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Monday, July 1, 2019

Chronic Obstructive Pulmonary Disease (COPD)

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Chronic obstructive pulmonary disease (COPD) is a lung disease that causes difficulty in airflow into and out of the lungs. Patients with COPD experience difficulty breathing that may be intermittent or persistent, wheezing and increased amounts of mucus production. According to the American Lung Association, COPD affects 30 million Americans and is the third leading cause of death in the United States behind cancer and heart disease. The most common cause is longterm exposure to irritating inhaled gases such as cigarette smoke or other environmental exposures. In the United States, the main cause of COPD is tobacco smoking. The disease is chronic in that it cannot be completely reversed, but does respond to treatment.

Emphysema and chronic bronchitis are the two most common conditions of COPD. Chronic bronchitis is inflammation and irritation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. The inflammation results in a persistent cough and an increase in mucus (sputum) production. Emphysema is a condition in which the tiny air sacs at the end of the smallest air passages are damaged beyond repair because of long-term exposure to cigarette smoke and other environmental irritants.

With proper management, most people with COPD can achieve good control of their symptoms and improve their quality of life, as well as reduce their risk of other associated conditions.

COPD symptoms may not appear until significant lung damage has already occurred. Symptoms usually worsen over time, particularly if smoking exposure continues and may include:

• Frequent respiratory infections

• Chest tightness

• Wheezing

• Chronic cough with or without sputum

• Cyanosis (blueness of fingernail beds and/or lips)

• Shortness of breath, especially with exertion or activity

• Lack of energy

• Unintended weight loss (in later stages)

• Swelling in ankles, feet or legs

Over the last 20 years, LSU Health Shreveport has been developing inventive ways to treat people with severe respiratory diseases, including those with COPD that become severely ill. Researchers at LSU Health Shreveport recognized early on that placing someone with severe COPD on artificial ventilation could produce more harm than good. The research team has concentrated on innovative methods to treat patients with severe respiratory failure from lung injury or infections, including advanced COPD, to reduce the risk associated with placing someone on artificial ventilation.

Mechanical artificial ventilation requires a patient to have a tube placed into their windpipe with a ventilator that forces air into their lungs with the goal that adequate amounts of oxygen can be provided and carbon dioxide removed. This procedure works well in most patients with respiratory failure, but there are exceptions. When lung inflammation is severe, artificial ventilation may not be adequate to provide exchange of gases, and patients cannot survive. Researchers at LSUHS have been developing methods to treat the blood directly using an artificial lung. By providing gas exchange directly to the blood, the need for artificial ventilation is reduced.

Recently, a new process for carbon dioxide removal directly from the blood has been developed that only requires a small intravenous catheter placed in the neck or groin. Patients on this therapy may no longer require a tube in the windpipe, reducing the need to keep them heavily sedated. These patients can often talk and eat while this machine removes their carbon dioxide and allows them to breathe normally while waiting for their lungs to improve.

This therapy is experimental, but it has the potential to significantly change medical care for people afflicted with severe exacerbations of their COPD and may also help patients with severe asthma. LSUHS has been at the forefront of this technology for more than 20 years and will continue to work to provide excellent and state-of-the art care addressing this and other critical illnesses. The research team began with one intensivist physician, Dr. Steven A. Conrad, in the early 1990s. Since then, the research team has significantly grown, and now our team conducts integral clinical research in the use of artificial organs and other novel treatments to support patients with a critical illness.

To learn more about COPD or critical care research projects at LSU Health Shreveport, please contact ksmit9@lsuhsc.edu or ecask1@lsuhsc.edu.

Steven Conrad, MD, Ph.D., MCCM, is the Ike Muslow MD Endowed Chair in Healthcare Informatics and a professor of medicine, emergency medicine, pediatrics and surgery at LSU Health Shreveport, and the director of the Extracorporeal Life Support Program at Ochsner LSU Health Shreveport. L. Keith Scott, MD, MS, FCCM, is a professor of pediatrics, surgery and medicine at LSU Health Shreveport and an attending physician in the Pediatric Intensive Care Unit and Surgical Intensive Care Unit at Ochsner LSU Health Shreveport.

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