Chronic obstructive pulmonary disease (COPD)
Description of Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a chronic lung disorder in which there is difficulty in emptying air out of the lungs (airflow obstruction). Due to this obstruction, patients experience difficulty in breathing or get tired easily because of this breathing strain. COPD is a general term used for chronic bronchitis, emphysema, or a combination of both.
Causes and Risk Factors
1. The most common cause of COPD is cigarette smoking. 85% to 90% of COPD cases are diagnosed in patients who smoke.
2. Environmental factors: Those who have heavy exposure to dust, chemicals, or air pollution are more prone to COPD.
3. Genetic factors: There is a rare type of COPD called as alpha-1 deficiency-related emphysema, which is seen among people who have an inherited condition wherein production of alpha-1 protein that protects the lungs is affected.
Signs and Symptoms
Early symptoms include:
1. Chronic cough
2. Recurrent respiratory tract infection
3. Dyspnea (shortness of breath)
4. Production of excessive mucus (phlegm or sputum)
5. Wheezing sound
Late symptoms include:
1. Fatigue due to breathing difficulty
2. Cyanosis (a condition where lips, face, tips of fingers start turning blue)
1. Lab tests include complete blood analysis, erythrocyte sedimentation rate, and arterial blood gas test may be done.
2. Imaging includes chest x-ray, which is usually sufficient to diagnose COPD. However, a CT scan too might be called for.
3. Others -- after a thorough examination and history taking, if the doctor suspects COPD, spirometry will be advised. Here one is asked to blow air through the mouthpiece attached to a machine, which will help in confirming the diagnosis. The test assesses the lung’s capacity to inhale, exhale, and hold air.
1. Medications -- the most important part of treatment in smokers is to stop smoking. Medications that are usually prescribed are:
(a) Bronchodilators: To widen the airways
(b) Anti-inflammatory drugs: To reduce swelling of air passages, e.g., steroids
(c) Antibiotics: To treat infection with the lungs if any
(d) If the blood oxygen level is low, oxygen support needs to be given
To control symptoms patient should take prescribed breathing medications regularly as recommended.
2. Surgery -- in severe cases surgical procedures like lung volume reduction surgery or lung transplantation will be advised.
3. Others -- lung exercises must be done to help improve lung capacity.
Complications and When Should You See a Doctor
1. Changes in heart and respiratory system, which are evident on an electrocardiogram (ECG) and in clinical tests.
2. Chronic hypoxia (a condition where the oxygen that body gets is insufficient) that can be fatal.
3. The presence of cough with excessive mucus, breathlessness, and fatigue for a very long time or symptoms that do not regress.
Prognosis and Prevention
COPD is often preventable and treatable. Prognosis is generally excellent with right medications, lifestyle changes, and regular follow up. Hence, preventive measures like quitting smoking, avoiding exposure to causative factor along with regular intake of medication is must for patients to lead a normal life.
Did You Know?
1. WHO estimates that over 64 million people suffer from COPD in the world.
2. Estimates show that COPD becomes in 2030 the third leading cause of death worldwide.
Frequently Asked Questions about Chronic obstructive pulmonary disease (COPD)
Yes, asthma patients are at an increased risk of development of COPD if they have asthma for longer duration. Children with severe persistent form of asthma are at increased risk of development of COPD at adult stage of life. This might be attributed to irreversible changes in bronchi due to long-standing, persistent asthma which might lead to airflow obstruction .
Smoking is one of the important risk factor for development of COPD, but non-smokers are also at risk of development of COPD. This might be due to exposure of people to smoke from biomass fuel such as burning of woods, exposure to dust, and other gases. The smoke released from biomass fuels can lead to inflammatory changes in airways which in turn can lead to COPD.
In COPD, there is irreversible obstruction of airways. This can be due to exposure to tobacco smoke, smoke from biomass fuels, occupational exposure to lung irritants, or frequent lower respiratory tract infection, e.g., pneumonia. Exposure to these risk factors can lead to abnormal inflammatory response in lungs which may lead to COPD.
Association of COPD with heart failure (right-sided or left-sided) is common in clinical practice. Inflammatory process in COPD patients is not only limited to airways, but it also include gneralized inflammation in various parts of body. This systemic inflammation can accelerate narrowing of blood vessels suppying heart. This narrowing of blood vessel supplying hear can lead to heart failure predominantly left-sided. COPD patients also have pulmonary hypertension which can lead to right-sided heart failure.
COPD and cancer are two different conditions even though they share common risk factors such as genetic predisposition, smoking, and occupation exposure to lung irritating gases. However, in COPD, there is associated gene damage due to prolonged exposure to inflammatory cells which may increase the chances of lung cancer in such patients.
COPD flare-ups are episodes of worsening existing respiratory symptoms like increased breathlessness and cough. COPD flare-ups can occur due to various bacterial, viral, or fungal infections. Increase in air pollution, increased exposure to lung irritating gases, and presence of other conditions such as heart failure can also result in COPD flare-ups.
Pursed lip breathing is type of breathing technique to overcome shortness of breath in COPD patients. In pursed lip breathing, patients are instructed to inhale slowly through nose with closed mouth. Then patients are instructed to pucker their lips (like puckering of lips while whistling) and patients are instructed to breath out slowly through puckered lips (pursed lips). Pursed lip breathing helps in efficient ventilation in lungs, decreases work of breathing, and keeps airways open for longer duration.
Rescue inhalers are the drugs which provide immediate relief during acute exacerbations of COPD by dilating airways. Short acting airway dilators like albuterol or ipratropium bromide given as metered-dose inhaler or via nebulizer provide quick symptomatic relief in COPD patients.
Prevalence of COPD is increasing in India. This might be due to increased air pollution, inhalation of smoke from cigarette, and biomass fuel.
Air pollution, extremes of temperature, humid climate predisposes COPD patients to acute exacerbations. Currently, air pollution is problem in majority of cities of India, but patient can choose city with less air pollution, minimal fluctuation of temperature, and city with availability of specialist doctors.
Fruits like apples, peaches, strawberries, blueberries, apricots, and flavonoid rich fruits, e.g., grapefruits, oranges, reduces risk of COPD. Vegetables such as broccoli, cauliflower, coleslaw, carrots, raw spinach, and food rich in dietary fiber, e.g., beans, lentils also reduce risk of development of COPD. Diet rich in cured meat (processed meat, bacon, hot dog), sweets and desert (home-baked cake, doughnuts, pancakes) or refined cereals (white bread, pasta) should be avoided as they increases risk of development of COPD.
COPD and chronic heart failure (CHF) both are the leading cause of death worldwide. COPD is fourth leading cause of death worldwide. Ten year survival rate with severe form of COPD is 15%. Heart failure with left ventricular dysfunction has a survival rate of 27%. Due to better availability of treatment option for heart failure, survival rate in patients with heart failure has been increased recently.
COPD patient needs ventilator support in the form of venturi mask during acute worsening of symptoms of COPD for effective oxygen saturation. Use of portable noninvasive ventilator improved symptoms of COPD such as breathlessness and fatigue, but data about efficacy of mask for daily use in COPD patient is still lacking.
Clubbing of fingers is important clinical sign in medicine. It involves swelling of terminal part of fingers. Though clubbing is not sign of COPD, if present it might be due to other associated conditions such as lung cancer.
Yes, the symptoms of COPD get worsened at night. This is because at night, there is increase in activity of nervous system which leads to contraction of bronchi and thus decrease in airflow to lungs. This decrease in airflow lead to worsening of symptoms of COPD, like more breathlessness at night.
Yes, COPD is one of the leading cause of death around the world. Multiple attacks of respiratory failure can increase risk of death in patients of COPD.
Yes, COPD patients need vaccination against flu and against bacteria causing respiratory infection, e.g., pneumococci. This is because airways of COPD patients are sensitive to inflammatory changes caused by flu and other respiratory infections which may lead to worsening of symptoms of COPD.
Acidosis occurs due to increase in acidic ions (like hydrogen ions) in blood and body fluids, the concentration of which depends on carbon dioxide (CO2). Normally, CO2 is released in body from metabolism of carbon containing food. Under normal respiratory function, this CO2 formed is exhaled via airways, but, in COPD patients, during acute episode of respiratory failure, CO2 is not effectively washed out via airways. This leads to increase in concentration of CO2 inside the body fluid leading to synthesis of H+ ions which are derived from CO2 by enzymes in the body. This increase in H+ ions in body fluids and blood lead to development of acidosis.
Yes, COPD is an irreversible disease. Airflow obstruction in COPD is chronic, and progressive.
Sleep apnea is condition where upper airways collapse intermittently during sleep. There are chances that COPD patient might have sleep apnea, but the exact mechanism of such co-existence is still unknown. However, sleep apnea in COPD patient can lead to exacerbations of signs and symptoms of COPD during sleep.
Chronic, progressive shortness of breath is one of the important feature of COPD. COPD patients also experience chronic cough with or without mucus production. If patient is experiencing these symptoms he or she should consult doctor. Other symptoms of COPD are wheezing (high pitched sound produced during breathing), chest tightness, fatigue, and weight loss.
COPD is chronic, progressive obstructive lung disease. COPD is fourth leading cause of death in the world. Life expectancy of patient suffering from COPD depend upon the severity of disease. Ten year survival period among smokers with mild COPD symptoms is 65% and 15% with severe COPD symptoms.
Corticosteroids can be used as systemic form (oral) and inhaled form in COPD patients. Inhaled corticosteroids are used in stable COPD patients in combination with long-acting bronchodilators (drugs which dilate airways). Such combination improves symptoms and reduces frequency of acute attack in COPD patients.Use of oral corticosteroids in COPD patients is limited to treatment of acute exacerbations of COPD.
Exacerbations of COPD can result either from viral or bacterial infection. Selection of antibiotics should be based on local bacterial resistance pattern. Generally, amoxicillin with clavulanic acid, fluoroquinolones such as levofloxacin, third generation cephalosporins like ceftriaxone are preferred. Choice of antibiotics may vary depending upon the culture report of infection and on your treating doctor.
Breathlessness is common symptom in COPD patients. Respiratory function is already compromised in COPD patients. Drugs which further depress respiratory functions, e.g., morphine, codeine, alcohol, antihistamines like promethazine should be avoided in COPD patients.
Inhaled drugs used in the treatment of COPD can be given with use of inhalers or nebulizers. Three different types of inhalers are currently available in the market namely pressurized metered dose inhalers (pMDI), dry powdered inhaler (DPI), soft-mist inhaler. pMDI requires coordination of actuation with inhalation, slow inhalation, and breath holding. DPI inhaler requires crushing of capsule and subsequent inhalation. Soft mist inhaler is new form of drug delivery which is propellant free.
COPD is more worse than asthma. COPD results in more death than asthma worldwide.
Nebulizer is medical device used to deliver liquid medication in aerosol form via inhalation in various respiratory conditions such as asthma and COPD. Compressor driven jet-nebulizers, ultrasonic types, vibrating-mesh types are the types of nebulizers currently available in India. Among these, jet nebulizer is the oldest type. Noise is the disadvantage associated with jet nebulizer. Ultrasonic nebulizer utilizes ultrasonic vibrations to generate aerosol form of drug. They are expensive than jet nebulizers. Third type is vibrating mesh type nebulizer which is expensive than other two types.
COPD is commonly associated with sleep disorders like sleep apnea and insomnia. Sleep induced decreased oxygen saturation, increased CO2 in blood during sleep, COPD medications, and nicotine use might contribute to sleep problems in COPD patients.
In COPD patient, there is increased metabolic demand of the body due to increased work of breathing. This along with decreased oxygen in tissues and decreased protein synthesis can lead to loss of muscle mass in severe cases. These factors along with some COPD medications may cause weight loss.