Chronic obstructive pulmonary disease (a.k.a:COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis+Emphysema;)

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD:

● Chronic bronchitis, which involves a long-term cough with mucus

● Emphysema, which involves hyperinflation and damage to the lungs over time

Most people with COPD have a combination of both conditions.

Causes, incidence, and risk factors

Smoking is the leading cause of COPD. The more a person smokes, the more likely that a person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 anti-trypsin can develop emphysema.

Other risk factors for COPD are:

● Exposure to certain gases or fumes in the workplace

● Passive smoking

● Excessive exposure to road traffic pollution

● Frequent use of cooking fire without proper ventilation

Symptoms

● Cough, with or without mucus

● Fatigue from heavy breathing

● Recurrent chest infections

● Shortness of breath that gets worse with activity

● Trouble catching one’s breath

● Wheezing

Because the symptoms of COPD develop slowly, some people may not know immediately that they are sick and need to see a doctor.

Signs and tests

1. The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation.This test reveals a lot of information regarding the severity of the patient’s disease, predictability of the response to medication, requirement of oxygen.

2.Pictures of the lungs (such as chest x-rays and High resolution CT scan) can be helpful and are routinely advised by healthcare practitioners for the first time as well as for follow ups.

3.Sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and carbon dioxide in the blood. This helps the doctor judge the severity of disease and prescribe treatment accordingly.

Treatment

There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse.

1.Persons with COPD MUST stop smoking. This is the best way to slow down the lung damage.

2.Medications used to treat COPD include:

● Inhalers (bronchodilators) to open the airways, such as Ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol

● Inhaled steroids(Fluticasone,Beclomethasone) to reduce lung inflammation

● Anti-inflammatory medications such as Montelukast (Singulair) and Roflimulast are sometimes used

3.In severe cases or during flare-ups, you may need to receive:

● Steroids by mouth or through a vein (intravenously)

● Bronchodilators through a nebulizer

● Oxygen therapy

● Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)

4.Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse.

5.You may need oxygen therapy at home if you have a low level of oxygen in your blood.

6.Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs.

What can I do for myself and my family members?

Walk to build up strength.

● Ask the doctor or therapist how far to walk.

● Slowly increase how far you walk.

● Try not to talk when you walk if you get short of breath.

● Use pursed lip breathing when breathing out (to empty your lungs before the next

breath)

Things you can do to make it easier for yourself around the home include:

● Avoiding very cold air

● Making sure no one smokes in your home

● Reducing air pollution by getting rid of fireplace smoke and other irritants

● Wear a mask while walking to work,riding a 2-wheeler etc

Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories.

Surgery may be used, but only a few patients benefit from these surgical treatments:

● Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema

● Lung transplant for severe cases

Support Groups

People often can help ease the stress of illness by joining a support group in which members share common experiences and problems.

Expectations (prognosis)

COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking. Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about breathing machines and end-of-life care.

Complications

● Irregular heartbeat (arrhythmia)

● Need for breathing machine and oxygen therapy

● Right-sided heart failure (heart swelling and heart failure due to chronic lung disease)

● Pneumonia

● Pneumothorax

● Severe weight loss and malnutrition

● Thinning of the bones (osteoporosis)

Calling your health care provider

Go to the emergency room or call the local emergency number if you have a rapid increase in shortness of breath.

Prevention

Avoidance of smoking prevents most COPD. Ask your doctor or health care provider about quit smoking programs. Medicines are also available to help kick the smoking habit. The medicines are most effective if you are motivated to quit.

Chronic Obstructive Pulmonary Disease: A Summary

Chronic obstructive pulmonary disease (COPD) is characterized by long term obstruction of airflow out of the lungs.

● COPD is comprised primarily of two related diseases – chronic bronchitis and emphysema.

● In chronic bronchitis there is inflammation and swelling of the lining of the airways that leads to their narrowing and obstruction.

● In emphysema there is permanent enlargement of the terminal parts of the airway due to the destruction of the walls between alveoli.

● COPD causes poor gas exchange in the lungs leading to decreased oxygen levels in the blood, increased carbon dioxide levels, and shortness of breath.

● The major cause of COPD is smoking. Other less common causes include air pollution, repeated lung damage from infections, and inherited disease (alpha1 antitrypsin deficiency).

● Treatment consists of cessation of smoking, medications to open the airways and decrease inflammation, prevention of lung infections, oxygen supplementation, and pulmonary rehabilitation.