Chronic obstructive pulmonary disease (COPD)

Symptoms Of COPD

Common symptoms of COPD can include:

• Shortness of breath
• Persistent cough
• Wheezing
• Chest tightness or heaviness
• Tiredness/ fatigue
• Frequent chest infections
• Sputum production

Other symptoms (usually seen in advanced stages)

• Weight loss
• Swollen ankles 
• Chest pain
• Coughing up blood

Symptoms of chronic obstructive pulmonary disease usually worsen gradually, making daily activities harder over time, although treatment can slow progression.

Causes Of COPD

• Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease that causes inflammation/swelling and blocks airflow, making it hard to breathe. 

• This damage often results from smoking or air pollution, which harms the tiny air sacs in the lungs called alveoli. 

• As the lungs lose their elasticity, air gets trapped during exhalation, leading to shortness of breath.

• In rare cases, a condition called alpha-1 antitrypsin deficiency (AATD) can also cause lung damage. 

• This genetic issue reduces the lungs’ protection against harmful enzymes, leading to damage similar to smoking-related COPD. 

• People with COPD often have difficulty exhaling fully, causing a buildup of carbon dioxide in the body. 

• Over time, the lungs can become overinflated and less efficient at exchanging gases. Several factors can raise the risk of developing COPD, which will be explored in the following section.

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Risk Factors For COPD

Tobacco smoking accounts for over 70% of COPD cases. Other risk factors can include:

• Secondhand smoke: Breathing in smoke from others around you can damage your lungs over time and increase COPD risk.

• Air pollution: Long-term exposure to polluted air can irritate and inflame your lungs.

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• Fumes and dust: Breathing in chemicals, dust, or smoke from cooking or workplaces can increase your likelihood of developing COPD.

• Lung development problems: Poor lung growth in the womb or childhood (due to asthma or pollution) can increase the risk.

• Infections: Conditions like HIV infections or tuberculosis can weaken your lungs and raise your chances of getting COPD.

• Age: Risk goes up with age, especially if you've been exposed to other risk factors like smoking.

• Family history: Having close relatives with COPD may increase your risk, especially if you also smoke.

• Genetic condition (AAT deficiency): A rare inherited problem that makes lungs more vulnerable to damage.

• Small airways: Some people are born with smaller airways, which can raise COPD risk even without smoking.

• Race or ethnicity: American Indian or Alaska Native populations, and those of more than one race, may have a higher risk of COPD.

Diagnosis Of COPD

Early diagnosis of COPD is important to slow disease progression, manage symptoms effectively, and improve quality of life. Diagnostic tests include:

1. History and physical examination

• Individuals with persistent cough, shortness of breath, or frequent mucus production, especially with a history of smoking or exposure to pollutants, are suspected for COPD.
  

• Signs such as a barrel-shaped chest, distant breath sounds, or reduced air movement may be present on examination.

2. Pulmonary function tests (PFTs)

• Spirometry: This is the key test for diagnosing COPD. It measures how much air you can breathe out and how fast. 

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• Lung volume testing: It measures the total amount of air the lungs can hold. It is done if basic spirometry is unclear or another lung issue is suspected.

• Diffusing capacity (DLCO): It measures how well your lungs transfer oxygen into your blood; it helps identify emphysema.

3. Lab tests

• Complete blood count (CBC): Helps detect infections, anemia, or high red blood cell counts (polycythemia), which can occur in COPD.

• Alpha-1 antitrypsin levels: This test is done to rule out a genetic cause of COPD, especially in younger individuals or those without a history of smoking.

• Arterial blood gas (ABG): This test measures oxygen and carbon dioxide levels, especially in advanced disease.

• Pulse oximetry: It helps detect low blood oxygen levels, which can indicate impaired lung function in COPD.

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4. Imaging tests

• X-ray chest: It helps detect signs of lung damage and rules out other diseases.

• CT scan chest: It may be indicated for a more detailed lung view if needed.

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Specialists To Visit

A general physician is often the first point of contact for individuals experiencing symptoms of COPD. They play a key role in early diagnosis and may refer patients to appropriate specialists for further evaluation and management, like:

• Pulmonologist
• A thoracic surgeon, if surgery is indicated
• Intensivist
• Respiratory therapist

A pulmonologist specializes in diagnosing and managing lung diseases like COPD and guides long-term treatment plans.

A thoracic surgeon may be consulted if surgical intervention is needed for complications.

An intensivist manages severe or critical cases of COPD, especially during acute exacerbations requiring intensive care.

A respiratory therapist assists with breathing techniques, oxygen therapy, and pulmonary rehabilitation to improve lung function and quality of life.

When to see a doctor?

See a doctor immediately if you experience: 

• Trouble breathing or speaking clearly
• Lips or fingernails turning blue or gray
• Confusion or lack of alertness
• Very fast or irregular heartbeat
• Usual treatments aren’t relieving your symptoms.

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Prevention Of COPD

Preventing COPD involves reducing exposure to lung irritants and making healthy lifestyle choices like:

1. Quit smoking

• Smoking is the top cause of COPD; quitting significantly reduces risk

• Join a support group or seek professional help if you're struggling to quit.

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2. Focus on air quality

• Use clean fuels and ventilate cooking areas to cut down on indoor pollutants

• Avoid high-pollution areas like traffic-heavy roads, industrial zones, construction sites, coal plants, and brick kilns

• Limit outdoor activities when air quality is poor, especially during early mornings and late evenings

• Keep doors and windows closed during peak pollution hours

• Use wet mopping instead of sweeping to reduce dust indoors

• Avoid burning mosquito coils or incense in closed spaces

• Use air purifiers and make sure the filters are maintained, and avoid ozone-generating models.

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3. Prevent respiratory infections

• Wash your hands regularly with soap and water, especially after coughing, sneezing, using the toilet, or before eating

• Avoid touching your face, particularly your mouth, nose, and eyes, with unwashed hands

• Cover your mouth and nose with a tissue or your elbow when you cough or sneeze

• Dispose of used tissues properly and wash your hands immediately afterward

• Keep your surroundings clean, including frequently touched surfaces like doorknobs and mobile phones

• Stay away from sick people to prevent catching infections like colds or flu

• Stay up-to-date on vaccinations, including the flu shot and pneumococcal vaccine, to protect your lungs.

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4. Promote physical activity

• Regular exercise builds respiratory strength and general wellness

• Breathing exercises can strengthen lung capacity, improve oxygen flow, and reduce breathlessness

• Pair them with light activities like walking, yoga, or swimming for better lung health.

5. Ensure proper nutrition

• Eat a balanced diet with fruits, vegetables, whole grains, etc, to strengthen immunity and support healthy lung function.

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6. Early detection and management

• Regular check-ups enable early diagnosis and better outcomes

• Knowing the signs can also lead to faster medical help and tailored care.

Treatment Of COPD

Chronic obstructive pulmonary disease (COPD) cannot be cured, but with the right treatment, its progression can be slowed down, and symptoms can be effectively managed. It includes:

1. Smoking cessation

Quitting smoking is the most important step to stop COPD from worsening. It includes:

a) Medications 

• Varenicline
• Bupropion
• Cytisine

b) Nicotine vaccine (experimental)

• Being developed to block nicotine from affecting the brain
• Still in research stages

C) Nicotine replacement therapy (NRT)

• Gives you nicotine without harmful smoke
• Consists of nicotine patch, nicotine gums, and nicotine lozenges

Note: Using medication + counseling or multiple meds together improves success.

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2. Inhalers

a) Short-acting bronchodilators: Used for quick relief from breathlessness. They work by quickly relaxing the muscles around the airways. Examples include: 

• Beta-2 agonists: Salbutamol and Terbutaline
• Antimuscarinics: Ipratropium

b) Long-acting bronchodilators: These are used once or twice daily for persistent symptoms. These relax airway smooth muscle by stimulating certain receptors (LABAs) or blocking certain receptors (LAMAs). Examples include:

• Beta-2 agonists: Salmeterol, Formoterol, and Indacaterol
• Antimuscarinics: Tiotropium and Glycopyrronium

c) Steroid inhalers: Prescribed for ongoing breathlessness or frequent flare-ups. They contain corticosteroids and are usually combined with long-acting bronchodilators.

3. Oral medications

a) Theophylline: This is a bronchodilator that helps relax the muscles around the airways and may reduce inflammation. 

b) Steroids: Short courses are used for managing severe flare-ups. Prednisolone is used most commonly.

c) Antibiotics: Given during chest infections when symptoms worsen or phlegm becomes discolored. Commonly used antibiotics are:

• Amoxicillin
• Doxycycline
• Clarithromycin

d) Mucolytics: These help break down thick mucus, making it easier to cough up and clear from the lungs, especially in a chronic productive cough. Commonly used drugs include:

• Carbocisteine
• Acetylcysteine
  
  

e) Roflumilast: This is an anti-inflammatory tablet used for people with frequent flare-ups and chronic bronchitis to reduce swelling in the airways.

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4. Oxygen therapy

• Long-term oxygen therapy (LTOT): It is prescribed if blood oxygen levels stay low over time. It should be used for at least 15 hours daily to improve survival and organ function.

• Ambulatory oxygen therapy: Given during activities like walking if oxygen levels drop with exertion. Helps reduce breathlessness and increase mobility.

5. Nebulised medications

• Nebulisers turn liquid medications into a fine mist that’s easier to inhale. These are used during severe COPD when standard inhalers aren't effective enough.

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6. Non-invasive ventilation (NIV)

• A breathing support machine connected via a mask helps reduce the effort needed to breathe during serious flare-ups. This is commonly used in hospitals.

7. Pulmonary rehabilitation

• A structured program combining exercise, education, nutrition, and emotional support to improve breathing and quality of life. 
• Typically lasts 6 weeks with 2 or more sessions per week.

8. Surgery

• Bullectomy: A procedure to remove large air pockets (bullae) that interfere with breathing and healthy lung tissue.

• Lung volume reduction surgery: Damaged, non-functioning lung sections are removed to improve airflow and make breathing easier.

• Lung transplant: It is considered for very severe cases in carefully selected patients when other treatments no longer work.

Complications Of COPD

COPD can lead to several serious complications that affect not just the lungs but multiple organs and overall quality of life. These include:

• Acute exacerbation of COPD: A sudden worsening of symptoms of COPD, like breathlessness, cough, and sputum, often triggered by infections or pollution.

• Acute and/or chronic respiratory failure: Occurs when the lungs can't provide enough oxygen or remove carbon dioxide. This can lead to life-threatening complications.

• Pulmonary hypertension: High blood pressure in the lungs' arteries, caused by long-term low oxygen levels from COPD.

• Cor pulmonale: It is right-sided heart failure due to increased pressure in the pulmonary arteries from chronic lung disease.

• Weight loss: Unintentional weight loss is common in advanced cases of COPD due to increased energy use for breathing and poor appetite.

• Bacterial infections: People with COPD are more prone to lung infections like pneumonia and bronchitis, which can worsen symptoms.

• Adverse reactions to glucocorticoids: Long-term use of steroids in COPD can cause side effects such as high blood sugar, bone thinning, and increased infection risk.

• Osteoporosis: People with COPD often develop weaker bones due to smoking, poor nutrition, low activity, and steroid use, increasing the risk of fractures.

• Cognitive and nervous system problems: Low oxygen levels due to COPD can affect memory, thinking, and nerves, leading to confusion, depression, or even muscle cramps.

• Depression and anxiety: Emotional distress is common in COPD due to the chronic nature of the disease, and it may worsen breathlessness or treatment adherence.

• Gastro-oesophageal reflux disease (GERD): Acid reflux is common in COPD and may worsen breathing issues or lead to more frequent flare-ups.

• Anaemia: COPD may cause chronic anaemia, worsening fatigue, and reduced quality of life.

Alternative Therapies For COPD

Complementary or supportive therapies can help them cope better with COPD symptoms such as breathlessness, fatigue, and anxiety. These therapies should never replace prescribed treatments. Always talk to your doctor before starting any new therapy. 

Therapies that can help include:

1. Acupuncture

Acupuncture is a traditional Chinese therapy that involves inserting thin needles into specific points on the body to stimulate healing and balance energy flow. It may help reduce symptoms like breathlessness and improve quality of life by promoting relaxation and reducing inflammation. But larger-scale research is needed to confirm its effectiveness and safety.

2. Yoga 

Yoga can improve breathing control, lung function, and overall well-being through breathing exercises and gentle movements. However, more rigorous studies are required to fully understand its benefits and best practices for people with COPD.

3. Muscle strengthening therapy

Electrical stimulation is not used very often. It may be used only during flare-ups to maintain or improve muscle strength when physical activity isn't possible.

4. Supplements

• NAC (N-Acetylcysteine): A supplement that may thin mucus and ease cough in COPD, but current research shows limited evidence of significant benefit.

• Vitamin D: It can help reduce COPD flare-ups in people with low vitamin D levels, though it may not help those with normal levels.

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• Melatonin: A natural sleep aid that might improve breathing and sleep quality in people with COPD, but research results are mixed.

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5. Herbal remedies

• Ginseng: Traditionally used for lung health, but recent studies show it performs no better than a placebo for COPD symptoms.

• Salvia (Red sage): It may protect lungs during COPD flare-ups, but more studies are needed to confirm its effects.

• Echinacea: Used to prevent colds that can worsen COPD, but it hasn't been specifically studied for COPD benefits yet.
  
  

Living With COPD

Living with COPD requires daily attention to lifestyle, environment, and emotional well-being to manage symptoms and maintain quality of life. Tips that can help include:

1. Stay active and eat well

• Engage in regular, moderate exercise to improve breathing and stamina
• Maintain a healthy weight; seek dietary advice if experiencing weight loss

2. Manage your breathing

• Practice breathing techniques like pursed-lip breathing to ease breathlessness
• Use simple techniques like coughing exercises that help clear mucus (phlegm) from your lungs

3. Avoid triggers

• Steer clear of smoke, dust, strong odors, and poorly ventilated spaces to reduce flare-ups
• Monitor weather conditions; extreme temperatures can worsen symptoms

4. Prioritize vaccinations

• Get annual flu shots and a one-time pneumococcal vaccine to prevent infections

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5. Support mental and emotional health

• Talk to family, friends, or join a COPD support group to share your feelings and reduce loneliness.
• Don’t hesitate to speak with a doctor or counselor if you're feeling anxious, sad, or overwhelmed.

6. Plan your travels well 

• Consult your doctor before flying; you may need a fitness-to-fly assessment
• Ensure you have all necessary medications and equipment for your trip

7. Explore financial support 

• If COPD affects your ability to work, check if you’re eligible for government benefits or support schemes
• Caregivers can also look into local or state-level caregiver allowances or social support schemes

Tips for caregivers

• Learn about COPD to offer better support
• Help manage medications and doctor visits
• Encourage healthy habits like quitting smoking and exercising
• Watch for signs of worsening symptoms
• Take breaks and care for your own health, too.