Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease , or COPD, is a common form of chronic inflammatory lung disease. It is one of the major causes of death worldwide.

The disease is characterized by inflammation and damage of the airways, lung tissue, and pulmonary veins as a result of exposure to gases and chemicals that cause prolonged irritation. These can cause airways to gradually narrow and constrict or lead to permanent obstruction — which cannot be fully rehabilitated.

The 2 most common forms of COPD are emphysema and chronic bronchitis, conditions that often occur in conjunction with one another; asthma and bronchiectasis are also related forms of the disease.

Causes and Risk Factors of COPD

The most common causes of COPD are as follows:

  • Smoking – The most common cause is due to cigarette smoke containing over 400 types of chemicals and gases. These cause irritation to the airways and air sacs which lead to chronic inflammation and eventually causes irreparable damage to the lungs. As a result, people who smoke for a prolonged period of time are more at risk of developing the condition than those who do not. Passive smokers are also more at risk of developing the disease than those who are not exposed to cigarette smoke.
  • Air pollution – Dust particles, fumes and prolonged exposure to some forms of chemicals are examples of harmful pollutants. These cases usually occur in people who work in environments that contain high levels of chemicals in the air, such as in mines, metal work factories, factories that burn fuel during food preparation, and those which operate various types of heavy machinery.
  • Genetic Conditions – Alpha-1-antitrypsin (AAT) deficiency, for example, is a condition that affects the AAT enzyme which is produced in the liver and released into the bloodstream in order to prevent against lungs being damaged by various chemicals. This condition can therefore affect young men and women, while emphysema can be triggered earlier in smokers with an AAT deficiency than it would in non-smokers with the same condition. However, this genetic condition is not common and is found more often in those of Caucasian descent.

During the initial stages of the disease, symptoms do not present themselves until the lungs become increasingly damaged, at which point the patient will develop a chronic cough, an accumulation of phlegm in the early mornings after waking, tiredness, a lack of energy, difficulty breathing, tightness in the chest, wheezing, and regular chest infections. Some sufferers may even develop additional symptoms such as chest pain, coughing up blood, and the mouth and finger nails turning purple.

As the condition worsens, patients will become so weak that their normal physical activities become a struggle and they drastically lose weight. Eventually, during the final stages of the disease, respiratory infections will become more frequent and may lead to respiratory failure or congestive heart failure.

The doctor diagnoses COPD by assessing the medical history of the patient and their family, reviewing the patient’s lifestyle, asking the patient about the symptoms, as well as performing a full body check-up and various other laboratory-based assessments including:

  • Spirometry (lung function assessment) – This is a standardized method for testing volumes of air inhaled and exhaled from the lungs. The patient is required to inhale as much air as they can, before exhaling with full force and speed into a spirometer device. The device assesses the amount of air exhaled in 1 second and compares this to how much air is exhaled in total. The doctor will then administer bronchodilator medication and repeat the test. When these results are analyzed in conjunction with the patient’s other symptoms, an accurate assessment of the severity of the condition can be made.
  • Chest and Lung X-ray – This is done in order to distinguish between conditions of similar characteristics, as well as to diagnose any underlying health issues that may be present such as cardiovascular disease.
  • CT scan – This may be utilized for some patients to assess the extent of the emphysema and to help doctors who are considering surgery to treat the COPD. Alternatively, this scan may also be used to screen for cancer.
  • Arterial blood gas assessment – This is another method used in the evaluation of lung function, carried out by assessing the levels of oxygen and carbon dioxide present in the bloodstream.
  • Other types of assessments – Assessments that aim to determine the root causes of various symptoms as well as to rule out other conditions. An example would be an alpha-1-antitrypsin deficiency analysis for younger patients or patients with a family history of chronic obstructive pulmonary disease. A phlegm analysis may also be carried out to diagnose any present infections.

Although chronic obstructive pulmonary disease is incurable, there are ways to relieve some of the symptoms and slow the progression of the disease:

  • Quit smoking – As smoking is a major cause and the most crucial risk factor in developing chronic obstructive pulmonary disease, quitting smoking will help to slow the deterioration of the patient’s symptoms and lead to breathing more easily. In cases where patients are unable to give up smoking permanently on their own, attending behavioral therapy sessions and medication may assist with quitting.
  • Avoiding air pollution and spaces which contain high levels of chemicals in the air – If it is necessary to be in such spaces, devices should be worn to prevent chemicals from entering the respiratory system, for example, specialized dust and chemical masks.
  • Medication – A course of treatment may be prescribed with the aim of treating the symptoms, reducing the chances of the disease flaring up, and increasing the patient’s quality of life. Prescribing the correct medication is determined according to the symptoms as well as the severity of the condition. The main types of medication used to treat chronic obstructive pulmonary disease are as follows:
    • Bronchodilator medications – These are used to relax the respiratory muscles in order to reduce coughing and wheezing. Patients will therefore be able to breathe more easily than before. These types of medications are categorized into short term relief and long-term relief. They are available in inhaler and oral medication forms.
    • Inhaled corticosteroids – These are used in conjunction with bronchodilator medication for patients with severe symptoms in order to reduce the chances of the symptoms flaring up. The use of such medication will be based on the doctor’s assessment of the patient on a case by case basis.
    • Antibiotics – They are administered to fight against infection or to reduce the chances of the condition flaring up.
  • Supportive treatments – These include, for example, long term oxygen therapy, influenza and pneumonia vaccinations to reduce the risk of serious illness, lung rehabilitation therapy programs, nutritional advice, and caring for the mental and physical wellbeing of the patient.
  • Surgery – In cases where the patient does not respond to medication or other forms of treatment, the doctor may consider surgery to remove the large air sacs which put pressure on the lung. Surgery to reduce lung capacity, to install a device into the patient’s airways or to completely replace the lung, if a donor can be found, may also be considered.
COPD can be prevented by not smoking, avoiding being around people who are smoking, protecting yourself against air pollution and dust particles, as well as having regular lung check-ups, especially if you belong to one of the groups considered most at risk for developing the disease.

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