Chronic Obstructive Pulmonary Disease (COPD)

Overview

Chronic obstructive pulmonary disease, commonly called COPD, is a group of long-term lung diseases that make breathing difficult.

Most individuals with COPD experience chronic bronchitis and emphysema, two common lung disorders. The conditions vary in severity among individuals, but COPD is preventable and treatable.

COPD is a chronic condition that progresses gradually over time. It can limit the daily activities of individuals, and they can have trouble climbing up the stairs, doing exercises, or simply performing daily tasks.

The diseases can be managed and treated if detected early. But individuals often ignore the early warning signs, and the condition is diagnosed when it's too late. If the disease is left untreated, it will lead to several other problems like heart problems and respiratory infections.

Individuals who smoke tobacco or are exposed to irritants or air pollutants daily suffer from COPD. Also, lung infections can be another reason for COPD.

Types of COPD:

There are two main types of COPD: chronic bronchitis and emphysema. Some people may also have a related condition called asthma-COPD overlap syndrome (ACOS), which presents with symptoms of both COPD and asthma.

Chronic bronchitis is a long-term inflammation of the bronchi (breathing passages in the lungs), resulting in increased mucus production, coughing, and shortness of breath. 

Emphysema is a chronic lung condition in which the alveoli (air sacs in the lungs) are damaged, causing them to lose their elasticity and ability to transfer oxygen into the bloodstream. 

ACOS is a condition that affects people ages 40 and older who have both COPD and asthma. It can lead to more problematic respiratory symptoms, affect the quality of life, and increase the chances of hospitalization.

Symptoms:

Some of the symptoms of COPD are:

• Shortness of breath, especially during physical activity or when lying down.

• Frequent coughing, with or without mucus.

• Wheezing or noisy breathing.

• Chest tightness or pain.

• Fatigue and lack of energy.

• Frequent lung infections, such as pneumonia or bronchitis.

• Weight loss and loss of appetite.

Causes:

• Smoking, which is the main cause of COPD. The more you smoke, the higher your risk of developing COPD.

• Exposure to air pollution, dust, chemicals, or fumes, especially at work or home.

• Genetic factors, such as having a rare condition called alpha-1 antitrypsin deficiency, which affects the lungs and liver.

• Having asthma or other lung diseases can damage the airways and the lungs.

COPD is a serious and progressive condition that can affect your quality of life and increase your risk of other health problems, such as heart disease, lung cancer, depression, and osteoporosis. 

Risk factors:

Some of the risk factors of COPD are:

• Age, as lung function, declines naturally as we age. People who have smaller airways for their lung size may develop symptoms similar to those of COPD later in life, even if they do not smoke or are exposed to lung irritants.

• A history of childhood respiratory infections, smoke exposure from coal or wood burning stove, exposure to secondhand smoke, or having underdeveloped lungs.

You can reduce your risk of COPD by quitting smoking, avoiding secondhand smoke and other irritants, getting vaccinated against flu and pneumonia, and seeking medical attention if you have any respiratory symptoms. Early detection and treatment can help you manage your condition and improve your quality of life.

Possible complications:

If COPD is left untreated, the disease progresses faster, and problems like heart issues and lung infections become common. Patients will catch cold more frequently.

Since COPD causes breathing issues, when left untreated, the disease can damage the lung tissue, and patients will suffer from breathing trouble while performing daily activities.

COPD should be treated early or as soon as it is diagnosed. It can interfere with daily activities and reduce lifespan. The disease can increase the risk of heart attacks and respiratory infections and cause sudden death. Patients are also at risk of increased comorbidities and cardiovascular diseases, which are a serious concern.

Prevention:

There is no cure for COPD, but you can take steps to prevent it or slow down its progression. Some of the prevention tips are:

• Quit smoking and avoid secondhand smoke. Smoking is the leading cause of COPD and damages your lungs and airways. 

• Avoid other lung irritants, such as air pollution, dust, chemicals, or fumes, especially in your workplace or home. Use proper ventilation, masks, or filters to protect your lungs from harmful substances.

• Get vaccinated against flu and pneumonia. These infections can worsen your lung function and increase your risk of COPD complications. Ask your doctor about the best vaccines for you.

• Eat a healthy diet and drink plenty of water. A balanced diet can help you maintain a healthy weight, boost your immune system, and prevent inflammation. Water can help you stay hydrated and thin the mucus in your lungs.

• Exercise regularly. Physical activity can improve lung capacity, strengthen muscles, and reduce stress. Aim for at least 150 minutes of moderate-intensity weekly exercise, such as walking, cycling, or swimming. You can also do some breathing exercises to improve your lung function.

• Seek medical attention if you have any symptoms of COPD, such as shortness of breath, coughing, wheezing, or chest tightness. Early diagnosis and treatment can help you manage your condition and prevent further lung damage.

COPD is a serious and progressive disease that can affect your quality of life and increase your risk of other health problems. Following these prevention tips can lower your risk of developing COPD or keep it from worsening.

When to Consult a Doctor?

Several factors may indicate that an individual needs to visit the doctor for COPD. Sometimes, the symptoms may go away with home remedies, but most of the time, they gradually progress and worsen.

An individual should talk to the doctor immediately if he/she notices the symptoms are not improving. The common symptoms that indicate an individual should consult a doctor for COPD include:

• Shortness of breath

• Difficulty in breathing while performing daily activities

• Lack of energy or extreme fatigue

• Frequent wheezing or coughing

• Losing weight rapidly

• Tightness of chest

• Blue fingernails or lips

• Swollen feet, fingers, and ankles

One should consider visiting a pulmonologist as soon as more symptoms arise. Many patients initially confuse the symptoms with the common flu and do not visit a doctor until the disease progresses to the second stage.

Diagnosis:

Once a patient visits a pulmonologist, the doctor will ask about the patient's family medical history, lifestyle habits, symptoms, and whether the patient smokes or has been exposed to any harmful chemicals or pollutants.

The doctor will then perform a physical test to check if the ankles are swollen, listen to breathing to understand the lung condition and examine the nose and throat for any signs of infection. They will also check blood pressure, pulse, and weight loss history as part of the physical examination.

1. Lab Tests

Spirometry is a pulmonary functioning test used to measure the functioning of the lungs. For this, the patient has to blow air into a tube attached to a machine to analyse how much air can be pumped by the lungs.
Other tests include pulse oximetry to measure the oxygen in the blood, a six-minute walk test and lung volume and diffusing capacity measurement.

2. Imaging Tests

Chest X-rays or CT scans may be performed to detect lung cancer or other lung and heart diseases. These imaging tests help to rule out other possible causes of shortness of breath or similar symptoms.

Treatment:

Different treatment options are available for patients with COPD. The treatment depends on the severity of the disease, age, and physical condition of the patient.

1. Home Care:

Patients with COPD may have to make some lifestyle changes to improve their health. This can be adopted at home with a doctor's guidance.

Popular home remedies for COPD include:

• Quitting smoking and protecting oneself from pollutants or irritants (both first and second-hand)

• Practicing regular breathing exercises

• Going for regular walks or practising light exercise

• Adopting a healthy diet that includes a lot of fresh fruits and vegetables

• Staying hydrated

• Avoiding anything that can worsen the symptoms of COPD

• Taking measures to improve immunity

• Getting enough sleep

• Getting vaccinated against pneumonia and flu

2. Medication:

There is no cure for COPD, but there are various medications that can help you manage your symptoms and prevent complications. Some of the common types of medications for COPD are:

Bronchodilators: These are drugs that relax the muscles around your airways and make it easier to breathe. Depending on how long their effects last, they can be short-acting or long-acting. You take them through an inhaler or a nebulizer. Some examples of bronchodilators are albuterol, ipratropium, salmeterol, tiotropium, and indacaterol.
Steroids: These are drugs that reduce inflammation and swelling in your airways. They can be inhaled or taken orally. They can help you breathe better and prevent flare-ups, but they can also cause side effects such as weight gain, high blood pressure, and osteoporosis. Some examples of steroids are budesonide, fluticasone, prednisone, and methylprednisolone.
Oral medications: These are drugs that you take by mouth to treat other conditions that may affect your COPD, such as infections, allergies, or heart problems. Some examples of oral medications are antibiotics, antihistamines, beta-blockers, and diuretics.
Your doctor will prescribe the best combination of medications for your COPD based on your symptoms, lung function, and overall health. You should follow your doctor’s instructions on using your medications and report any side effects or changes in your condition.

3. Surgical Treatment: 

No surgery can cure COPD or ease the symptoms of the disease. However, lung volume reduction surgery (LVRS) is a surgical method to remove emphysematous lung tissue. This helps improve breathing and increases the lung capacity of patients with COPD. Surgery is a rare procedure.

4. Alternative Management:

Alternative management is often used with the standard treatment of COPD. Although there is no sufficient research on this, many consider massage therapy, acupuncture, and meditation to manage the symptoms of COPD. 

These alternative ways do not cure COPD but can improve the quality of life and increase the efficiency of the standard treatment. These can also help in managing the anxiety and stress associated with the disease.

There is also a pulmonary rehabilitation program that is aimed at increasing awareness among patients with COPD. This involves group sessions with individuals suffering from COPD. Professionals provide mental support to patients and help them understand their physical condition. They also provide physical training to make them understand their capabilities.

Doctors suggest different alternative management of COPD alongside the standard course of treatment. This is ideal for patients who are at high risk.

Additional Information

There are different stages of COPD, and the disease progresses through these stages over time. In the early stage, the symptoms of COPD are not noticeable. This worsens and reaches the severe stage.

Since the disease worsens over time, it is best to get proper treatment as soon as it is diagnosed.

The four stages of COPD include:

• Early Stage: The First Stage

The first stage, i.e., the early stage, is when the symptoms are barely noticeable. The only symptoms include a heavy cough and mucus production with it.

The doctor may conduct a spirometry test to check the symptoms. Depending upon the test results, a doctor may prescribe an inhaler to open up the passage of the lungs. Doctors may prescribe additional medicines to prevent further infection or slow the condition's progression.

• Mild Stage: The Second Stage

The FEV1 value determines the stage of COPD. If the symptoms are not diagnosed at stage 1, it progresses to stage 2 gradually. The symptoms for this stage may include increased coughing, excessive mucus production, difficulty breathing or running out of breath even while walking.

Usually, most people are diagnosed with COPD at this stage because the symptoms are prominent.
Many patients have to take steroids or oxygen at this stage. Doctors may also recommend bronchodilator medication for improved airflow into the lungs.

• Severe Stage: The Third Stage

The third stage is when the symptoms flare up. Patients quickly get tired from daily activities, and breathing and coughing worsen.

Other symptoms like fever, chills, tightness of the chest, and frequent infection are common.
Patients suffering from stage 4 of COPD need oxygen.

• Very Severe Stage: The Fourth Stage

This is the most severe stage, where the blood oxygen levels are low, and patients are at high risk of heart or lung failure. Patients may experience breathing trouble even while they are sitting idle.
At this stage, the doctor may recommend surgery to improve COPD.