Chronic Obstructive Pulmonary Disease (COPD)

November 20, 2018

 

What really is?
There are four hidden words inside COPD that explain to us what it means.These are, Chronic Obstructive Pulmonary Disease. So it is about a complex of chronic diseases that limit the airflow into your lungs. Chronic bronchitis and emphysema are the two most common conditions  that contribute to COPD .

 

COPD awareness day is celebrating this year on 21st of November! 21.11.2018

 

 

Why is it so important to know about COPD?
First of all, it’s an extremely severe disease which can even be life-threatening! It is actually the 3rd leading cause of death worldwide; while in some countries can be even the 2nd (ex. India)! There is no cure for COPD.  We can only provide them with drugs and a general health plan that will improve their life quality by relieving   the symptomatology and prolong their lives. 

 

“TYPES” OF COPD
COPD encompasses several diffuse pulmonary diseases including chronic bronchitis, asthma, cystic fibrosis, bronchiectasis, emphysema. The term usually refers to a mixture of chronic bronchitis and emphysema!

 

Chronic bronchitis 
It is a chronic inflammation of the bronchi* that leads to mucus production and daily cough. (for at least 3 months/year for 2 consecutive years).

 

 

 

 

 

 

 

 

* Anatomy crash course!
Respiratory system is composed from all the organs that are involved in breathing! So the air enters through the nose, passes through the pharynx and after larynx to reach the trachea. Trachea is the connecting tube (made up from cartilage) between pharynx-larynx and the lungs. Then trachea splits into right and left bronchi that enter inside the right and left lung. Each bronchi divides many times into smaller and smaller branches called bronchioles (in order to cover all the lung surface) and each bronchiole terminates into a cluster of alveoli**(small air-sacs ,where the gas exchange takes place!).

 


 

Pulmonary emphysema 


Is a lung condition, in which the alveoli** are damaged. Over time these air-sacs rupture and they are replaced by empty spaces-holes throughout lung surface. As the alveoli diminish, the exhaling becomes difficult. 
Main symptom of the disease is shortness of breath, that doesn’t appear early and aggravates gradually.

 

 

CAUSES:
Main causes that can lead to COPD development are,

  • Smoking. Mostly heavy smokers for many years have a high risk to suffer from the disease in their late life. The 25% of smokers will have COPD. That doesn’t mean only smokers can have it, passive smokers are also in danger especially children. As well as non-smokers can deal with COPD due to other causes.

  • Exposure so some irritants, such as fuels from cooking and heating, air-pollution mostly in developing and poor countries.

  • Occupational exposure to irritants, like mineral dusts, sulfur dioxide, cadmium, silica etc. Researches have shown that occupational COPD represents the 15% of all cases!

  • It can be due to a genetic disease which is called, “alpha-1-antithrypsine deficiency”, but it is really rare (1%of COPD cases).

  • Chronic untreated-asthma can lead progressively to COPD!

 

SYMPTOMATOLOGY
Early symptoms;

  • Frequent coughing throughout the day

  • Weight loss

  • Mucus production

  • Fatigue

  • Shortness of breath

Late symptoms;

  • Noticeable shortness of breath(unable to tolerate activity)

  • Excess sputum

  • Chronic cough

  • Chest tightness 

  • Modification of skin color(blue-cyanotic or pink)

  • Dyspnea

 

RISK FACTORS

  • Main COPD risk factor is smoking (25% of chronic smokers will have the disease!)

  • Age, most common in people >40 years old

  • Gender, is equal for both males and females in nowadays.

  • Family history of the disease

  • Genetic factors  

 

DIAGNOSIS
The physician in order to make a positive diagnosis of COPD should firstly;

  • Discuss the symptoms

  • Ask about the family and medical history

  • Discuss about the lung irritants you may have exposed in your area (city), at your work, or in your house. Also about your habits (smoking, etc.). After all, the most important is to make some tests in order to establish the diagnosis!

  • Lung function tests -> SPIROMETRY


    Spirometry, is the golden standard for COPD diagnosis! During this examination, the doctor will give you a tube (which is connected with a device that collect your data, measures and analyzes the lung volumes.) to blow inside. It is used worldwide to establish the diagnosis, to check the progress of the disease and help us choose the best treatment option for each patient. Besides spirometry, further investigation may be needed, in order to find or exclude possible causes.

  • Chest X-ray, to check for lung diseases, such as emphysema which represents a major cause of COPD.

  • CT scan , may give us further information and details.

  • Arterial blood gas analysis, to check how well your lungs are working specially the arterioles(where gas exchange is done)

  • Lab tests, to check for A1-antithrypsine deficiency.


COMPLICATIONS
As any serious and chronic disease it does have a lot of sever complications.

  • Heart disease, heart failure due to pulmonary hypertension.

  • Lung cancer and recurrent lung infections(pneumonia).

  • Pneumothorax, mostly in patients with empyhsema


TREATMENT
Before we proceed to the treatment, we should understand that COPD is a chronic disease and there is not an actual therapy to help us get rid of it forever!Also the damage that has been done from the disease to our lungs until the day we made the diagnosis and started the treatment is IRREVERSIBLE! That's why the earlier we discover the disease the better for us!

 

So there is treatment ONLY for relieving the symptoms and delay the progress of the disease.


Another point we need to sort out is that the treatment is personalised for every patient according to his medical history, symptoms and the stage of the disease.


First of all, its important to;

  • Avoid the exposure to irritants (fumes, etc.)

  • Quit smoking

  • Get vaccinated (ex. pneumococcal polysaccharide vaccine)

 

 

 

 

 

 

Medications;
There are different types of medications to treat the symptoms of the disease. Some of them are appropriate for chronic use(in order to control the disease)and others to treat possible exacerbations.


These are;

  • Inhaled steroids(reduce inflammation and exacerbations-used for patients with frequent exacerbations, ex. fluticasone, budesonide)

  • Bronchodilators (B.) There are short-action and long-action bronchodilators. Long action are used for regular basis-daily treatment (reduces symptomatology), while some patients with extreme shortness of breath need also short-action treatment before activity etc. (short B-ex. ipratropium, albuterol etc./Long B. ex. salmeterol)

  • Oral steroids

  • Theophylline

  • Antibiotics

  • Combination treatment (using more than one medications together as a therapeutical  scheme)

  • Other lung therapies may be used (ex. Oxygen therapy)

 

* It is advisable to consult your personal physician to assist you appropriately!

 

Be healthy and happy!

 

About Author
Dr. Chrysoula Valaroutsou is a Greek medical doctor graduated from UOC (english division Constanta,Romania). She is passionate about medicine and always eager to learn more. She has lots of love and loyalty towards serving mankind.​

References

www.mayoclinic.org  , www.goldcopd.org , www.healthline.com, www.who.int , Burden of COPD in India (DOI:10.19080/IJOPRS.2018.02.555599) , www.copdfoundation.org , www.stanfordhealthcare.com , Medical semiology book (Ovidius Univ. of Constanta/I.T. Tofolean , Prof. of semiology), www.piktochart.com (for the infographic), For the images; www.emedmd.com , www.drugs.com , www.dreamstime.com , www.sciencephotolibrary.com , www.askdoctor.com , www.gettyimages.com , www.healthyshetland.com , www.lunginstitute.com , www.healz.in . 

 

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