Chronic Obstructive Pulmonary Disease, or COPD, is a term used to describe a spectrum of chronic inflammatory lung diseases that block the airflow to the lungs and makes breathing difficult. It is caused due to long-term exposure to irritating gases and particulate matter suspended in the air, usually cigarette smoke.COPD is a progressive and irreversible disease that makes breathing difficult.
The two most common conditions of COPD are:
- Emphysema: The alveoli, or the minute air sacs present at the end of the air passages in the lungs are damaged due to prolonged exposure to cigarette smoke, harmful gases and chemical irritants, and particulate matter.
- Chronic Bronchitis: It is characterized by inflammation of the airways or the bronchial tubes which supply the alveoli with air. The signs of this condition include frequent and regular coughs along with the production of sputum.
All types of COPD are caused due to airborne irritants. The common causes are:
- Smoking: About 80 to 90 percent of all the cases of COPD are caused due to smoking, although non-smokers who’ve had a prolonged exposure to second-hand smoke are also likely to get this disease.
- Exposure to chemicals and fumes in the workplace, such as cadmium dust, grain and flour dust, welding fumes and coal dust.
- Fumes from burning fuel used for cooking and heating, which is more likely in developing countries.
- Respiratory infections
- Indoor air pollution
- In a small percentage of cases, it might be due to genetic factors such as deficiency in alpha-1-antitrypsin protein which causes deterioration of the lung function.
Symptoms of COPD
The symptoms don’t usually manifest until the disease is in its advanced stages and there has been a considerable damage to the lungs. Some of the early symptoms of COPD are:
- Persistent, mild cough with the production of mucus
- Shortness of breath
- Chest tightness
When the condition worsens, other symptoms may develop, such as:
- Edema (swelling of the ankles and the feet)
- Unexplained weight loss
- Cyanosis (blueness of the lips and the fingernail beds)
- Frequent respiratory infections such as the cold, flu etc.
- Breathlessness, even after mild physical activity or at night
- Cough with or without the mucus
What are the stages of COPD?
A particular grading system of the GOLD classification is used to assess the severity of COPD, based on the spirometry testing. There are four grades:
- Grade 1: Mild
- Grade 2: Moderate
- Grade 3: Severe
- Grade 4: Very severe
There is no single test for diagnosing COPD. The doctor assesses the patient’s medical history, including enquiring about smoking habits, exposure to airborne pollutants, family history etc. and performs some tests to diagnose this condition.
A physical examination is performed to look for any visible signs of COPD, such as cyanosis. The tests performed to assess the lung function include:
- Spirometry: This is a common pulmonary function test to measure the amount of air that a person can breathe in and out and check if the lungs are supplying the blood with sufficient oxygen. It makes use of a device known as Spirometer which measures how much air can be stored in the lungs and the speed of exhalation. This test can detect COPD even before the person starts showing the symptoms.
- Imaging Tests: Chest X-rays and CT scan provide a detailed image of the lungs, heart and the blood vessels. A CT scan also helps detect emphysema.
- Arterial blood gas test: A sample of the blood is taken from an artery to measure the levels of oxygen and carbon dioxide in the blood.
- Exercise Tolerance Test: This evaluates the impact of exercise on the ability of the heart and lungs to bring in oxygen and expel carbon dioxide from the bloodstream.
- Bronchial Provocation Test: This test is done very rarely. In this, the patient undergoes spirometry after inhaling a specific drug such as methocholine or a histamine to assess the sensitivity of the lungs.
- Peak flow test: This is a breathing test which determines how fast a person can exhale and is helpful in ruling out asthma.
Is COPD same as Asthma?
Although there are many common symptoms and treatment options for both these conditions, they are quite different. In asthma, the bronchial tubes of the lungs become inflamed and become very sensitive to environmental factors such as dust and smoke. Moreover, most cases of asthma are detected in childhood and the symptoms are also intermittent, i.e., there are periods of time when there aren’t any symptoms.
On the other hand, COPD is mainly caused due to smoking and isn’t usually diagnosed until much later in life. The symptoms are also persistent.
How is COPD treated?
COPD doesn’t have a cure as yet, and hence the treatment options focus on slowing down the rate of progression of this disease, relieving the symptoms and improving the quality of life through adequate lifestyle modifications.
- Cease to smoke: This is the most important and highly mandatory step in the treatment plan for COPD.
- Oxygen Therapy: In order to enhance the oxygen levels in the blood, supplemental oxygen can be given through a portable mask to help the person breathe better. It increases the survival rates in the patients and improves the quality of life.
- Pulmonary Rehabilitation: This includes a mix of exercise, education and psychological support to help patients with debilitating symptoms and should be carried out for a long enough time to provide optimum benefits.
- Medications: The kinds of medications used to treat COPD include:
- Bronchodilators: These are taken through an inhaler and help relax the muscles located in the airways. They help make breathing easier by relieving the coughing and the shortness of breath. They also help clear mucus from the lungs. Short-acting bronchodilators such as albuterol, levalbuterol and ipratropium last for four to six hours while the long-acting versions like tiotropium, salmeterol, formoterol etc. last for about 12 hours.
- Corticosteroids: These can help reduce inflammation of the airways and lower mucus production. But they may have certain side-effects such as bruising, oral infections and hoarseness.
- Antibiotics: These can help prevent exacerbations caused due to respiratory infections. These are prescribed if the person displays signs of chest infection, such as high temperature, rapid heartbeat, chest pain and feelings of confusion or disorientation.
- Theophylline: This medicine, available in the form of a pill, eases the chest tightness and shortness of breath. Side-effects may include headache, nausea and tremors.
- Phosphodiesterase-4 inhibitors: This drug reduces the inflammation of the airways and relaxes them.
- Surgery: If the medications are ineffective, surgery is an option. However, not everyone affected by COPD qualifies for a surgery. The types of surgery are:
- Lung Volume Reduction Surgery: The damaged tissue is removed from the upper part of the lungs to enable them to expand further so that the person can breathe more easily.
- Lung Transplant: The damaged lung is replaced by a healthy lung from a donor. But there is an inherent risk involved in the rejection of the lungs by the host body.
- Lifestyle modifications such as following a healthy diet plan, doing yoga etc. also have beneficial effects on the patients.