COPD – Symptoms, Causes and Treatment

Image Courtesy of National Heart Lung and Blood Institute

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable lung disease that is characterized by airflow obstruction and alveolar problems. The airflow obstruction is generally progressive and irreversible. Clinical features of COPD closely resembles chronic bronchitis and emphysema chronic bronchitis is manifested by daily productive expectations for 3 months or more in 2 consecutive years. Emphysema is distal air spaces and destruction of alveoli. In addition, extrapulmonary features like anorexia, weight loss and muscle weakness are also found in this condition.

RISK FACTOR

Multiple risk factors predispose COPD (Chronic Obstructive Pulmonary Disease). Tobacco smoking is the most common and most significant risk factor for developing this lung disease. Other risk factors are –

  • Outdoor and indoor air pollution.
  • Smokes from wood, animal dung and coal fire.
  • People working in coal mines.
  • Recurrent lung infections.
  • Low socioeconomic status.
  • Poor nutrition.
  • Low birth weight babies may develop COPD in adult life.
  • Genetic factors like Alpha 1 – antiproteinase deficiency.

SIGNS AND SYMPTOMS

Signs and symptoms of COPD (Chronic Obstructive Pulmonary Disease) are commonly present over 40 years of age. Common presenting symptoms include shortness of breath, excess cough associated with sputum production. The disease usually starts with dyspnoea on heavy work. After that disease progresses and dyspnoea occurs with mild work or at rest. The MMRC ( Modified Medical Research Council ) grading system is used to diagnose the severity of COPD. In majority cases, acute exacerbation of the disease occurs periodically. Acute exacerbation is manifested by increased dyspnoea and increased cough and sputum. However, the acute exacerbation is associated with a viral or bacterial infection. Later stages of COPD may be characterized by pulmonary hypertension, cor pulmonale or chronic respiratory failure.

INVESTIGATIONS

Spirometry provides useful information about the pulmonary function and helps to diagnose various obstructive lung diseases. At early stages of COPD may show reduced mid expiratory flow rate. COPD differs from asthma by bronchodilator reversibility as it is little or no severability FEV1 / FVC less than 0.7 and FEV1 is less than 80% of the predicted value indicates airflow obstruction. The severity of COPD is based on spirometric classification of post-bronchodilator FEV1 and FVC. The helium dilution technique is used for measuring lung volume and hyperinflation. Radiographs like x-ray and CT scans are also helpful for diagnosis. Hyperinflation of lung and flattening of the diaphragm are common radiological features. HRCT ( High-resolution computed tomography ) is more sensitive and specific than a plain x-ray. In advance stages of COPD, doppler echocardiography is used to measure pulmonary artery pressure for diagnosing pulmonary artery hypertension.

COMPLICATIONS OF COPD

Generally, complications occur during the advanced stage of COPD (Chronic Obstructive Pulmonary Disease). Common complications include cor pulmonale, pulmonary hypertension and chronic respiratory failure. However, spontaneous pneumothorax or hemoptysis may occur rarely.

TREATMENT

The main aim of COPD treatment includes acute reducing dyspnoea and preventing acute reducing dyspnoea and preventing exacerbations. Stable COPD patients may take home-based treatment but acute exacerbations need hospitalization.

  • SMOKING CESSATION – The most important step of COPD treatment is smoking cessation. All COPD patients must be encouraged for smoking cessation. Behavioral therapy is very much useful for this purpose. Drug therapy is also useful in the case of behavioral therapy failure. Vernecline and bupropion help in smoking avoidance. Nowadays nicotine replacement therapies using a transdermal patch, lozenge, gum are very popular.
  • SUPPLEMENTAL OXYGEN – Supplemental oxygen can be given at home as a part of domiciliary treatment. In fact, it reduces the chances of nosocomial infection. Oxygen therapy with nasal prongs should be given for 24 hours or at least 15 hours per day for a better outcome. Supplemental oxygen increases the survival rate in COPD patients with recurrent hypoxemia.
  • INHALED BRONCHODILATONS – Inhaled bronchodilators are those drugs that dilate branches and bronchioles given in inhalation route. These are usually 2 types – short-acting and long-acting bronchodilators. Commonly used short-acting bronchodilators are SABA (Short-Acting Beta-agonists) and SAMA (Short-Acting Muscarinic Antagonist) used as inhalation therapy using MDI device (Metered-dose inhaler). Ipratropium is longer acting than SABAs. Albuterol, Metaproterenol are commonly prescribed SABAs cause palpitation tremors and tachycardia as side effects. Similarly, long-acting bronchodilators are 2 types – LAMAs and LABAs. LAMAs are Long-Acting Muscarinic Antagonists and LABAs are Long-Acting Beta Agonists. Tiotropium, Aclidinium and Umeclidinium are commonly prescribed LAMAs. In fact, inhaled bronchodilators give symptomatic relief to the patient and reduce dyspnoea. Physicians prefer combinations of LAMA and LABA for better results and efficacy.
  • CORTICOSTEROIDS – Oral corticosteroids are preferred during acute exacerbations of COPD. Prednisolone is commonly used for this purpose. However, inhaled corticosteroids are better for stable COPD patients. Inhaled corticosteroids should not be used alone and must be combined with other bronchodilators. Oral corticosteroids are avoided for long term therapy in COPD due to various side effects.
  • THEOPHYLLINE – Theophylline is used orally when inhaled bronchodilators and corticosteroids fail to reduce respiratory distress. This is a good bronchodilator along with anti-inflammatory properties. It also increases cardiac contractility and diaphragm strength.

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