Chronic obstructive pulmonary disease (also called emphysema), is a progressive disease that makes it hard to breathe. The commonest cause of COPD worldwide is cigarette smoking. Long term exposure to other irritants, such as air pollution, chemical fumes or dust may also contribute to COPD. Rarely, a genetic condition called alfa-1 antitrypsin deficiency causes COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver. Smokers with alfa-1 antitrypsin deficiency develop COPD at a young age. Although uncommon, asthma sufferers can develop COPD, esp if they are undiagnosed or untreated.
COPD includes two main conditions— emphysema and chronic bronchitis. In emphysema, the walls between many of the air sacs are damaged. This damage leads to fewer and larger air sacs instead of many tiny ones. As a result, the amount of gas exchange in the lungs is reduced.
In chronic bronchitis, the inner lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have a combination of both emphysema and chronic bronchitis.
- chronic cough
- shortness of breath
- sputum production
- chest tightness
- ankle swelling (if severe)
To confirm the diagnosis of COPD, a spirometry or lung function test (breathing test) is usually done. Other tests that may be done include chest X ray, chest CT and arterial blood gas. Methacholine Challenge test is usually negative.
Quitting smoking is the most important step one can take to treat COPD. Success rates at quitting smoking are generally low (less than 10% success rate at 6 months). As such, most patients do need help, either in terms of pharmacotherapy or attending quit smoking clinics.
The usual treatment of COPD is the use of bronchodilators. Most of these are via the inhalation route. In severe cases, steroid inhalers are added to decrease the inflammatory response.
The flu can cause serious problems for patients with underlying COPD. As such, WHO and CDC (USA) recommends that patients with COPD get vaccinated against the flu at least annually.
This vaccine lowers the risk for pneumococcal pneumonia and its complications. People who have COPD are at higher risk of pneumonia than people who don’t. Professional societies also suggest that COPD patients be vaccinated routinely against the pneumococcus.
Pulmonary Rehabilitation Programme
Pulmonary rehabilitation is an outpatient 6 week, 3 times a week exercise program designed for those with COPD. The program includes aerobic exercise, muscle strengthening exercises, disease and medication education, nutritional and psychological counselling.The program equips the individual with skills to cope with daily activities. The rehabilitation program is usually delivered by a multidisciplinary team including doctors, nurses, physical therapists, respiratory therapists, exercise specialists and dieticians.
Long term Oxygen Therapy
Some patients with severe COPD have low blood oxygen levels. In such a situation, low dose, continuous oxygen administered by a nasal cannula is usually prescribed. It may ease shortness of breath and improve quality of life. Two major studies also showed that such patients actually live longer than those not using oxygen.