Pharmacists COPD Accreditation Site

SIGNS, SYMPTOMS & PROGNOSIS

COPD

COPD is associated with a variety of symptoms including dyspnea (shortness of breath, difficulty breathing), cough and sputum.

Symptoms are due to the pathologic consequences of chronic bronchitis and emphysema. Although, COPD patients rarely fall within one of the two extremes(8) (i.e., "pure" chronic bronchitis or "pure" emphysema) the symptoms of each are described separately in Table 3.

Symptom severity falls on a continuum ranging from no symptoms to severe symptoms at rest and cor pulmonale (enlargement of the right ventricle due to lung disease with or without right ventricular failure)(9) (Figure 5).

>> Spirometry Definitions

Symptoms correlate with a decline in lung function measurements (i.e., FEV1) (Figure 5). Patients with mild COPD are often asymptomatic.(5) By the time symptoms are noticeable, significant lung function has been lost.(8) Therefore, lung function tests should be conducted once COPD is suspected(5) so further reductions in lung function can be minimized through smoking cessation. Lung function tests may be used to determine the severity of disease and periodically thereafter to determine the rate of lung function decline. Lung function tests may also serve as a means to motivate a patient to stop smoking.

With respect to prognosis, COPD patients experience a slow, steady decline in lung function.

COPD versus Asthma

	There are important distinctions to be made between COPD and asthma, regarding signs, symptoms and prognosis. Key distinguishing symptoms and features relevant to pharmacists are described in Table 4.
	Approximately 10% of COPD patients have asthma as well.(10) Unlike most COPD patients, those with mixed COPD and asthma have a reversible component to their disease and are more likely to respond to inhaled steroids.
	The prognosis of COPD differs greatly from that of asthma. COPD patients experience a continuous decline in lung function. Asthma patients experience intermittent symptoms and with proper disease control should not die of their condition. Compared with asthma, the mortality attributable to COPD is at least 14 times greater.(11)

Detection & Diagnosis