Chronic obstructive pulmonary disease (COPD) is an upper airway disease characterized by the progressive development of airflow limitation that is not fully reversible (American Thoracic Society, 1995). The two most common types of COPD are chronic bronchitis and emphysema. In chronic obstructive bronchitis, mucus hypersecretion causes inflammation and constriction in the small and large airways of the lung, restricting airflow in and out of the lungs. Chronic bronchitis is defined clinically as the presence of cough and sputum for a minimum of 3 months during each of two consecutive years. In emphysema, there is permanent destruction of the protein elastin, a principal component of elastic fibers in the lung’s extracellular matrix that keeps the strength in the alveolar walls. Loss of this protein causes narrowing or collapse of the bronchioles, limiting airflow in and out of the lungs. Elastin loss can also cause the alveoli to overstretch and rupture, leaving permanent enlargement of airspaces and fewer alveoli for oxygen exchange. During inhalation, air continues to reach the alveoli, however, much of the air cannot escape during exhalation leading to stale air trapped in the lungs. The respiratory muscles must then work harder to push air through the obstructed airways, which tires the muscles for getting enough fresh air into the alveoli during inhalation. The result is carbon dioxide build up in the blood while blood oxygen diminishes, leading to hypoxia. COPD generally has a progressive course, beginning with symptoms of cough with sputum, to wheezing, to shortness of breath, and finally breathlessness (dyspnea).
Dyspnea is usually the symptom that leads the patient to seek medical attention, and this typically occurs in the fifth decade and beyond. The decreased amount of oxygen in the blood (hypoxia) also causes weakness, fatigue, difficulty concentrating, and depression. Survival and quality of life has been shown to be lower in patients diagnosed with COPD. The number one cause of COPD is chronic cigarette smoking; however, COPD also occurs in nonsmokers whose occupations are associated with high levels of particles inspired (dust is the most significant). A small percentage of COPD is also genetic. According to the National Center for Health Statistics approximately 11 million people are diagnosed with COPD in the United States, rendering disabled. Chronic obstructive pulmonary disease (COPD) is a progressive illness that leaves patients severely disabled and breathless. Long-term oxygen therapy (LTOT) has been shown to significantly increase survival and to improve neuropsychological functioning in hypoxemic patients with COPD. Further, supplemental oxygen has been reported to substantially reduce dyspnea and to increase exercise endurance in some patients with COPD. To achieve these benefits, oxygen therapy should be administered at least 15 hours per day.
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