COPD – Chronic obstructive pulmonary disease

Kemboi Kibet

COPD comprises a group of lung diseases which includes chronic asthmatic bronchitis and emphysema. Most people with COPD have a combination of both conditions. These conditions make it difficult to breathe by obstructing air flow through the airways and out of the lungs. It eventually interferes with exchange of oxygen and carbon dioxide in the lungs. This condition is permanent and may progress overtime. There may be periods of exacerbations when symptoms get worse and may be life threatening. COPD is the most common lung disease and the leading cause of death worldwide. Damage done to the lungs by the disease cannot be reversed. Treatment is aimed at relieving signs and symptoms.

Chronic Asthmatic Bronchitis : It causes inflammation and narrowing of the airways that leads to narrowing and obstruction of these airways. It may result in long-term cough with mucus and wheezing.

Emphysema : This involves lung destruction over time. Damage occurs in the tiny air sacs in your lungs called the alveoli. Emphysema may gradually destroy the inner walls of the alveoli thereby reducing the surface area available for gas exchange. It may also weaken the alveoli wall, making it less elastic. These walls collapse during exhalation and trap air in the alveoli.

STAGES

STAGE I : Minimal shortness of breath with or without cough and mucus. The disease is considered mild.

STAGE II : At this moderate stage, shortness of breath may be severe with or without cough and mucus. Medical attention is usually sought at this stage.

STAGE III : It is considered severe. It is accompanied by severe shortness of breath with or without cough and sputum, fatigue, reduced exercise capacity and repeated exacerbations .

STAGE IV : At this stage, the disease is very severe, quality of life is affected and exacerbations may be life threatening.

CAUSES

Smoking is the leading cause of COPD. The more a person smokes, the higher his risk of getting this disease. Non smokers may also get this condition and so does long periods of exposure to dust, chemical fumes and air pollutants.

RISK FACTORS

Some factors may put one at high risk of this disease than others. These factors include the following:

Smoking : Long term exposure to tobacco smoke puts you at high risk of getting this disease. Your risk of this disease is increased by the number of years and packs you smoke. Second hand smoking also puts you at risk.

Age : COPD usually occur in people 40 years and older.

Genetics : A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of some new cases of COPD.

Long-term exposure to chemical fumes, vapors and dusts can also inflame and irritate your lungs. Frequent use of cooking fire without proper ventilation may also be a contributing factor.

SYMPTOMS

Some typical signs and symptoms of COPD include the following:
•shortness of breadth (dyspnea)
•cough with or without mucus
•wheezing
•chest tightness
•fatigue
•respiratory infections
•fever

In severe cases patients may experience headache, weight loss, cyanosis (bluish discoloration of the lips and nail beds) and pulmonary hypertension (elevated pressure in the blood vessels of the lungs ).

TEST AND DIAGNOSIS

Doctors diagnose COPD based on questions about medical history , symptoms and physical examinations. Typical tests to diagnose this disease include :

Imaging Test : Chest x-ray may be done to rule out other lung problems, such as lung cancer or heart failure. The x-ray can also show an enlarged chest cavity and decreased lung markings which may indicate lung tissue destruction. Computerized tomography (CT) accurately shows the abnormal lung tissue and airways in COPD. It gives detailed cross-sectional areas of internal organs.

Arterial blood gas : This blood test measures how well oxygen goes to the blood and carbon dioxide is eliminated from the blood. It also determines the acidity (pH) of your blood.

Sputum examination : Mucus that come up when you cough is taken to the lab to be analysed for bacteria pathogens. This helps rule out other possible causes of your symptoms.

Lung function test : Spirometry is the best lung function test for COPD. Your lung capacity is checked by blowing out as much as possible into a large tube connected to a spirometer. The spirometer measures how much air your lungs can hold and how fast you can blow the air out of your lungs.

TREATMENT

There is no cure for COPD. Treatment is aimed at relieving symptoms and reducing your risk of exacerbations and complications.

Smoking cessation is the most essential step in treating COPD. This may prevent further damage to the lungs and prevent the disease from getting worse.

Medications may also be used to treat COPD and these include the following :

Bronchodilators : They are used to open the airways by relaxing the muscles around them. They usually come in the form of inhalers. Examples include ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol. Broncholdialators makes breathing easier.

Inhaled steroids : They make you breath better by reducing inflammation in the lungs. They are usually reserved for people with moderate to severe COPD because of it’s potentially serious side effects.

Antibiotics : They are used when necessary to fight bacterial infection of the upper respiratory tract. These infections such as pneumonia and influenza may aggravate COPD symptoms.

Anti-inflammatory medications such as montelukast (Singulair) and roflimulast may also be used.

Other treatment options for this disease include:

Oxygen therapy : This include using lightweight portable devices to deliver oxygen to the lungs.

Pulmonary rehabilitation program : It teaches you to breathe in a different way so you can stay active. It also includes education, exercise training, nutrition advice and counselling.

In severe cases when medications alone are not enough, surgery may be needed.
•Lung volume reduction surgery creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently .
•Lung transplant can improve your ability to breathe and be active.

Even with treatment, there may be times when symptoms may get worse. This is called acute exacerbation. Seek immediate medical attention when this happens.

COMPLICATIONS

COPD can present these serious complications.
•heart problems such as arrhythmia
•respiratory infections such as pneumonia
•severe weight loss
•osteoporosis
•high blood pressure

PREVENTION

The best way to prevent this disease is to stop smoking. Don’t start smoking if you haven’t already. Don’t sit in a smoking zone when you go out because second hand smoking can be as harmful. It is also important to protects yourself from lung irritant and chemicals at work by wearing mask .

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