficacy of LABAs improved with the combined use of anti-cholinergic drugs. These results were only found in patients with severe COPD and only for the first 12-24 hours after ingestion (Van Noord et al., 2005). | Studies have shown the long-acting beta-agonist’s (LABAs), such as formoterol, are the best course of medical treatments for individuals with COPD (Rossi, Khirani & Cazzola, 2008). These LABAs are more effective due to their rapid onset and prolonged duration (Barnes, 1995). When used, COPD patients saw improvement with common symptoms, such as dyspnea and decreased exercise tolerance, within minutes-hours after ingestion. Additionally, these drugs also helped improved lung function, reduce exacerbations and overall improve the health status of symptomatic patients with moderate-severe COPD (Rossi, Khirani & Cazzola, 2008). In a clinical study done by Van Noord et al. (2005), results showed that the efficacy of LABAs improved with the combined use of anti-cholinergic drugs. These results were only found in patients with severe COPD and only for the first 12-24 hours after ingestion (Van Noord et al., 2005). | ||
| - | <box width classes round white centre|>{{:improvement_of_lung_capacity.png|}}</box| Figure : Improvement of lung capacity, within the first 12-24 hours, in individuals with severe COPD after the ingestion of both long-acting beta-agonist’s and anticholingeric medications. Modified from: Van Noord et al. (2005)> | + | <box width classes round white centre|>{{:improvement_of_lung_capacity.png|}}</box| Figure 15: Improvement of lung capacity, within the first 12-24 hours, in individuals with severe COPD after the ingestion of both long-acting beta-agonist’s and anticholingeric medications. Modified from: Van Noord et al. (2005)> |
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| ===== References ===== | ===== References ===== | ||
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