COPD stands for Chronic Obstructive Pulmonary Disease. It is illustrated by a long-term restriction to airflow causing severe respiratory symptoms. (1)

Summary

COPD is a lung disease that progresses with time. It causes either productive or non-productive cough. Routine activities, such as jogging or walking may worsen the severity of the disease. A patient suffers from shortness of breath when having COPD. According to the research in 2019, 3.2 million died globally and 80% of them were from lower and middle-class families. Most cases of COPD can be treated just by avoiding environmental risk factors such astobacco and outdoor pollutants.

Subtypes of COPD

The two phenotypes of COPD are “emphysema” and “chronic bronchitis”. In emphysema or Type A, the size of alveoli (air sacs) increases, alveolar walls rupture, and lungs tissues are damaged permanently. Structural abnormalities in emphysema limit the airflow.Due to pink complexion, pursed lips, and fast heart rate this type is also called “Pink Puffers”. Chronic bronchitis or Type B is stated as a persistent productive cough for about three months. It does not necessarily cause limited airflow but acts as a starting point of COPD. It is also called “blue bloaters” because, in this type, oxygen level falls that cause bluish lips and skin.

Signs and symptoms

  • Shortness of breath

The characteristic symptom of COPD is chronic and progressive shortness of breath. It is the most aching and uncomfortable symptom causing anxiety to the patient. Chest tightness and wheezing associated with COPD varywith time. Many patients with COPD breathe through the mouth, which improves their breathlessness. This symptom does allow the patient to do heavy physical activity. In severe cases, a patient may suffer from constant weight loss, anorexia, muscle loss, and tiredness.

  • Cough

It is considered an initial symptom of COPD. The cough remains persistent with or without mucus production. Only in 30% of cases, patients are seen with productive cough. Symptoms are worse in the daytime. In severe circumstances, strenuous cough causes loss of consciousness or ribs fracture.

  • Exacerbations

Acute exacerbations indicate the severity of COPD. It is depicted by increased wheezing, breathlessness, coughing, and air trapping. Viral infection such as the common cold is thought to be a cause of the above symptoms. Besides this, pollutants and tobacco are some other risk factors of exacerbations.

Causes

  • Smoking

Tobacco smoking is a primary cause of COPD. 20% of smokers have chances to get affected. These chances enhance with the use of tobacco. Female smokers are at higher risk of developing COPD than male smokers. According to a study, among 8 million deaths of smokers due to COPD, 1.2 million were passive smokers. Tobacco smoking through hookah or water-pipe is way more harmful than cigarette smoking.

  • Pollution

Those houses that are poorly ventilated and use biomass, dry dung, and coal as fuel to cook food have a high ratio of indoor pollutants. These indoor pollutants act as an underlying cause of COPD and are more prevalent in women due to their higher exposure. Some pieces of evidence have shown that COPD is more common in urban areas than rural areas. It is because urban areas are highly polluted by industrial wastes, traffic smokes, etc.

  • Occupational exposure

An individual is likely to get COPD if he is working in areas where fumes and chemicals are in use. These chemicals and fumes include welding fumes, silica isocyanate, and dust in the cotton textile, gold mining, and coal mining. Occupational exposure accounts for about 20% of COPD cases.

Diagnosis (2)

Diagnosis of COPD includes a physical examination, medical history, and several tests.

  • Medical History

A physician takes a medical history by asking some questions related to:

  • Smoking habits
  • Frequency of exposure to pollutants or dust
  • Presence of any other COPD family member
  • Severity of breathlessness
  • Wheezing and coughing symptoms
  • Productive and non-productive cough
  • Physical examination

Along with medical history, a physical does a different physical examination to diagnose COPD. These include:

  • Listening to heart and lungs
  • Checking pulse and blood pressure
  • Examination of throat and nose
  • Checking for swelling in ankles and feet
  • Test
    • Spirometry is a test that tells the functionality of the lungs. In this test, the patient blows air in the tube. This experiment indicates how much a patient can breathe in and breathe out. It also measures the rate of breathing.
    • Pulse oximetry is performed to check the oxygen level in the blood.
    • ABGs (arterial blood gases) measure the levels of carbon dioxide and oxygen in the blood.
    • ECG or electrocardiogram rules out the possibility of heart disease being a cause of breathlessness.
    • Chest X-ray is done to check the extent of lungs damage due to COPD
    • Exercise testing is performed to check whether the blood oxygen level drops while exercising or not.

Management of COPD

The management or treatment of COPD includes alleviation of symptoms and prevention of infections.  A physician may suggest:

  • Bronchodilators

Mist of bronchodilators is inhaled to expand airways and reduce symptoms of breathlessness and coughing. These include salbutamol, salmeterol, and theophylline.

  • Anti-inflammatory medicines

Lungs inflammation is generally reduced by taking some steroids. Steroids can be inhaled as a mist as well as taken as a pill. An example includes prednisolone.

  • Supplemental oxygen

In conditions of hypoxemia, the supplementary tank of oxygen is used to fulfill the need for oxygen.

  • Antibiotics

A person with COPD is vulnerable to other lungs infection as well. These infections enhance the severity of COPD. Some antibiotics are prescribed to prevent such circumstances. Examples include levofloxacin, azithromycin, etc.

  • Vaccinations

As mention above, lung infection increases the severity of COPD it is necessary to have vaccination shots of pneumonia and flu.

  • Anticholinergics

These medications relaxed tighten bands of muscle around airways. It allows more air to flow in and or of the lungs. These also eradicate excessive lung mucous. The function of Anticholinergics is different from bronchodilators. Examples include Tiotropium and Ipratropium.

  • Expectorant

It soothes air passages and shrinks the mucus layer in the airways. That allows a patient to cough out sputum more easily.

References

  1. https://en.m.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease
  2. https://my.clevelandclinic.org/health/diseases/8709-chronic-obstructive-pulmonary-disease-copd