Chronic Obstructive Pulmonary Disease (COPD) Treatment- Pulmonary And Respiratory Medicine

Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease that’s mostly seen in lifetime smokers.

The disease is characterized by airflow obstruction and destruction of lung tissue. This prevents the blood from properly oxygenating and slowly leads to oxygen starvation.

COPD patients usually complain of a chronic productive cough, breathlessness, and decreased ability to exercise. If not properly treated, the disease can progress severely, leading to recurrent exacerbations, oxygen dependence, and eventually an early death.

According to the WHO, around 251 million people have COPD globally. In 2015 alone, COPD was responsible for more than 3.17 million deaths worldwide (5% of global deaths that year).

Keep reading to learn more about COPD, its causes, symptoms, and available treatments.

What is COPD?

Chronic pulmonary obstructive disease (COPD) is an umbrella term that refers to lung diseases characterized by airflow obstruction. There are 2 very similar diseases currently regarded as COPD:

• Emphysema: Stiffening of the small air sacs in your lung and destruction of their walls, leading to airflow obstruction and air trapping
• Chronic bronchitis: Chronic inflammation, thickening, and blockage of the airways

Emphysema and chronic bronchitis can co-exist, and their symptoms, prognosis, and treatment are usually very similar with only minor differences.

Most of those diagnosed with COPD are smokers or ex-smokers, and smoking is responsible for up to 90% of COPD deaths. Second-hand smoking is also a proven risk factor.

The disease is progressive, which means that it worsens over time. Early diagnosis, lifestyle adjustments, and treatment can significantly slow down the progression and maintain an acceptable quality of life. If untreated, the disease can progress and become limiting.

People with advanced COPD often have exacerbations that require hospitalization. Many can become oxygen dependent (require oxygen around the clock) and can become breathless even at rest.

Symptoms

Early on, COPD can have mild symptoms. Many will regard the cough and sputum as “just” a consequence of smoking, when in fact it’s a sign of progressing disease. Over the years, the symptoms will worsen and can become debilitating.

Early symptoms

• Persistent cough. Can come and go early on.
• Sputum (phlegm) production
• Persistent wheezing
• Increasing breathlessness with exercise

Advanced symptoms

• Chronic persistent cough
• Shortness of breath with minimal exercise. In end-stage COPD, patients can have breathlessness while at rest.
•  Recurrent lung infections (pneumonia), requiring frequent hospitalization
• Weight loss
• Decreased energy and fatigue
• Constant need for oxygen
• Leg swelling

Risk Factors

Numerous studies have been done in the last decades to better understand COPD and its causes. It’s currently obvious that smoking is the greatest risk factor for developing COPD. Nevertheless, 1 in every 4 COPD patients is a non-smoker.

Here are the COPD risk factors that we know of:

• Smoking: Cigarette or pipe smokers are more than 3.5 times more likely to develop COPD than non-smokers. Almost all COPD patients are either smokers or ex-smokers. You don’t have to be a smoker yourself to be at risk. Living with a smoker (i.e. secondhand smoking) also increases your risk of COPD significantly. The longer and more heavily you’ve smoked, the more likely you are to develop COPD, and the worse your symptoms will be.
• Chronic noxious inhalations: Working or living around harmful chemical fumes can have the same effect as smoking on your lungs. It can lead to their destruction and developing COPD in the long run.
• Asthma: Having asthma is an independent risk factor of COPD. You are at even higher risk if you have asthma and smoke at the same time.
• Genetics: A condition known as alpha-1-antitrypsin deficiency is behind 5% of all COPD cases. This condition, where the body can’t produce the alpha-1-antitrypsin protein, is characterized by lung tissue abnormalities, emphysema, and liver problems. Genetics can also make some people more susceptible to developing COPD compared to others.

Diagnosis

The diagnosis of COPD is done by a pulmonologist who specializes in treating lung and airway diseases.

During your first visit, your doctor will ask you about your symptoms, any breathlessness, cough, and your ability to exercise. They will, of course, ask you about your smoking history.

If you’re a middle-aged heavy smoker and have the typical symptoms of COPD, it will be the first diagnosis your physician will think of. To confirm the diagnosis, further testing is usually ordered, and can include:

• Spirometry: Pulmonary function testing is done to assess the lung capacity and its elasticity. During this test, you’ll be asked to blow into a machine according to a certain protocol. It can help diagnose COPD and can differentiate it from other similar lung diseases.
• Chest imaging: A chest X-ray or chest CT scan might be ordered to assess the extent of your disease, rule out other possible causes of your symptoms, and screen for lung cancer.
• Arterial blood gases (ABGs): This blood test can give an idea about the oxygen and carbon dioxide saturation in your blood, helping your physician understand your pulmonary function better.

These, and other tests, might be ordered to diagnose COPD and follow your response to therapy.

Staging

The staging of COPD is done according to a value measured by spirometry called “FEV1”. This value refers to the ability of your lungs to expel air. Having an FEV1 of 80% means that you have 80% of the normal expiratory capacity for someone of your age, sex, height, and weight.

The GOLD classification stages COPD as such:

• Grade 1: Mild COPD (FEV1 of 80% or more)
• Grade 2: Moderate COPD (FEV1 between 50% and 79%)
• Grade 3: Severe COPD (FEV1 between 30% and 49%)
• Grade 4: Very severe COPD (FEV1 less than 30%)

The higher your grade, the more advanced your disease is, and the more likely it will interfere with your quality of life and lead to complications.

Treatment

Chronic obstructive pulmonary disease is a lifetime illness that will require commitment and persistence to manage. You will be prescribed medications to help improve your symptoms and halt the disease process. Lifestyle changes and quitting smoking are crucial elements to improving your symptoms.

The treatment of emphysema and chronic bronchitis includes:

• Quitting smoking: This is the single most important prognostic factor when it comes to COPD. Quitting smoking can significantly halt the progression and improve your symptoms.
• Lifestyle changes: Weight loss and exercise can help improve your overall health and decrease the symptoms of COPD
• Inhalers: you might be prescribed inhaled bronchodilators (LAMA and LABA) to help deal with breathlessness and improve symptoms
• Oral medications: you might be prescribed medications to soften your sputum and decrease airway inflammation (e.g. acetylcysteine, corticosteroids)
• Oxygen therapy: During a COPD exacerbation, or in patients with end-stage COPD, oxygen might be administered using a nasal cannula either temporarily or around the clock.
• Antibiotics: During exacerbations, you might be prescribed antibiotics to treat lung and airway infections
• Vaccination: Since COPD makes you susceptible to infections, you should receive certain vaccines to be protected (pneumococcal vaccine, pertussis vaccine, and tetanus booster)
• Lung transplant: Very few patients are eligible to receive a lung transplant, which is a definite treatment for COPD

If you’re not a smoker, don't start. If you’re a smoker, quit immediately. Symptoms or no symptoms, smoking can lead to many deadly diseases including COPD. If you smoke and have a recurrent cough, it might be COPD. Don’t dismiss it as something normal. Early diagnosis and treatment can really save your life, so stay diligent and safe.

To learn more about Chronic Obstructive Pulmonary Disease (COPD), please check our blog on CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A SILENT RESPIRATORY PROBLEM.

Sources:

• https://www.cdc.gov/tobacco/campaign/tips/diseases/copd.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128042/
• https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
• https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447047/

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