All You Need to Know About Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) or in Hindi, we call it “Kaladama” as deposition of black tar occurs in the lungs. COPD, which stands for Chronic Obstructive Pulmonary Disease, is a progressive lung disease that causes obstructed airflow from the lungs, making it difficult to breathe. It is characterized by long-term breathing problems and poor airflow, typically caused by long-term exposure to harmful substances like tobacco smoke and air pollution. This is different from asthma (dama).

Asthma vs COPD

Asthma is predominantly an allergic disease caused by a combination of genetic and environmental factors. Asthma is characterized by variable and recurrent symptoms of wheeze, cough, chest tightness, shortness of breath, and the patient may be asymptomatic during allergy-free periods in the early part of the disease. Asthma is predominantly associated with nasal symptoms as well, which characterizes its allergic nature. COPD, on the other hand, is a progressive lung disease that causes airflow limitation due to the gradual destruction of lung tissue, and it is irreversible.

COPD is characterized by narrowing of airways along with destruction of lung tissue. Patients usually complain of gradually progressive shortness of breath, cough with sputum production. Other symptoms that may be present are chest tightness and wheezing. As COPD advances, patients may also experience frequent exacerbations, which are sudden worsening of symptoms, such as severe difficulty breathing, increased coughing, and sputum production.

In advanced disease, the patient may have leg swelling, which is due to increased pressure on the right heart (increased obstruction with increased lung size compresses blood vessels coming from the right heart), which prevents systemic drainage of blood to the heart and increases swelling, especially in the legs. Additional complications can include heart failure, osteoporosis, and depression, which are common among individuals with COPD.

Causes of COPD

Tobacco Smoke

Tobacco smoke is the most common cause of COPD worldwide. In India, among tobacco use, smoking is one of the major causes of deaths and diseases like COPD, lung cancers, and others, and accounts for millions of such cases. Inhalation of tobacco smoke damages the lungs by causing inflammation, narrowing of the airways, and breakdown of lung tissue over time.

Smoke exposure can also contribute to the development of COPD, even in individuals who have never smoked themselves.

Other Causes

• Occupational Exposure: Increased exposure to dust, chemicals, and fumes increases the risk of COPD. The industries commonly implicated are mining, cotton textile, and welding. Long-term exposure to hazardous particles or gases in the workplace can lead to the development of COPD, particularly if protective equipment is not used.
• Air Pollution: Air pollution, especially indoor air pollution, is increasingly being implicated as the cause of COPD in developing countries. Coal or biomass fuels are most commonly seen as a cause due to increased smoke production, which is detrimental to health whenever there is an inefficient exhaust system or poorly ventilated areas. Outdoor air pollution, such as vehicle emissions and industrial pollutants, also contributes significantly to the rising incidence of COPD.
• Genetic Factors: Genetic factors may be involved in the development of COPD. This is suggested by the increased prevalence of COPD among relatives of patients with COPD. Alpha-1 antitrypsin deficiency is a rare genetic disorder that can increase risk of development of COPD in future life.

Symptoms of COPD

The symptoms of COPD can develop gradually and worsen over time. The most common symptoms of Chronic Obstructive Pulmonary Disease (COPD) are difficulty breathing (shortness of breath), chronic cough (sometimes with phlegm), fatigue, and feeling tired.

Additional common signs and symptoms of COPD include:

• chest tightness
• Increased mucus production
• Wheezing
• Frequent respiratory infections

As the disease progresses, individuals may also experience unintentional weight loss, swollen ankles or feet, and difficulty sleeping due to breathing problems.

Diagnosis of COPD

Clinical Diagnosis

The diagnosis of COPD can be made on the basis of history and symptoms itself, which are in themselves very classical and self-explanatory.

Diagnostic Tests

• Lung Function Test: Lung function test, especially spirometry, shows the presence of obstruction in the airways and that is irreversible after giving bronchodilator drugs.
• Chest X-ray: Chest X-ray also helps in diagnosis and ruling out other causes. It shows an increase in the size of lungs, which is a characteristic of patients with COPD.
• CT Scan: Can give a more detailed image of the lungs, helping to assess the extent of damage in the lungs.
• Arterial Blood Gas Test: Measures oxygen and carbon dioxide levels in the blood, which helps in assessing lung function.

Prevention of COPD

There is no cure for COPD; therefore, prevention forms an important aspect, which needs to be considered in every individual with risk factors for COPD. This includes smoking cessation, improving workplace conditions, and indoor air quality.

Preventing COPD involves making lifestyle changes and reducing exposure to harmful substances:

• Avoid smoking: This is the most important preventive measure.
• Avoid smoke and air pollution: Whenever possible, stay in well-ventilated areas and avoid exposure to harmful fumes and gases.
• Wear protective equipment: If you work in industries that involve exposure to dust and chemicals, always wear protective gear.
• Get vaccinated: Vaccines for pneumonia and the flu can help prevent respiratory infections, which can worsen COPD symptoms.

Treatment of COPD

Major Treatment Goals

The major goals of management are to reduce risk factors, manage stable COPD, prevent and treat acute exacerbations, and manage associated illnesses. Smoking cessation and supplemental oxygen are not only beneficial but also reduce mortality among patients with COPD. Vaccination with influenza every year and pneumococcal vaccine every five years or lifelong is another important component of treatment.

Medical Management

• Inhaled Bronchodilators: Inhaled bronchodilators are the mainstay of medical management. They reduce symptoms, exercise limitation, decrease exacerbations, and improve overall quality of life.
• Inhaled Corticosteroids: Inhaled corticosteroids may not have a role in mild COPD but are helpful in combinations with inhaled bronchodilators, especially in patients with moderate and severe COPD.
• Steroids: Oral or intravenous steroids are used in exacerbations as they increase the chance of recovery and decrease the overall duration of symptoms. They should be used as a short course, whereas long-term use is associated with its own significant side effects.
• Phosphodiesterase-4 Inhibitors: Help reduce the risk of exacerbations.
• Other Medications: Long-term antibiotics, mucolytics, and methylxanthines are also commonly used.

Advanced Therapies for COPD

Oxygen Therapy

Patients may require oxygen as the severity increases, especially those who have low levels of oxygen at rest. If oxygen is required, it should be used for at least 15-16 hours per day to show some benefits. It decreases the risk of heart failure and improves the ability to exercise. The oxygen can be delivered via cylinder or through concentrators. The concentrators are useful for long-term use as they themselves make oxygen and are not very cumbersome as are the cylinders. The only important issue is the requirement of 24-hour electricity for concentrators, and therefore, during power failures, backup with oxygen cylinders becomes a necessity.

Non-Invasive Ventilation (NIV)

Non-invasive ventilation (NIV) e.g., BiPAP, is an important tool in patients with COPD who present with acute exacerbation and have respiratory distress with carbon dioxide retention. NIV is an important adjunct to the medical management of patients presenting with acute exacerbation.

Surgical Interventions

In very severe COPD cases or advanced cases, lung volume reduction surgeries or lung transplantation may be considered, especially for those who fit the eligibility criteria.

• Lung Volume Reduction Surgery: Involves removing the portion of the lung that is hyperinflated and thus allowing the good remaining part of the lung to expand and work better.
• Lung Transplantation: May be useful in younger patients with a very severe form of COPD.

Pulmonary Rehabilitation (PR)

A structured program that includes exercise, education, and counseling to improve quality of life.

Importance of PR

Pulmonary rehabilitation (PR) forms another important component of treatment in patients with COPD. The aim is to reduce symptoms, increase muscle strength and exercise tolerance, and decrease hospital length of stay. This involves respiratory muscle training and counseling (psychological and nutritional), energy-conserving techniques, breathing strategies, and education about the disease and how to manage it. And this improves overall quality of life, ability to exercise, and reduces mortality.

Types of Exercise in PR

The types of exercise include aerobic, strengthening or resistance, and stretching and flexibility exercises.

PR Team and Role

The PR team involves pulmonologists, nurses, respiratory therapists, physiotherapists, nutritionists, and psychologists. Respiratory or chest specialists play a pivotal role in the PR program by educating about the disease, medical management, and coordinating with other specialties.

The Global Impact of COPD

Globally, millions of people are affected by COPD. The increase in the developing world is associated with an increased incidence of the disease. It is the fourth leading cause of death in the world. The economic cost to COPD is also huge and runs into trillions of dollars, with half of it required in the developing world.

Need for Stronger Regulation on Smoking

I believe there is a need for increased and much harsher government regulation on smoking and cigarette use. The addiction that causes diseases and increases countries' economic costs is rampant at the moment. The argument that cigarette production and sale bring revenue seems to be a sheer myth, as the costs involved in treating a large number of diseases caused by smoking are enormous and run into billions of rupees. Secondly, the loss of humanity is priceless and irreversible.

Conclusion

COPD is a serious lung disease that can affect your ability to breathe and impact your overall quality of life. With early diagnosis and proper management, individuals with COPD can lead an active life, but it is crucial to avoid triggers like smoking and air pollution.

If you or someone you know is experiencing symptoms of COPD, such as a persistent cough or difficulty breathing, consult a healthcare provider for an assessment. Early intervention can help slow the progression of the disease and improve long-term outcomes.