Chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory lung disease that causes your air passage to narrow down. As a result of which, you face difficulty in breathing.

Overview

Chronic obstructive pulmonary disease, from the name, is a long-term condition that affects your lungs.

COPD causes permanent damage to your lungs that can narrow your bronchi. When your airways are narrowed or blocked, it causes difficulty in breathing.

COPD affects the quality of life and makes everyday activities difficult. Even activities like walking, climbing stairs and cleaning can be difficult and you tend to feel out of breath.

COPD is not a disease that you get in a day. It takes years to damage your bronchi and lungs and it is difficult to identify during the early years.

The symptoms of COPD are very common in the early stages and only during the later stages, the symptoms are clear. The goal of COPD treatment will be to mitigate the symptoms.

 According to the European Respiratory journal titled “Chronic obstructive pulmonary disease: molecular and cellular mechanisms” COPD is a leading cause of death and disability.

Types of COPD

COPD is a common term used to describe various lung diseases. COPD causes lung damage and over the years it makes you difficult to breathe.

Emphysema

Pulmonary emphysema is a progressive lung disease and a condition where there is continuous inflammation of the bronchi. Human lungs contain tiny air sacs that help in breathing and take up oxygen your body needs.

They are microscopic and also called workhorses of the respiratory system. There are about 480 million alveoli in human bronchial tubes.

Emphysema damages your alveoli walls. When the alveoli walls are damaged your breathing capacity is lowered making it difficult to breathe.

Emphysema causes an incomplete exchange of air, and it gets built up in the lungs. The alveoli become collapsed, narrowed, overinflated, destroyed and stretched.

The causes of emphysema are smoking, breathing irritating fumes and specks of dusts and exposure to chemical fumes and other small particles.

The symptoms of emphysema include rapid breathing, coughing, wheezing, sputum production and shortness of breath.

Chronic bronchitis

Chronic bronchitis is also a form of chronic obstructive pulmonary disease. Chronic bronchitis is caused by the overproduction of mucus by goblet cells.

The cells that line the epithelial respond to toxic and infectious stimuli which releases inflammatory and pro-inflammatory cytokines.

Chronic bronchitis also decreases the release of the regulatory substance. The inflammation starts in the alveolar epithelium and is an initiator for chronic bronchitis.

There will be a sudden blockage, and the airways will be clogged by debris and cause irritation. In chronic bronchitis, there will be hypersecretion secretion of mucus.   

According to PMC4951627, chronic bronchitis affects adults in the range of 3.4-22%. The common symptom of chronic bronchitis is cough assisted with sputum. The cough persists for 3 months and the colour of the sputum changes to yellow, green or at times blood-tinged.

The colour of the sputum may change due to the onset of bacterial infection and the colour change may be an indication of that.

According to NBK482437, 50% of patients have cough assisted with sputum. And the colour change of the sputum is due to the peroxidase released by leukocytes in the sputum.

Fever is uncommon in chronic bronchitis and fever is suggestive of influenza and pneumonia. Generalised malaise is a common symptom and chest or abdominal pain due to forceful coughing is very rare. Patients can experience wheeze when there is severe inflammation.

Refractory asthma

Refractive asthma is when you get frequent asthma attacks despite taking medications. Some common symptoms of asthma include mucous hypersecretion, airway inflammation and smooth muscle bronchoconstriction that leads to airway obstruction.

According to PMC6284776, 30% of patients with refractive asthma require oral corticosteroids. Prolonged use of corticosteroids will have side effects like osteoporosis, infections, stroke and glucose metabolism changes.

Only a few percent of people are affected by refractory asthma, but they will require frequent health care treatments and will reduce their quality of life.

Smoking, infections, allergens and some medicines may aggravate the asthma symptoms. The other causes of refractive asthma include genetics, exposure to tobacco smoke in childhood and premature birth.

Stages of COPD

COPD is a long-term inflammatory lung condition characterised by a persistent cough. Doctors use a grading system to determine the severity of COPD called the Global Initiative for Chronic Obstructive Lung Disease GOLD staging or grading system.

A pulmonary function test is used in the diagnosis and staging of COPD. The GOLD system determines the severity of the disease depending on your symptoms, how COPD has worsened, administration of hospital care due to COPD’s worsen symptoms and the results from spirometry.

The severity of symptoms is evaluated based on the modified Medical Research Council (MRC) questionnaire and the COPD Assessment Test (CAT).

A six-minute walk test is commonly used to assess the submaximal functional test of the patient and the walk test takes place indoors on a flat surface.

Mild COPD

Mild COPD is the presence of any one of the symptoms such as worsening dyspnea, sputum volume and purulence. In addition to it, increased coughing and wheezing, fever without any cause, upper respiratory infection and increased heart rate or increased respiratory rate from the patient’s baseline.

Moderate to severe COPD

In moderate to severe COPD patients would experience two or three symptoms of the above mentioned such as worsening dyspnea, sputum volume, purulence, increased coughing and wheezing, fever without any cause, upper respiratory infection and increased heart rate or increased respiratory rate from the patient’s baseline.

Very severe COPD

In very severe COPD, patients have acute respiratory failure or lung failure, hypoxaemia and hypercapnia. This is the end stage of COPD.

Causes of COPD

The significant cause of COPD is smoking and 9.7-97.9% are affected due to smoking according to PMC3657849. The other causes of COPD include air pollution and exposure to second-hand smoking.

Substances linked to COPD are cadmium dust fumes, silica dust, welding fumes, coal dust, grain and flour test and isocyanate.

Breathing polluted air for a long period is also a cause of COPD. The risk factor of COPD increases when you smoke and breathe polluted air. However, COPD associated with air pollution is not conclusive and further research is required.

According to National Health Services, genetics also plays a major role and makes people vulnerable to COPD.

Symptoms of COPD

Shortness of breath

Shortness of breath or dyspnea is a common symptom of COPD. Shortness of breath occurs due to damaged lungs and inflammation.

This affects your breathing and you feel breathless even when you are relaxing.

Wheezing

When you try to breathe air through the narrow air passage that is blocked due to inflammation of the airway and you may hear a whistling sound when you try to force breathe. This is called wheezing.

COPD causes excessive secretion of mucus and this may also be the reason for narrowed airways. Muscular tightening is also a reason for wheezing.

COPD is not the only reason for wheezing. It may be due to asthma and pneumonia.

Chest tightness

When you experience chest tightness it can indicate some significant health issues. Chest tightness signifies various health issues but COPD can be predominant.

A chronic cough that may produce mucus

COPD exerts pressure on your lungs and there is excessive secretion of mucus which causes you to cough frequently.

Coughs clear your mucus but not all coughs help you to clear the mucus. Sometimes excess coughing leads to collapsed airways and traps the mucus.

Frequent respiratory infections

Recurrent infections are common in adults but the duration of the persistent cough could indicate a medical condition like COPD. Always be watchful of your symptoms.

Lack of energy

People with COPD can be very tired most of the time. Even when they had a small walk, they might feel tired and all their energy has drained.

This is because people have trouble getting oxygen to their lungs and expire carbon dioxide from their lungs. The shortage of oxygen and the carbon dioxide build-up inside their lungs can make a person feel tired and lack energy.

Another reason for feeling tired is persistent coughs. People with COPD will have cough as a major symptom and continuous coughing can make them tired.

Unintended weight loss

People with COPD may require extra energy for their daily tasks due to the increased requirement for breathing. So, weight loss happens. According to PMID 14718026, 23% of COPD patients are classified as malnourished.

Swelling in ankles

Swelling in the ankles and legs can be seen in people with COPD and this condition is called pulmonary hypertension. COPD does not directly cause swelling but the complications caused by COPD can cause swelling in your legs and ankles.

Treatments of COPD

The goal of COPD treatment will be to ease your breathing struggles and get back on your regular task without any difficulty.

COPD treatment is a long journey and requires proper nutrition along with medications. The medications your doctor prescribes should not be missed and always keep track of your doctor’s appointment.

Bronchodilators

Bronchodilators are drugs used to make your breathing easy and widen your bronchi. They relax the muscles in your lungs and reduce inflammation.

Bronchodilator drugs are used for long-term conditions where the airways have been narrowed and inflated.

Bronchodilators are used for short-term and for long-term relief. Short-term relief is used for sudden attacks of breathlessness and helps you breathe and relax your muscles.

A short-acting bronchodilator can be taken in an inhaler and it lasts for about 4-6 hours. A long-acting bronchodilator lasts for 12 hours and it can be taken every day.

Corticosteroids

Corticosteroids are one of the main treatments for COPD to reduce inflammation and flare-ups. The initial treatment for COPD is short-acting bronchodilators.

When the symptoms aggravate corticosteroids are assisted with bronchodilators. Long-acting bronchodilators are always taken with corticosteroids and require separate inhalers at the start then the medication is provided in the same inhaler.

Combination inhalers

Combination inhalers are when symptoms aggravate and for immediate risks. They also help to reduce the severity of the breathlessness attacks.

The combination of drugs effectively relaxes your muscles and widens your bronchi. As a result, you will be able to breathe without any difficulty.

Beta2-agonist and corticosteroids are combined and inhaled. This combination of drugs widens your bronchi, reduces inflammation and also eases your symptoms of breathlessness. They also reduce the sensitivity of your bronchi.

After taking your inhalers it is advised to rinse your mouth to avoid any side effects.

Antibiotics

Antibiotics are used when the symptoms are hard to control. Antibiotics are not recommended for all patients and only your doctors will decide depending on your symptom.

Antibiotics are given to patients who have COPD assisted with bacterial infections. The use of antibiotics is suggested for people with severe dyspnea, increased sputum or people who need ventilator support.

Roflumilast

Roflumilast is a drug used for COPD treatment. The drug is administered to reduce the episodes of COPD symptoms which are hard to control.

It is a phosphodiester inhibitor and when administered it reduces the swelling in the lungs.

Pulmonary rehabilitation

Pulmonary rehabilitation is an education program for people with COPD. It guides them with the exercises and improves their quality of life.

The caretakers help you in the exercise program and it will help you to reduce the severity of the symptoms. The program will not cure any lung disease but reduces the problems related to breathlessness.

Oxygen therapy

When you are affected with COPD, oxygen supply is limited and carbon dioxide build-ups inside the lungs.

When the oxygen is deprived, it affects your organs like the heart and brain. Oxygen therapy is given to improve the quality of life and helps reduce breathing problems.

Surgery for COPD

Surgery can benefit people with COPD. Yet, only a small percentage of people will require surgery and it will benefit them.

There are 3 types of surgery for COPD bullectomy, lung volume reduction surgery (LVRS) and lung transplant.

Bullectomy

COPD causes the air sac in your lungs to become inflamed. These inflamed cells press against the healthy cells and cause the healthy cells to function less.

So bullectomy is performed to remove the affected cells and the healthy cells will help in the exchange of air with full efficiency.

Lung volume reduction surgery

The inflamed air sac cells damage the upper portion of both lungs. The healthier cells will be present in the bottom below the damaged cells and the lungs will become inflated.

So, the surgery is performed to reduce the upper portion of the lungs. Bullectomy removes the damaged cells but in lung volume reduction surgery some healthy cells are also reduced.

Lung transplant

Lung transplantation is a replacement of the damaged lungs, either one or both the lungs. The lung donor should be healthy with no major health issues.

Risk Factors of COPD

Respiratory infections

COPD increases your risk of certain infections and diseases. The risk factor for respiratory infection increases when you have COPD.

You might have a frequent occurrence of cold and experience difficulty in breathing. Risk factor of getting infected with pneumonia increases when you have COPD.

So always get yourself vaccinated with yearly shots.

Heart problems

The risk factor for getting heart problems is high when you have COPD. The oxygen supply to the vital organs reduces as a result of which you might get affected with heart problems.

Still, there is no proper evidence and it requires more research.

Lung cancer

Chronic obstructive pulmonary disease affects your lungs. So, the chances of getting affected by lung cancer are high. Smoking can increase your risk factor so it is advised to quit smoking.

High blood pressure

High blood pressure in the lung arteries is called pulmonary hypertension. In COPD, the air sacs become inflated as a result which presses against the other cells and narrows the airways.

The blood pressure in your arteries may get raised due to the condition.

Depression

COPD reduces the quality of life. You will become dependent on someone for all your daily routine. Even a small walk may cause breathlessness and this might lead to depression.

If you feel depressed, sad or helpless you can talk to your doctor. They might guide you better.

Prevention of COPD

Don’t Smoke

Smoking is the major cause of many other diseases like cancer, heart diseases and other respiratory problems. So, it is advised by doctors to quit smoking to safeguard yourself from getting any diseases.

Avoid exposure to indoor pollutants that can damage your lungs

Avoid exposure to dust and other small pathogens inside your home that might interfere with your respiratory process.

Minimise exposure to outdoor air pollution

The small particles and fumes that are released from the industries will be carried by air. When you breathe the polluted air, these pollutants may get inside your lungs and can further cause respiratory problems.

Prevent Infection

Protect yourself from any infection. Do not miss your vaccinations. Hydrate yourself.

Get Regular Check-up

Never skip your check-up. Always consult your doctor if you have any aggravated symptoms.

Exercise

Always do some light exercises like walking. Also, practise meditation. Exercise not only promotes your respiratory health but also keeps you fit.

When to see a doctor

Consult your doctor when you have uncontrolled shortness of breath when you walk, your flare-ups worsen, your heartbeat is uneven, and your fingernails turn blue.

Conclusion

COPD cannot be cured, but the symptoms can be reduced and improve the quality of life with medication and certain exercises.

Read more about COPD and get to know more about the disease from a professional. Do not smoke and if you have the habit of smoking quit it immediately. Talk to your doctor and they might help you with the process.

Consume nutritious food so that your body will have energy and can avoid unintended weight loss. Have your medicines handy so that they can help you during an emergency.

Avoid any exposure to pollutants that might damage your lungs. Do not stop any medicine without your doctor’s advice.

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