Chronic Obstructive Pulmonary Disease
"Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. The disease is predominantly caused by smoking."1
"An estimated three million people are affected by COPD in the UK. About 900,000 have been diagnosed with COPD and an estimated two million people have COPD which remains undiagnosed"1
Management and medication
COPD cannot be cured but effective treatments can improve the quality of life. These can include advice to quit smoking, pulmonary rehabilitation, medication, oxygen therapy, and possibly lung surgery. The main role of medication is to relax and dilate the airways, reduce inflammation and reduce the thickness of sputum, making it easier to cough.
Effects on the exercise response
COPD can make indiiduals less tolerant of exercise. This can be due to a combination of ventilatory limitations, skeletal muscle dysfunction, cardiovascular limitations and psychological factors.
Effects of exercise training
Exercise can improve quality of life in addition to reducing fear, anxiety and depression, improving efficiency of skeletal muscles, and improving the ability of an individual to perform activities of daily living or to return to work.
Guidelines for exercise programming
- NICE Guidance CG101 - COPD diagnosis and management
- American College of Sports Medicine (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics
ACSM Current Comment: Exercise and COPD [full text]
Ambrosino, N. and Strambi,S.(2004) New strategies to improve exercise tolerance in chronic obstructive pulmonary disease. Eur Respir J; 24: 313–322.[full text]
Albores J, Marolda C, Haggerty M, Gerstenhaber B, Zuwallack R. (2012) The Use of a Home Exercise Program Based on a Computer System in Patients With Chronic Obstructive Pulmonary Disease.
Aliverti, A., Kayser, B. and Macklem, P. T. (2007), A human model of the pathophysiology of chronic obstructive pulmonary disease. Respirology, Vol. 12, 478–485. doi: 10.1111/j.1440-1843.2007.01106.x [full text]
Bolton, C. E., Bevan-Smith, E. F., Blakey, J. D., Crowe, P., Elkin, S. L., Garrod, R., ... & Morgan, M. D. (2013). British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax, 68, ii1.
Buckley, J. (Ed) (2008) Exercise Physiology in Special Populations. Oxford; Elsevier. Ch4
Holland, A. E., Wadell, K., & Spruit, M. A. (2013). How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD. European Respiratory Review, 22(130), 577-586.
Macklem, P.T. (2010) Therapeutic implications of the pathophysiology of COPD Eur Respir J Vol. 35, 676–680 [full text]
Maltais, F., Decramer, M., Casaburi, R., Barreiro, E., Burelle, Y., Debigare, R., ... & Gosker, H. R. (2014). An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 189(9), e15-e62.
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease.The Cochrane Library.
National Institute of Clinical Excellence (2004) COPD: Management of chronic obstructive pulmonary disease in adults in primary and secondary care. London: NICE [full text]
Ng, L. W. C., Mackney, J., Jenkins, S., & Hill, K. (2012). Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis. Chronic respiratory disease, 9(1), 17-26.
O Donnell, D. E. (2001). Ventilatory limitations in chronic obstructive pulmonary disease. Medicine and science in sports and exercise, 33(7; SUPP), S647-S655.
Puhan, M. A., Gimeno‐Santos, E., Scharplatz, M., Troosters, T., Walters, E. H., & Steurer, J. (2011). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane Library.
Ries, A.L., Bauldoff, G.S, Carlin, B.W. et al (2007) Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Gudelines Chest 131(5) 4S-42S [full text]
Thomas, M., Decramer, M., & O'Donnell, D. E. (2013). No room to breathe: the importance of lung hyperinflation in COPD. Primary Care Respiratory Journal, 22, 101-111.
Troosters,T., Casaburi, R., Gosselink, R. and Decramer, M. (2005) Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Am J Respir Crit Care Med Vol 172, 19–38 [full text]
Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Stockley, R. A. (2013). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine, 187(4), 347-365.
Wagg, K. (2012). Unravelling self-management for COPD: What next?.Chronic Respiratory Disease, 9(1), 5
Zwerink, M., Brusse‐Keizer, M., van der Valk, P. D., Zielhuis, G. A., Monninkhof, E. M., van der Palen, J., ... & Effing, T. (2014). Self management for patients with chronic obstructive pulmonary disease. The Cochrane Library.
Suggested Web Sites
- BMJ Best Practice - COPD
- NHS Choices - Health A-Z - COPD [click here for link]
- NICE Guidance CG101 - COPD diagnosis and management
- NICE pathway - COPD
- Patient.co.uk - [click here]
- UK Government Policy on COPD - July 2011 [click here]