COPD, or chronic obstructive pulmonary disease, refers to a group of lung diseases that make it difficult to breathe. It is usually caused by long-term exposure to irritating gases and particulate matter, most often from cigarette smoking. The two main conditions that make up COPD are chronic bronchitis and emphysema. COPD is a progressive lung disease that cannot be cured, but early treatment can help manage symptoms and slow its progression. Smoking cessation is critical for COPD patients to prevent further lung damage.

1. COPDChronic Obstructive Lung Disease Developed by: Dana Hughes, RN, PhD Miners Hospital, University of Utah Libbey M. Chuy, MPH Asthma Program, Utah Department of Health

2. Overview What is COPD? How do I know if I have COPD? How common is it? General population Mining population What increases my risk of developing COPD? How can I prevent getting COPD? How is COPD treated?

3. What is COPD? A set of lung diseases that limit air flow and is not fully reversible. COPD patients report they are “hungry” for air Usually progressive and is associated with inflammation of the lungs as they respond to noxious particles or gases Potentially preventable with proper precautions and avoidance of precipitating factors Symptomatic treatment is available

4. Two Major Causes of COPD Chronic Bronchitis is characterized by Chronic inflammation and excess mucus production Presence of chronic productive cough Emphysema is characterized by Damage to the small, sac-like units of the lung that deliver oxygen into the lung and remove the carbon dioxide Chronic cough *Source: Braman, S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2005;9(1):1.

5. Primary Symptoms Chronic Bronchitis Chronic cough Shortness of breath Increased mucus Frequent clearing of throat Emphysema Chronic cough Shortness of breath Limited activity level

6. Normal versus Diseased Bronchi

7. Emphysema

8. How common is COPD? About 13.9% of the U.S. adult population (25+ years) have been diagnosed with COPD* An estimated 15-19% of COPD cases are work-related** 24 million other adults have evidence of troubled breathing, indicating COPD is under diagnosed by up to 60%*** *Braman, S. Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2005;9(1):1. **CDC programs in Brief– Workplace Health and Safety-Work-related Lung Diseases. www.cdc.gov/programs/workpl18.htm ***COPD Fact Sheet. Oct 2003. www/lungusa.org

9. COPD-A Major Cause of Hospitalization & Death COPD was the: Leading cause of hospitalizations in the U.S. in 2000 Fourth leading cause of death

10. COPD in the Mining Industry Studies show: An increased number of cases of chronic bronchitis in coal & gold miners Long-term exposures to low levels of silica may lead to the development of chronic bronchitis & emphysema Chronic exposure to coal dust, particularly high levels, may lead to severe respiratory impairment (emphysema) *Hnizdo & Vallyathan Chronic obstructive pulmonary disease due to occupational exposure to silica dust: a review of epidemiological and pathological evidence. Occup Environ Med 2003;60:237-243.

11. COPD Death Rates in Mining Industry1999 Coal mining was at the top of a list of industries with a significantly elevated death rate from COPD Non-metal and metal mines were also in the top 5 industries for elevated COPD death rate Top 5 occupations for elevated COPD death rate included: Helpers, mechanics and repairers Mining machine operators

12. What can cause COPD? Smoking is the primary risk factor Long-term smoking is responsible for 80-90 % of cases Smoker, compared to non-smoker, is 10 times more likely to die of COPD Prolonged exposures to harmful particles and gases from: Second-hand smoke, Industrial smoke, Chemical gases, vapors, mists & fumes Dusts from grains, minerals & other materials

13. Other Risk Factors for COPD History of childhood respiratory infections Genetic makeup Increasing age

14. Ways to prevent or slow the progression of COPD Stop smoking, if you smoke, to prevent further damage to your body Smoking cessation is critical for all severities of COPD Avoid or protect yourself from exposures to Second-hand smoke and Other substances such as chemical vapors, fumes, mists, dusts, and diesel exhaust fumes that irritate your lungs

15. How is COPD Treated? COPD can be managed, but not cured Treatment is different for each individual and is based on severity of the symptoms Early diagnosis and treatment can Slow progress of the disease Relieve symptoms Improve an individual’s ability to stay active Prevent and treat complications Improve quality of life

16. When should you see your doctor? If smoker, see doctor for baseline evaluation of your lungs When first experiencing shortness of breath or having other lung symptoms When your symptoms get worse Seek emergency medical treatment if: Breathing suddenly becomes more difficult If diagnosed with chronic bronchitis, emphysema or COPD, see doctor 1-2 times yearly to review your treatment plan

17. What medications are used to treat symptoms? Bronchodilators – Relaxes muscles around airways Steroids Reduces inflammation Oxygen therapy Helps with shortness of breath

18. What medications are used to prevent complications? Annual flu vaccine Reduces risk of flu and its complications Pneumonia vaccine Reduces risk of common cause of pneumonia

19. Resources & References American Lung Association. Breathing hazards at work, Workplace exposures can generate breathing hazards, accessed 11/02/06 American Lung Association. Chronic obstructive pulmonary disease (COPD) Fact Sheet, 2003 www.lungusa.org Centers for Disease Control, DHHS, CDC Programs in Brief-Workplace Health and Safety-Work-Related Lung Disease, 2005 www.cdc.gov/programs/workpl18.htm National Heart, Lung, and Blood Institute, NIH. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease Executive Summary, Updated 2003 National Heart, Lung, and Blood Institute, NIH. COPD-Key points and How is COPD treated? January, 2006 http://www.nhlbi.nih.gov/health