Alright without any further ado, let’s get started and let’s go over chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease which you will see abbreviated many times as COPD is the term used for two different chronic lung diseases which hinder breathing by limiting lung airflow, and becoming sever with time. According to the CDC it is the fourth leading cause of death in the United States. In the United States around 24 million individuals are affected by COPD, and over a half of them have symptoms and do not know it. Early screening is key to diagnosing someone with COPD before major loss of lung function occurs.
Pathophysiology. In order to understand the progression of COPD we need to understand the structure and functioning of the respiratory system. During the breathing process air enters the main windpipe. This windpipe divides into two smaller branches called bronchial tubes. Each bronchial tube goes to one of the two lungs where they are divided into numerous smaller known as bronchioles.
Bronchioles are fine branches with tiny air sacs at the ends. These balloon-like air sacs are called alveoli. During inhalation alveoli stretches and fills with air. And during exhalation they shrink again.
Alveoli are surrounded with a network of tiny blood capillaries which is the main site of gaseous exchange in the respiratory system.
When the inhaled air reaches the alveoli, oxygen is transferred to the blood capillaries through the alveolar walls, and carbon dioxide is removed from the blood and transferred to the air sacs to be exhaled out of the body. And there you have the normal breathing process. In the case of COPD some changes in the respiratory tract caused the volume of inhaled and exhaled air to be reduced. These changes can be one or more of the following:
- Clogging of air passages due to mucus
- Inflammation or thickening of the walls of air passages;
- Damaged alveolar walls
- Alveoli and air passages losing their stretching ability.
There are two types of COPD that may cause these damages:
- Chronic bronchitis
In the case of emphysema, the main damage takes place in the alveolar walls. When the walls between the different alveoli are destroyed, the alveoli lose shape, and it also results in larger and fewer air sacs instead of many tiny ones. This reduces the total surface area for gaseous exchange. The lungs reduce their efficiency, and the volume of air exchanged is decreased. In the case of chronic bronchitis, the lining of air passages are clogged with mucus or phlegm due to chronic inflammation, irritation and swelling. This hinders breathing. It is common for both emphysema and chronic bronchitis to occur together, which is why generally the term COPD is used for both.
Causes of COPD
Most cases of COPD are caused by inhaling pollutants. That includes:
- Smoking cigarettes and pipes
- Second-hand smoke, fumes, chemicals and dust found in some work environments can contribute to people having COPD.
Smoking, however, is the most common cause of COPD. Prolonged exposure to lung irritants can cause irritation and destroy air passages and lungs. Air pollution, dust, chemicals and chemical fumes from the environment or workplace can also cause COPD but they are less common.
Difficult to understand, genetics can also play a role in a person’s development of COPD even if the person has never smoked or been exposed to strong lung irritants in the workplace. There is a genetic condition known as Alpha-1 Antitrypsin Deficiency which can also contribute in the development of COPD. However, it is very rare. People with this condition are deficient of Alpha-1 Antitrypsin (AAT) which is a protein made in the liver. Accompanied with smoking or lung irritants this condition can destroy the lungs, and cause COPD.
Signs and symptoms. COPD is a progressive disease. In the early stages there may be no symptoms, or they may be very ordinary and mild ones. But with the progression of the disease more severe symptoms start to appear. Common signs and symptoms may be:
- A persistent cough for 3 or more months accompanied with the production of thick mucus which gets worse during the early mornings
- Dyspnea, which is a medical term which means “shortness of breath” especially during physically demanding activities
- Frequent respiratory infections flus, colds and pneumonia
- Tightness in the chest
Advanced COPD symptoms can include difficulty with talking and breathing at the same time, fevers and headaches due to high carbon dioxide levels in the blood, cyanosis which is a bluish or grayish-colored lips or fingernails. This is due to low oxygen levels in the blood. And a barrel chest-like appearance, swollen feet and ankles, weight loss, lack of mental alertness and clubbing of the fingers.
Diagnosis of COPD is done by a specialist using test results, physical examination, medical history of the family and other relative data gathered through questioning the patient.
Spirometry is a painless test used to confirm the presence of COPD. For this test a spirometer is used to find out the volume of air inhaled and exhaled by the person, and how fast the air moves in and out of the lungs.
The doctor may also suggest other tests including chest CT scans and X-rays to help provide visual pictures of the lungs and see if they show signs of COPD, if any. An arterial blood gas could also be done. It is a blood test to measure the level of oxygen in the blood. It helps determine the severity of COPD and whether oxygen therapy is required or not.
The damage is irreversible, but medications and changing lifestyle can slow down the progression of the disease and help the patient live a normal life. Things like quitting smoking and avoiding lung irritants are the main steps to treat COPD. For help in quitting smoking an individual can join a support group.
There are many different types of medications used to treat the symptoms and complications of COPD. These can include bronchodilators. Bronchodilators relieves coughing and shortness of breath, and assists in breathing. They are usually sold with inhalers. Examples of bronchodilators are short-acting: Ipratropium, Levalbuterol, Xopenex, Albuterol. And long acting dilators can include: Tudorza, Serevent, Brovia, Spirivva, Arcapta and Perforomist. Also, inhaled steroids and reduce inflammation of the air passages and prevent exacerbations. Examples of these could be Pulmicort and Flovent.
Theophylline is an inexpensive medication that prevents exacerbations and makes breathing easier. It can have side effects such as rapid heart rate, tremors and nausea.
Oral steroids help prevent further damage in moderate or severe acute exacerbation of COPD. Oral steroids may exhibit serious side effects such as diabetes, weight gain, cataracts, osteoporosis and vulnerability to infections.
Antibiotics are used to treat acute exacerbations by fighting respiratory infections, including bronchitis, influenza and pneumonia which can otherwise intensify COPD manifestations.
Lung therapies. Patients with moderate or severe COPD may require additional therapies such as supplemental oxygen.
Supplemental oxygen is given to patients with low oxygen levels in the blood. There are several lightweight portable oxygen devices available on the market that are used to provide oxygen to the lungs. It is the only COPD therapy proven to extend life and improve quality of life.
Pulmonary rehabilitation program may also be an option. It is based on a combination of education, nutrition advice, exercise training and counseling to fulfill every COPD patient’s individual requirements. The program may help reduce hospitalization periods, and enable clients to live more active lives and improve their quality of life.
Certain patients with acute emphysema, for whom medication is not enough, may have to go through surgery. These surgeries can include lung volume reduction surgery. This surgery is used to remove small wedges of damaged lung tissue to create extra space in the chest cavity. This helps the remaining lung tissue and the diaphragm to work more efficiently and thus potentially extending life and improving the quality of life.
A bullectomy can also be performed. Remember, whenever you see the letters “ectomy” at the end of a word, it means “the removal of”. A bullectomy is when the alveolar walls are damaged larger air spaces are formed known as “bulla”. Bulla can be so large that it can hinder breathing. A bullectomy is a surgery used to remove one or more large bulla from the lungs.
A lung transplant is recommended only to certain patients who meet certain criteria. A lung transplant improves breathing and helps to live an active life. However it is a major operation and so there are considerable risks associated with it, such as organ rejection in which the organ receiver has to take immune suppressing medications for the rest of his life.
Prevention is always better than the cure. The main cause of COPD is smoking. So the best prevention of COPD is to never start smoking or to quit as soon as possible. In the case of difficulty quitting smoking, you can advise your patient to consult the doctor about products or programs that can help them quit smoking.
Another preventative measure is avoidance of lung irritants such as air pollutants, second-hand smoke, dust, chemicals and fumes. When the disease progresses it is important to call 000 for help.
Call when they can’t walk and talk at the same time, or they can’t walk and talk in general. Or when their heart beats very fast or has an irregular beat. If their lips or fingernails turn blue, if he breathes fast and hard even when on medications.