COPD

1 What is Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) is a progressive and obstructive lung disease that includes chronic bronchitis and emphysema. It is characterized by shortness of breath, cough, sputum production and wheezing. COPD develops due to repeated and prolonged exposure to irritating gases or particles, mostly cigarette smoke.

WhatisCOPD

COPD increases the risk of developing heart disease, lung cancer and other different condition. Chronic bronchitis is inflammation of airways which carry air to and from the air sacs (alveoli) of lungs. Daily cough and sputum production indicate chronic bronchitis. Emphysema is a condition in which the air sacs (alveoli), responsible for oxygen exchange, are damaged due to exposure to offending particles.

Appropriate treatment can relieve symptoms of COPD and improve quality of life while minimizing chances of developing other medical conditions.

COPD (1)

2 Symptoms

You may not experience symptoms of chronic obstructive pulmonary disease until your lung is extensively damaged. Symptoms progressively worsen with time especially if you continue smoking. Chronic bronchitis is characterized by daily cough with sputum at least three months a year for two successive years. Signs and symptoms of COPD are:

  • Breathlessness mostly during physical activities 
  • Wheezing 
  • Chest tightness 
  • Frequent throat clearing, immediately after waking up
  • Persistent cough with clear, white, yellow or greenish sputum 
  • Cyanosis (blue lips and fingernail beds) 
  • Recurrent respiratory tract infections
  • Lethargy
  • Weight loss in later stages 

People with COPD are also likely to have acute exacerbations, during which COPD symptoms suddenly worsen and last for several days.

3 Causes

Tobacco smoking and exposure to smoke from combustion of fuel are the major causes of chronic obstructive pulmonary disease. Nearly half of chronic smokers develop minor symptoms of COPD whereas nearly one fourth of chronic smokers develop apparent symptoms of COPD. Some smokers may be falsely diagnosed with COPD which can be confirmed only after detailed examination. 

How your lungs are affected? 

After air is inhaled, it passes through different tube-like organs such as trachea, bronchi and bronchioles to finally reach air sacs (alveoli), where gaseous exchange occurs. In the alveoli, inhaled oxygen passes into the blood vessels whereas carbon dioxide from blood passes into alveoli. The carbon dioxide is then exhaled. Respiration depends on the elasticity of the bronchi and alveoli. In COPD, the elasticity of the bronchial tubes and alveoli is lost which causes air to be locked in your lungs as you exhale. 

Causes of airway obstruction 

  • Emphysema: Elasticity of alveoli is lost resulting in impaired alveoli function. It interrupts airflow as you exhale.
  • Chronic bronchitis: It is persistent inflammation and narrowing of bronchi and sputum production which also blocks the bronchi. Chronic cough develops in an attempt to clear airways.
  • Cigarette smoke and other irritants

Most of the people who have developed COPD are chronic smokers. But it is believed that other factors also have important role in the development of COPD, such as your genetic makeup (can increase your vulnerability), because only about one fourth of smokers develop COPD. Other lung irritants like cigar smoke, secondhand smoke, pipe smoke, air pollution, dust, smoke or fumes can cause COPD. 

Alpha-1-antitrypsin deficiency 

Nearly 1% of people suffering from COPD have genetic disorder which results in low level of alpha-1-antitrypsin, a protein. Alpha-1-antitrypsin (AAt) produced by liver, helps in protection of the lungs. Alpha-1-antitrypsin deficiency can cause lung as well as liver disease. Liver damage is not exclusive in adults and it can occur in infants and children also. AAt deficiency COPD in adults can be treated by medications used for treating common types of COPD. Also, AAt proteins can be replaced to prevent further lungs damage.

4 Making a Diagnosis

If you are suspected to have chronic obstructive pulmonary disease you are likely to be referred to a pulmonologist (lung disease specialist) to receive a diagnosis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor. Some typical questions can be: 

  • What are your symptoms? 
  • When did they appear? 
  • Does anything improve or worsen your symptoms? 
  • Do you have a family history of COPD? 
  • What treatment you had for COPD? If so, did it help? 
  • Have you ever taken beta blockers for your high blood pressure or heart? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

  • How long have you had a cough
  • Do you get short of breath easily? 
  • Do you wheeze while breathing? 
  • Are you a smoker? If yes, do you like to quit?

Tests for COPD include:

  • Pulmonary function tests: To test lung function, you will have to blow into a tube that is connected to spirometer. Spirometer assesses the amount and speed of air that your lung can inhale or exhale. Spirometry can record the development of COPD, evaluate the efficacy of treatment and measure the effectiveness of bronchodilator. Some other lung function tests are lung volumes, diffusing capacity and pulse oximetry
  • Chest X-ray: Emphysema can be noticed in a chest X-ray. An X-ray can help to distinguish whether you have COPD or other medical conditions such as, lung problems or heart failure.
  • CT scan: Emphysema and lung cancer can be detected with a CT scan of your lungs. Also, CT scan can determine whether you will be benefitted from surgery or not. 
  • Arterial blood gas analysis: This blood test evaluates how effectively your lungs are exchanging gases. 

5 Treatment

Many who suffer from mild chronic obstructive pulmonary disease (COPD) can be treated by lifestyle change, such as quitting smoking and taking fewer medications. In people with advanced COPD, medications can control symptoms, reduce complications and episodes of exacerbation as well as improve quality of life. 

  • Smoking cessation: Quitting smoking prevents worsening of COPD and reduces the episodes of breathlessness. Quitting is not easy. Consult your doctor if you need nicotine replacement therapy and other medications. Avoid places where there is cigarette smoke. 
  • Medications: Doctor can suggest you to take medications either regularly or whenever needed. Medications for controlling symptoms and complications include:

 Bronchodilators: Mostly used as inhaler, they relax bronchial smooth muscles and ease breathing by relieving cough and breathlessness. You may be advised to use short-acting bronchodilators before physical activities, long-acting bronchodilator everyday or both. Short-acting bronchodilators are albuterol, levalbuterol, and ipratropium. The long-acting bronchodilators are tiotropium, salmeterol, formoterol, arformoterol, indacaterol and aclidinium. 

 Inhaled steroids: Inhaled corticosteroids such as fluticasone and budesonide, decrease inflammation of bronchi and prevent flare up. Side effects include bruising, voice changes and oral infections. These medications are beneficial for people who experience recurrent COPD exacerbation. 

 Combination inhalers: Combined bronchodilators and inhaled steroids (salmeterol + fluticasone, and formoterol + budesonide) may be prescribed. 

 Oral steroids: They are prescribed for moderate or severe acute exacerbation of COPD and given for a short period. 

Prolonged corticosteroid use can cause weight gain, diabetes, osteoporosis (weakening of bone), cataracts and higher risk of infection. It also increases mortality associated with COPD.

 Phosphodiesterase-4 inhibitors: They relax the airways thereby reducing airway inflammation. Roflumilast is prescribed for severe cases and chronic bronchitis. 

 Theophylline: Theophylline, an oral bronchodilator, reduces breathlessness and prevents flare up. 

 Antibiotics: They treat, but do not prevent, acute exacerbation of COPD due to respiratory infections, such as acute bronchitis, pneumonia and influenza. Studies suggest azithromycin's effectiveness in preventing exacerbations however the exact mechanism is still unclear.

 Lung therapies 

Additional therapies are recommended for moderate or severe cases of COPD.

  • Oxygen therapy: It can improve quality of life as well as extend life. You may need to use oxygen all the times or during physical activities or sleeping. Portable oxygen delivering devices can be carried to wherever you go. 
  • Pulmonary rehabilitation program: It includes a combination of education, exercises, nutritional suggestion and counseling.. It can minimize duration of hospitalizations, increase your participation on daily activities and improve quality of life.
  • Managing exacerbations 

You may experience acute exacerbation, worsening of your symptoms, which can cause lung failure if not treated promptly. Exacerbations can be elicited by a respiratory infection, air pollution or other lung irritants. Visit your doctor immediately if you experience increased coughing and breathlessness or change in you mucus. You may need more medications, such as antibiotics, steroids or both, supplemental oxygen or you may need to be hospitalized. Post treatment, your doctor may suggest you preventive measures to avoid exacerbations. Preventive measures include quitting smoking, using inhaled steroids, long-acting bronchodilators or other medications, getting vaccinated and avoiding irritants whenever possible. 

  • Surgery: Surgery is opted if you can't be benefitted with medications. 
  • Lung volume reduction surgery: In this surgery, damaged tissues are removed so that your healthier tissues can expand while respiration. It can expand your life and improve quality of your life. 
  • Lung transplant: Lung transplantation improves your breathing ability as well as your quality of life. Lung transplant is associated with risk of organ rejection for which you need to take immune-suppressant throughout your life. 

6 Prevention

Quitting smoke or not smoking prevents chronic obstructive pulmonary disease (COPD). However, it is difficult to quit smoking if you have failed in previous attempts or have been smoking for a long time. You can discuss with your doctor about the programs and products which help you quit smoking. If your work place has higher level of respiratory irritants, use respiratory protective equipments while at work. Also, follow safety measures and precautions as directed by your employers.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with chronic obstructive pulmonary disease (COPD).

If you have COPD, following measures can slow progression of your disease:

  • Control your breathing: Your doctor or respiratory therapist can teach you efficient breathing techniques. Also, they can teach you breathing position and relaxation techniques when you have difficulty breathing. 
  • Clear your airways: Mucus collects in your airways which may not be cleared properly. Controlled coughing, drinking lots of water and using humidifier can help clear your airways. 
  • Exercise regularly: Regular exercise improves your health as well as strengthens your respiratory muscles thus making it easier to breathe. 
  • Eat healthy foods: A healthy diet maintains your health. Your doctor may recommend you to take nutritional supplement if you are under weight whereas if you are overweight your doctor advises you to lose weight. Losing weight makes it easier for you to breathe especially during physical activities. 
  • Avoid smoke and air pollution: Avoid secondhand smoke and places where air is polluted. 
  • See your doctor regularly: Visit your doctor at scheduled time for constant monitoring of your lung function. Getting vaccinated against flu can prevent infection and acute exacerbation of COPD. Ask your doctor if you need to be immunized against pneumococcus.
  • Join support group. Talk to someone whom you are comfortable with. Counseling or medication may help if you are depressed or anxious. 

8 Risks and Complications

There are several risks and complications associated with chronic obstructive pulmonary disease.

Risks

  • Exposure to tobacco smoke: Prolonged exposure to smoke considerably increases your risk of developing COPD. People who smoke pipe, cigar and marijuana as well as people who are exposed to higher level of secondhand smoke are at increased risk. 
  • People with asthma who smoke: If you are smoker and have asthma, your likelihood of developing COPD increases significantly. 
  • Occupational exposure to dusts and chemicals: Prolonged exposure to irritants, such as chemical gas, vapors and dusts, in the workplace increases your chances of COPD. 
  • Age: COPD gradually progresses with time. In most cases, symptoms appear between the age 35 and 40. 
  • Genetics: Alpha-1-antitrypsin deficiency, a type of genetic disorder, can cause COPD. Genetic disorders increase a smoker’s risk of COPD. 

Complications 

  • Respiratory infections: People with COPD are likely to suffer from colds, the flu and pneumonia. Having respiratory infection worsens breathlessness and damages lungs. Getting vaccinated against flu and pneumococcus can prevent certain infections.
  • Heart problem: You are likely to develop heart disease if you have COPD. Your risk decreases if you quit smoking. 
  • Lung cancer: Smokers suffering from chronic bronchitis have higher chances of lung cancer as compared to smokers don’t suffer from chronic bronchitis. Your risk of lung cancer decreases if you quit smoking. 
  • High blood pressure: COPD may cause pulmonary hypertension (high blood pressure in the arteries supplying blood to your lungs). 
  • Depression: Dealing with progressive and serious illness can cause depression. 
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