Chronic obstructive pulmonary disease (COPD)

What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that obstructs airflow from the lungs and causes difficulty breathing, especially during physical exertion. The main cause of COPD in developed countries is tobacco smoking. The disease typically includes two conditions: emphysema (damaged alveoli) and chronic bronchitis (inflammation of the airways).

Symptoms of COPD:

  • Wheezing
  • Chest Tightness
  • Chronic Cough: May produce mucus (sputum).
  • Frequent Respiratory Infections
  • Lack of Energy
  • Unintended Weight Loss
  • Blueness of Lips or Fingernail Beds: Due to low oxygen levels.
  • Swelling in Ankles or Legs: Related to heart or lung complications.

Risk Factors for COPD:

  • Tobacco Smoke Exposure: The most common cause of COPD.
  • Asthma and Smoking: People with asthma who smoke are at higher risk.
  • Occupational Exposure: Dust, fumes, and chemicals in the workplace.
  • Genetics: Some people inherit a genetic condition called alpha-1-antitrypsin (AAt) deficiency, which increases the risk of COPD, particularly in younger individuals.

Complications of COPD:

  • Respiratory Infections: Patients are more prone to infections like pneumonia. Annual flu vaccinations and pneumococcal vaccines are recommended.
  • Heart Disease and Heart Failure
  • Lung Cancer
  • Pulmonary Hypertension: Increased blood pressure in the lungs.
  • Depression: Difficulty in coping with chronic illness can lead to depression.

Diagnosis of COPD:

  • Pulmonary Function Tests: Measure lung volumes, gas exchange (diffusing capacity), and oxygen levels using pulse oximetry.
  • Spirometry: A key test that can detect COPD even before symptoms appear by measuring how much air you can exhale and how quickly.
  • Chest X-ray and CT Scan: Helps assess lung damage.
  • Arterial Blood Gas Analysis: Determines how well the lungs are moving oxygen into the blood and removing carbon dioxide.
  • Genetic Testing: For alpha-1-antitrypsin deficiency, especially if there is a family history of COPD or if the disease develops at an early age (under 45).

Treatment for COPD:

  1. Smoking Cessation: The most important step in treating COPD.
  2. Medications:
    • Bronchodilators: Open the airways and make breathing easier.
      • Short-acting bronchodilators: Albuterol (ProAir HFA, Ventolin HFA).
      • Long-acting bronchodilators: Tiotropium (Spiriva).
    • Inhaled Steroids: Reduce airway inflammation. Examples include Fluticasone (Flovent HFA, Pulmicort).
    • Combination Inhalers: Combine bronchodilators and steroids, such as Advair (fluticasone/salmeterol) or Symbicort (formoterol/budesonide).
    • Oral Steroids: For acute COPD exacerbations (flare-ups).
    • Phosphodiesterase-4 Inhibitors: Example: Roflumilast (Daliresp) to reduce inflammation and prevent flare-ups.
    • Theophylline: Used less frequently but helps open the airways.
    • Antibiotics: For infections like acute bronchitis, pneumonia, and influenza.
  3. Lung Therapies:
    • Oxygen Therapy: For patients with low blood oxygen levels. It improves quality of life and survival.
    • Pulmonary Rehabilitation: A comprehensive program that includes exercise training, nutritional counseling, and support.
  4. Surgical Options:
    • Lung Volume Reduction Surgery: Removes damaged parts of the lungs to improve lung function.
    • Lung Transplant: For severe cases where other treatments have failed.
    • Bullectomy: Removes large air spaces (bullae) that form due to emphysema and impair breathing.

Managing COPD:

  • Avoid Smoking and Secondhand Smoke.
  • Stay Active: Regular physical activity and breathing exercises can improve lung function.
  • Follow Treatment Plan: Adherence to medications and therapies is key to managing symptoms.
  • Monitor for Infections: Seek medical help early if respiratory symptoms worsen.

With proper management and lifestyle changes, many people with COPD can improve their quality of life and reduce the risk of complications. Regular follow-ups with your healthcare provider are essential to adjust treatments as needed.