Chronic Obstructive Pulmonary Disease - Essay Example

"Chronic Obstructive Pulmonary Disease" The most common conditions that patients are presented with in medical acute dependency have been respiratory and cardiac diseases. It is therefore imperative to have an in-depth knowledge about the diseases. (http://www.frimleypark.nhs.uk/departments/acute_med/MADU_html/). The disease presented in this study is Chronic Obstructive Pulmonary Disease (COPD). The foremost condition of therapy for medical acute dependencies is the use of non-invasive ventilation to facilitate and reduce the patient's efforts to breathe when they are facing chest infection, exacerbation of chronic obstructive pulmonary disease or cardiac failure (http://www.frimleypark.nhs.uk/departments/acute_med/MADU_html/). Chronic obstructive pulmonary disease (COPD) vastly affects the quality of life of patients and diminishes tolerance and ability to execute daily tasks. It is exemplified by airflow obstruction. Research data depicts that around 15 million people in United States are affected by COPD, which encompass chronic bronchitis and emphysema. There is a decline in the mortality rate caused by other chronic illnesses such as cardiovascular disease and stroke in the last 20 years (http://www.aarc.org/resources/confronting_copd/exesum.pdf). COPD is a great matter of concern as it is depicting constant rise in the mortality rate. Cigarette smoking is the major factor (90% cases) associated with the development of COPD. (http://www.trdrp.org/fundedresearch/Views/Grant_Page.aspgrant_id=2097). It is also established that all the smokers do not develop COPD. Over the decade a huge economic and personal cost has been mounted up but, our understanding to formulate the biological basis for the development of COPD and the disparity in the susceptibility to cigarette smoke stay relatively inadequate. Using a variety of investigational approaches, the study aims to develop an understanding of the biology of the disease. It becomes all the more crucial to carry out studies in COPD as it is the fourth leading cause of death and will become third by 2020, it is imperative to carryout research to combat the disease as it is causing risk of depression. (http://www.nlm.nih.gov/medlineplus/news/fullstory_74047.html). It is quite unfortunate that over the past three decades the research has not shown much progress, it has focused only on the pathogenic roles of cigarette smoke, inflammation, protease and antiprotease balance. Research has also established an association of COPD with cigarette smoking; and patients with emphysema are known to suffer with a gene deficiency in an inhibitor of a neutrophils protease (Stang et al, 2000). The theory of cigarette-inflammation-protease has done lot in the field of COPD epidemiology and pathology but is not able to reduce the pervasiveness and morbidity caused by COPD. It is therefore imperative to impose an urgent necessity for research in this area. The research is directed to sustain novel concepts and innovative experimental approaches and techniques pertinently suitable to COPD research. The research is also directed to explicate the cellular pathways involved in COPD pathogenesis. This is a step helpful in clinical trials of potential therapeutics. Explanation of these pathways is the step to develop capability of pharmaceutical industry to design the mechanism specific drugs. (http://www.nhlbi.nih.gov/meetings/workshops/copd_wksp.htm) Anonymity of COPD pathogenesis: COPD encompass emphysema and chronic obstructive bronchitis, both these conditions relentlessly limits airflow that is not significantly reversed by bronchodilators. COPD progressively turn down the pulmonary functions with a rapid pace as compared to that in normal aging. Stimulating factors known to induce changes in animal lungs are cigarette smoke, pancreatic elastase, bacterial lipopolysaccharides, cadmium, chloramine-T, oxidants, silica, and rigorous malnourishment (Shapiro, 2000). It is established that many apparently dissimilar pathways are capable of causing emphysema or bronchitis, therefore significance of any particular model to human disease is unsure. On the contrary, no single theory of COPD is so far competent to correlate human disease. (http://www.nhlbi.nih.gov/meetings/workshops/copd_wksp.htm) Based on these evidences it is useful to consider that COPD may not be consistent with a simple cigarette neutrophil protease theory. Various aspects of research are attributed for COPD namely: 1. Inflammation of airway and parenchyma 2. Mucous Hypersecretion. 3. Acute Exacerbation and Bacterial Infections. 4. Airway Hyperresponsiveness. 5. Spirometry. 6. Variation in susceptibility to COPD and Disease Progression- it is established that genetic and environmental factors are associated with the development of COPD. It is essential to develop an understanding why some smokers only develop COPD. 7. Long-Term Oxygen therapy (LTOT) in COPD patients with Moderate Chronic Hypoxemia and Chronic Heart Failure (CHF). (http://www.nhlbi.nih.gov/meetings/workshops/copd_wksp.htm) 8. A Study To Investigate The Safety, Toleration and Efficacy PF00610355 In COPD Patients. (http://clinicaltrials.gov/search/open/condition=%22Lung+Diseases,+Obstructive%22). 9. Other Lung Diseases Associated with Cigarette Smoking- Idiopathic pulmonary fibrosis (both usual interstitial pneumonitis and desquamative interstitial pneumonitis); respiratory bronchiolitis- associated interstitial lung disease and pulmonary histiocytosis X (Nagai, 2000). It is manifested that research in the field of COPD has thrown light on numerous unanticipated results, thoughts and approaches important in the field to focus on the basic understanding of the mechanisms that triggers the variation in vulnerability to cigarette smoking. Some of these approaches, encompass proteomic, genomic, genetic, and epidemiologic, to human-based research. This study requires lot of funds and instruments to carry out the study viz. Mass spectrometry, pedigree charts, knowledge of retinoid, CT quantitative image analysis and also serum and BAL biochemical measures, also physiology and symptoms score of the patients. (http://www.bumc.bu.edu/pulmonary/research/translational/copd/) Another research study is manifested based on the impairment to perform day-to-day tasks is due to damage to the lungs but research suggest that skeletal muscles of COPD patients are also damaged. Conversely, the incidences of this skeletal muscle dysfunction and the mechanisms accountable for it are not well established. The character of the disease is such that the skeletal muscles of COPD patients become reconditioned, consequently a focus of this research will be examining the contributions of skeletal muscle abandonment to the work intolerance associated with COPD. The study incorporates COPD patients and healthy individuals, both will exercise their calf muscles by pushing on a pedal. This type of exercise only involves a small muscle mass thus removing the limitation to exercise caused by airflow obstruction in COPD. This encompasses: 1. The subjects- they are required to perform the exercise, state-of-the-art techniques will be used to measure blood flow and metabolism in the exercising muscle. 2. Doppler flowmetry to assess the blood flow to the muscle during exercise. It determines adequacy of oxygen being delivered to the muscles. 3. Magnetic resonance spectroscopy and magnetic resonance imaging to measure the metabolism of the muscles. This also assesses the ability of the muscles to use oxygen during exercise. The combination of these techniques will assess the contributions of the peripheral factors of blood flow and muscle metabolism to the reduced exercise tolerance of COPD patients. The research based results allocate directions and appraisal of interventions designed to improve exercise tolerance in COPD patients. These techniques can be used to evaluate the effects of involvements such as exercise training, and lung transplantation on skeletal muscle oxygen delivery. (http://www.trdrp.org/fundedresearch/Views/Grant_Page.aspgrant_id=2097). According to the Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2006. Analysis performed by American Lung Association Research and Program Services using SPSS and SUDAAN software, Over 12.1 million U.S. adults (aged 18 and over) were estimated to have COPD in 2006. Also, according to Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Surveillance-United States, 1971-2000. Morbidity and Mortality Weekly Report, 24 million U.S. adults have verification of impaired lung function, indicating an under-diagnosis of COPD. Therefore it is becoming a matter of great concern because damage to the lungs is not noticed until the disease is well-advanced, thus limiting effective treatment options. Funds are needed for research to find a cure and improve treatment of chronic obstructive pulmonary disease (COPD), also known as Chronic Obstructive Lung Disease (COLD). COPD is an insidious disease, which is often diagnosed after some of the lung capacity is already lost. Diseases included under the umbrella term include emphysema and chronic bronchitis. In order to improve research in the field funding is available for improving some very encouraging studies, clinical trials and research for medications and treatments and to manage awareness to control the disease as it can be slowed down with persistence. Various organizations providing funds to perform research in this field: European Respiratory Society- aims to support research and training projects in COPD. Boehringer-Ingelheim offer a sponsored award to an ERS member who conducts innovative research in COPD. The research could be related to any segment of COPD, grants are provided on the projects and funds available could go 10k- 50k (http://rdfunding.org.uk/Queries/ListGrantDetails.aspGrantID=5591). Apart from this, various other organizations are also providing funds- research councils, higher education funding councils and large no. of UK government departments (www.dius.gov.uk). A good deal of research is funded by various charities, professional societies, universities and research institutes, International sources of funding like European Union, NATO and other European and international public bodies, Department for Innovation, Universities and Skills (DIUS) and the Department for Business, Enterprise & Regulatory Reform (BERR). (http://www.hero.ac.uk/uk/research/who_funds_research_/overview.cfm) http://rdfunding.org.uk/Queries/ListGrantDetails.aspGrantID=5591. Government and various hospitals are keen to fight COPD and so they are willing to implement the research and encourage the researchers by providing funds to carry out the tasks. Organizations like National Heart lung and Blood Institute (NIH) is the leading organization to support research in COPD along with various other organizations like American Lung Association (http://www.lungusa.org/site/c.dvLUK9O0E/b.4074821/). Expertise is required to deliver the change, research findings must target lung disease/ health issues, high level lung diseases like COPD. (http://www.lungusa.org/site/pp.aspc=dvLUK9O0E&b=934453). How can we go about it We have seen the severity of the disease and the need to carry out the research, the next step is to define the aim of the research area we shall be following to carry out the research in the field of COPD. This needs expertise and so the task must be accomplished by engaging with the stakeholders associated with the field of research in COPD and with hospitals, medical acute dependency unit. The request in the form of application may be submitted to the funding organization, either local body, private, university or government body stating the willingness and protocol to be followed with the Performa for pursuing research in COPD, with the hypothetical outcome of the research and expected/ presumed findings. Once the funds are secured then the tasks must be executed at the faster pace with devotion and care. One must remember that human nature and living conditions varies throughout the world and so no two patients can have the same etiology of COPD. Therefore a deep understanding about the disease and factors affecting the disease must be considered. Change in the plan must be executed as per the need and requirement of the research. The research findings must be concluded with the data evaluation process, supporting the validation of the research. There must be suitable and logical argument supporting the data collected during the process of research. If animal study is conducted then the possible outcome for the humans must be presented with suitable references if the study is carried out in past or else human volunteers should be promoted if the research outcome is factual. The research findings must be cross checked and repeated before proving the authenticity of the study. Benefits of the study: 1. Financial benefits: Treatment of COPD is becoming the financial burden on the society. It is becoming the leading cause of death in most of the developed and under developed nations affecting the economy of the country. Tremendous rise in the disease percentage and mortality caused by it is alarming for the world population. 2. Better Health Care: one can lead good and long life with a great deal of quality even after being diagnosed with COPD. Patients well-being and prognosis can improve to a larger extent with proper treatment and utmost care both medical and psychological. This can be achieved with the following: a. Early detection b. A knowledgeable physician, proactive in disease management. c. Faithful follow-up of medication regimen. Pharmacotherapy and respiratory rehabilitation are the major treatments for COPD. Bronchodilators such as BETA.2 agonists, anticholinergic agents and theophylline are the main drugs for treatment. d. Good and healthy eating habits, diet rich in vitamins E and C, selenium, and beta carotene may actually improve lung function e. By quitting smoking f. Personal exercise schedule g. Awareness and education about disease and outcomes h. Prevention of infection to reduce exacerbations for minimizing additional lung damage 3. Less time in hospital: following the medical regimen strictly can reduce the time span of hospital stay and also prevent the patient from hospital borne infections and also malnutrition prevalent in hospitals. These contribute to the good health and delay mortality. 4. More job satisfaction: recovery of the patient and delay of mortality provides great job satisfaction. If the research findings are able to provide the benefit to the patients then it is worth considering and implementing. 5. An advantage to families: Families are the ultimate sufferers in case of COPD or related illness both emotionally and financially. The research in COPD must be carried out keeping the sufferings of the family in consideration so as to provide a congenial psychotherapy to the patient. Conclusion: COPD is becoming the most prevalent disease in both developing and developed nations. It is turning out to be the fourth leading cause of mortality and with the increase in percentage it will be third most common cause of mortality, considering the severity of the disease it becomes imperative to carry research to find a resolution to combat the disease. References: 1. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2006. Analysis performed by American Lung Association Research and Program Services using SPSS and SUDAAN software. 2. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Surveillance-United States, 1971-2000. Morbidity and Mortality Weekly Report. August 2, 2002; 51(SS06):1-16. 3. Nagai, S., Hoshino, Y., Hayashi, M., Ito, I., 2000. Smoking-related interstitial lung diseases. Curr Opin Pulm Med . 6:415 -419. 4. Shapiro, S.D., 2000 Animal models for COPD. Chest. 117:223S -227S. 5. Stang, P., Lydick, E., Silberman, C., Kempel, A., Keating, E.T., 2000. The prevalence of COPD: using smoking rates to estimate disease frequency in the general population. Chest. 117:354S -359S. 6. http://www.trdrp.org/fundedresearch/Views/Grant_Page.aspgrant_id=2097 7. http://www.nlm.nih.gov/medlineplus/news/fullstory_74047.html 8. http://clinicaltrials.gov/search/open/condition=%22Lung+Diseases,+Obstructive%22 9. http://www.bumc.bu.edu/pulmonary/research/translational/copd/ 10. http://rdfunding.org.uk/Queries/ListGrantDetails.aspGrantID=5591 11. http://www.hero.ac.uk/uk/research/who_funds_research_/overview.cfm 12. http://www.lungusa.org/site/c.dvLUK9O0E/b.4074821/ 13. http://www.lungusa.org/site/pp.aspc=dvLUK9O0E&b=934453 14. http://www.frimleypark.nhs.uk/departments/acute_med/MADU_html/ 15. http://www.aarc.org/resources/confronting_copd/exesum.pdf 16. http://www.nhlbi.nih.gov/meetings/workshops/copd_wksp.htm Read More