CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Overview and Facts

Chronic Obstructive Pulmonary Disease (COPD) is a chronic, progressive, long-term inflammatory lung disease that causes breathing difficulties by obstructing airflow in the lungs. To force the air out when breathing, the lungs rely on the natural elasticity of the bronchial and air sacs. With COPD, they lose their elasticity and overexpand, leaving some air in the lungs when exhaling.

Air pollution and long-term exposure to irritating gases and particulate matter that irritate the lungs are the common causes of COPD, with smoking being the number one cause that places smokers as well as those exposed to secondhand smoke at a greater risk. COPD also develops gradually over the years and its symptoms mostly begin at age 40. Genetics may also play a role in the increased risk of contracting COPD. The deficiency of a protein called alpha 1 antitrypsin (AAT) that is made in the liver and whose role is to help protect the lungs harms the liver and lungs.

Types and Symptoms

TYPES

The most common types of COPD are emphysema and chronic bronchitis. Many people can have both of these conditions.

  • Emphysema is a condition where the fragile walls and elastic fibers of the air sacs are destroyed, causing these air sacs to merge to form one giant air sac. This further results in the collapse of the small airways causing interference when exhaling which traps air in the lungs resulting in shortness of breath.
  • Chronic bronchitis is a condition characterized when one has coughing, shortness of breath, and mucus that is lingering for at least 3 months for 2 years in a row due to inflammation and narrowing of the bronchial tubes. Hair-like fibers called cilia that help move the mucus out are gone causing the mucus to build up in these narrow tubes causing a chronic cough in the response of trying to clear the airways.

SYMPTOMS

COPD is a progressive disease which means symptoms may not appear not unless the lung had significant damage. Symptoms of COPD may include:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Chronic cough can be accompanied by mucus that may be clear, white, yellow, or greenish.
  • Needing to clear the throat when waking up in the morning due to excess mucus
  • Frequent respiratory infections such as colds and flu
  • Lack of energy and fatigue
  • Weight loss
  • Swelling in the ankles, feet, or legs

Diagnosis & Medications

DIAGNOSIS

In the diagnosis of COPD, the doctor will review the symptoms, family and medical history, and exposures. Tests that will help with the diagnosis of COPD include:

  • Pulmonary function tests measure the amount of air that can be inhaled and exhaled and if enough oxygen is delivered in the blood.
  • X-ray on the chest that can show emphysema.
  • CT scan to detect emphysema and to screen for possible lung cancer
  • Arterial blood gas analysis that measures how well the lungs deliver oxygen and removes carbon dioxide.
  • Laboratory tests to rule out other diseases and check AAT deficiency.

 

TREATMENT

For smokers, the most essential step is smoking cessation to keep COPD from becoming worse. For both smokers and non-smokers which include those who contracted COPD through other causes aside from smoking, medications may be prescribed. Medications may include:

  • Bronchodilators to relax muscles around the airway.
  • Inhaled steroids to reduce airway inflammation.
  • Oral steroids for exacerbations
  • Phosphodiesterase-4 inhibitors to decrease airway inflammation and relax the airways.
  • Theophylline to help improve breathing
  • Antibiotics to aggravate symptoms.

Additional therapies may also be recommended for moderate and severe cases. Therapies may include oxygen therapy and pulmonary rehabilitation program.

For severe cases where medications and therapies are not sufficient, surgery is an option. Surgery includes:

  • Lung volume reduction surgery where small wedges of damaged lung tissue are removed.
  • Bullectomy where large air spaces called bullae are removed in the lungs.
  • Lung transplant.

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