Chronic Obstructive Pulmonary Disease (COPD)


History


Chronic obstructive pulmonary disease (COPD) is a disease characterized by airflow limitation and is the fourth leading cause of death worldwide and it is largely preventable. Many physicians have worked on tracing the history of chronic obstructive pulmonary disease (COPD) back to the mid-1600s.



The COPD came into picture with the writings of the Swiss-born physician, Theophile Bonet, in the mid-17th century.







In 1814, British Physician Charles Badham became the first to use the term “bronchitis”.






In 1837, Dr. William Stokes became the first person to use the term “chronic bronchitis"






It was in 1846 that John Hutchinson invented the spirometer. Besides, initially it was recognized with the use of the stethoscope and spirometer. This was the key to diagnose COPD.





"Dr. William Briscoe is thought to be the first person to use the term COPD at the 9th Aspen Emphysema Conference in 1965"



Meaning


COPD









In Chronic obstructive pulmonary disease the small airways in the lungs are damaged making it harder for air to get in and out. This damage and narrowing causes the symptoms of COPD which are:

  • Increasing shortness of breath

  • Coughing

  • Increased mucus production by your lungs.

In simple words -

Chronic = It’s a long-term condition,cannot be reversed but treatable

Obstructive = Airways are damaged, so it’s harder to breathe out quickly and air gets trapped in your chest

Pulmonary = Affects your lungs

Disease = It’s a series medical condition and should be treated on time



Types of COPD












1. Emphysema:


Normally, air sacs in lungs are elastic or stretchy. So when we breathe in, each air sac fills up with air, like a small balloon and when we breathe out, the air sacs deflate, and the air goes out.


But in emphysema, the walls between many of the air sacs in the lungs are damaged. This causes the air sacs to lose their shape and become floppy which makes it harder for the lungs to move oxygen in and carbon dioxide out of your body.


Besides, damage to your air sacs (alveoli) will further merge into one giant air sac. Air gets trapped in your lungs and you can’t breathe it out, so you feel short of breath.


The cause of emphysema is usually long-term exposure to irritants like pipe, cigar, and other types of tobacco smoke damage lungs and the airways. Besides, age also matters as most people who have emphysema are at least 40 years old when their symptoms begin.


Also, genetics play a vital role as alpha-1 antitrypsin deficiency, which is a genetic condition is more likely to get it if they have a family history of COPD.



2. Chronic bronchitis


bronchitis









Chronic bronchitis is inflammation (swelling) and irritation of the bronchial tubes. Airways are the bronchial tubes in the lungs that air passes through. These tubes are the airways that carry air to and from the air sacs in your lungs. The irritation of the tubes causes mucus to build up.


Furthermore, when the airways are irritated, thick mucus forms in them and makes it harder for lungs to move oxygen in and carbon dioxide out of your body. All these mess in lungs makes it hard to breathe and mucus in lungs makes chest tight and uneasy. Finally, when lungs are attacked by chronic bronchitis then we also lose hair-like fibers called cilia in bronchial tubes.


Cigarette smoking is the main cause of chronic bronchitis. When tobacco smoke is inhaled into the lungs, it irritates the airways, and they produce mucus.



Causes


a. Smoking - The harmful chemicals in smoke can damage the lining of the lungs and airways.


b. Fumes and dust at work - Exposure to certain types of dust and chemicals like silica dust, welding fumes, coal dust, isocynates etc. Moreover the risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke at work may damage the lungs and increase your risk of COPD.


c. Genetics - Its worst for you and your family if you smoke more or have a close relative with the COPD condition, which suggests some people's genes might make them more vulnerable than the effect of smoking cigar. Around 1 in 100 people with COPD has a genetic tendency to develop the condition, called alpha-1-antitrypsin deficiency and without alpha-1-antitrypsin makes the lungs more vulnerable to damage.


d. Second-hand smoke - Some non-smokers can develop COPD from being exposed to second-hand smoke, often at home or at work. So its better stay away from smoking or stop them from smoking.


e. Asthma - If you don't treat your asthma, lung damage over time can lead to COPD because asthma constricts the air vessels in the lungs.


Diagnosis


diagnosis







Initially medical practitioner will ask routine questions to patient like


Do you have a cough ?

Do you have a lot of sputum ?

Have you noticed any wheezing when you breathe?

Do you’ve been chain smoker and if you’ve been exposed to dust, fumes or chemicals and other questions about your general health.


After initial examination doctor may recommend several tests to get the right diagnosis. They might include:


1. Stethoscope

stethoscope






Stethoscope is placed on the instrument on your chest to listen for anything unusual such as wheezing. Besides, doctor will recommend few more tests based on what she hears in stethoscope.


2. Spirometry

spirometry





It’s the most common lung function test and considered the best way to diagnose COPD. It’s simple, painless and helps to understand the amount of air you can breathe in and out by taking deep breaths, and you’ll blow hard into a mouthpiece that is connected to a small machine. That machine is called as spirometer which measures how fast you blow air out of your lungs. 3. Chest X-ray

spirometry







This creates an image of your chest, including heart, lungs, and blood vessels. This shows whether there are problems in the lungs, including other diseases such as pneumonia, cancer, and heart failure (when your heart can’t pump enough blood).

4. Chest CT scan

chest ct scan







This also creates an image of your chest, although it has more details than a chest X-ray. This test is also painless, although a dye may be injected into a vein in your arm to get clearer images of your chest.

5. Arterial blood gas test

arterial blood gas test






This measures how much oxygen and carbon dioxide you have flowing in your blood. You will get blood drawn so a lab can analyze it. If you’re not getting enough oxygen into your bloodstream, it could be a sign that you have COPD or other lung diseases.

6. Alpha-1 Antitrypsin Deficiency Testing

Alpha-1 Antitrypsin Deficiency Testing










This tests is conducted to check proportion of a protein called AAT, which is found in your lungs and blood. This protein helps protect your lungs from diseases such as COPD and some people don’t make enough AAT because they inherited a genetic mutation.



Treatment


Treatments include:

  • Inhalers and tablets to help make breathing easier

  • Pulmonary rehabilitation a specialized programme of exercise and education

  • Surgery or a lung transplant 

. There are several different types of inhaler for COPD. The main types include:


1. Short-acting bronchodilator inhalers - This inhaler makes breathing easier by relaxing and widening your airways. There are 2 types of short-acting bronchodilator inhaler:

  • Beta-2 agonist inhalers such as Salbutamol and Terbutaline

  • Antimuscarinic inhalers such as Ipratropium


2. Long-acting bronchodilator inhalers - This inhaler is used by those people who are

experiencing symptoms regularly throughout the day i.e a long-acting bronchodilator inhaler will be recommended. Each dose lasts for at least 12 hours, so they only need to be used once or twice a day.


There are 2 types of long-acting bronchodilator inhaler:

  • Beta-2 agonist inhalers – such as salmeterol, formoterol and indacaterol

  • Antimuscarinic inhalers – such as tiotropium, glycopyronium and aclidinium


3. Steroid inhalers


This inhaler is used by those who are still becoming breathless even after using a long-acting inhaler, or have frequent flare-ups (exacerbations). It contains corticosteroid medicines, which can help to reduce the inflammation in the airways.


Besides, doctor depending on the bases of severity experienced by every COPD patient suggest

- Oral steroids

- Phosphodiesterase-4 inhibitors

- Antibiotics

- Lung therapies such as oxygen therapy and pulmonary rehabilitation program



Prevention


Though their is no cure for chronic obstructive pulmonary disease (COPD). Interestingly, medical practitioner consider it one of the most preventable respiratory issues.


Lets walk through few preventive measures -


1. The most common cause of COPD is cigarette smoking as it accounts for eight out of 10 COPD-related deaths, according to the Centers for Disease Control and Prevention (CDC).


2. Consult your doctor or respiratory therapist about techniques,breathing positions for breathing more efficiently throughout the day. Pranayam can be one of the technique for relaxing lungs which will eventually help in breathing smoothly


3. Follow basic tips like -

  • If you have a wood-burning stove or fireplace in your home, make sure it's well ventilated to avoid concentration of smoke in rooms

  • Try to stay indoors if there's noticeable air pollution outside, such as smog or a nearby wildfire or take precautions like wearing mask, stay away from direct exposure of smoke etc.

  • Make your home an environment free from secondhand smoke to avoid respiratory diseases.

  • If you work in an environment where you are exposed to chemical fumes and dust, speak with your supervisor about respiratory protective equipment and other ways to protect yourself.

  • Discuss with your doctor which activities are appropriate for you for patients having few or severe symptoms of COPD and then opt for regular exercise which will improve overall strength and endurance and strengthen your respiratory muscles.

  • Eat healthy foods to control obesity as being overweight can significantly disturb breathing especially during times of exertion. A healthy diet can help you maintain your strength.


Frequently asked questions about COPD


1. What is the basic difference between Asthma and COPD ?


Answer : COPD is mainly due to damage caused by smoking, while asthma is due to an inflammatory reaction. COPD usually develops after age 40 and Asthma may develop in people of almost any age. The one main difference is that asthma typically causes attacks of wheezing and tightness in your chest. COPD symptoms are usually more constant and can include a cough that brings up phlegm.


2. Is COPD contagious ?


Answer : COPD is a progressive disease and is not contagious as its only caused by smoking, lung irritants, and genetics and not by mere coughing, sneezing in public. And its very important to know that every COPD patient has different treatment based on the severity of the condition. This can be prevented with some lifestyle changes.


3. What is the life expectancy of COPD patient ?


Answer : The life expectancy of COPD patients can vary patient to patient and depends on factors such as the severity of airflow obstruction, a patient’s smoking history, genetics, immunity and overall health. Moreover, instead of worrying about life expectancy its recommended to be in present moment and give complete efforts in maintaining healthy life throughout the treatment.


4. Can i have my domestic pets or will they make my COPD worse ?


Answer : Dogs and cats fill the house with hairs or skin particles that can irritate the lungs and have allergic reactions which eventually might affect the functioning of lungs. So its better to avoid them at home but if you wish to have pets then you must keep them clean and maintain hygienic environment in home . And most important do not keep them in your bedroom at bedtime.

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5. How can I exercise when I can't breathe?


Answer : Consult doctor to suggest you exercises to avoid shortness of breath and they will surely assist you find an exercise program that works for you by teaching various breathing techniques which should be inculcated in daily routine slowly without over exertion on your lungs.


6. Why should I use pursed lip breathing while exercising with COPD?


Answer : It can help you focus on your breathing and relax by reducing the amount of trapped air in the lungs and giving more room to breath. So doctor recommends purse lip breathe anytime if you are short of breath and anytime you are moving (walking, exercising, chores, etc.)


7. I have recently been diagnosed with COPD, and I still smoke. Is it too late to quit smoking now that my lungs are already damaged?


Answer : When you quit smoking your breathing and response to the COPD treatment may noticeably improve efficiently. So, if you quit smoking even if you used tobacco for many years, you will still get benefit.


8. Is having pain in the lungs typical of COPD?


Answer : Chronic lung pain is not commonly associated with COPD. However, pain can come from the wall of the chest and not directly from the lungs and this can be symptoms of COPD. There are many reasons for chest pain i.e it can be indigestion too. So its better to check with your health care provider to find out the cause of your pain.


9. Why women suffer more than men ?


Answer : Women tend to be diagnosed later than men and when it is diagnosed the disease is more advanced and treatment is less effective. Women also seem to be more vulnerable to the effects of tobacco and other harmful substances.


In 2017, COPD was the third leading cause of death among US women. The age-adjusted death rates for COPD have dropped gradually among US men, but death rates have not changed for women. More women than men are also living with COPD in the United States. Hence, women tend to get COPD in young age because of deliberate smoking and unhealthy sedentary lifestyle.



Myths of COPD


1. You have to be a smoker to get COPD.


- While it's true that about 75 percent of the estimated 30 million people with COPD are current or former smokers, that's not the only cause of COPD. But there are other causes like exposure to secondhand smoke,chemical fumes, concrete dust etc. And even a genetic disorder called Alpha-1 antitrypsin deficiency can cause COPD.


2. COPD affects only lungs.


- Bronchitis and emphysema affect lung tissue, but COPD can have effects throughout the body. Patient is prone to heart diseases due to low oxygen levels and becomes difficult to the heart to send blood through your lungs. Due to heart diseases patient becomes physically inactive and eventually can also affect mental heath because of social isolation and depression.


3. Breathlessness is a symptom of old age


- Many people assume breathlessness is clear indication to just getting older or sometimes avoid thinking its just an acidity or indigestion issues and ignore it. But breathlessness can occur with many health conditions and is a primary symptom of COPD. If you experience symptoms, don't ignore them. Talk with your doctor immediately.


4. COPD is rare disease.


- The sad fact is COPD is the fourth leading cause of death in the U.S. after heart disease, cancer, and stroke. About 24 million Americans have COPD, but half of them don’t know it yet as it can be silent for many years. So it highly recommended to consult doctor if you have chest pain, difficulty in breathing, coughing or sneezing etc.


5. Shortness of breath is the main symptom


- People with COPD can also have coughing, wheezing, and a tight feeling in their chest, but shortness of breath is often the first sign. Rather than thinking on which is the first symptom its important to focus more on how to prevent symptoms of COPD.



Facts/Statistics of COPD


  • More than 90% of COPD-related deaths occur in low and middle-income countries.

  • It is estimated that 90% of people with COPD are current or former smokers

  • Estimates are that by the year 2030, COPD will rise to the 3rd leading cause of death worldwide unless urgent action isn't taken to reduce tobacco use.

  • Women have higher rates of COPD than men throughout most of their lifespan, although it appears that they’re especially vulnerable before the age of 65

  • More than $32 billion was spent on COPD-related patient care in 2010, and those costs are projected to increase to $49 billion by 2020.


Conclusion


The information we read above is all about the deadly disease which is not in our hands i.e we don't know when and how such disease can attack our body. But the only thing left with us to inculcate and maintain healthy lifestyle and motivate people around you to embrace their life with such good habits. Unlike some diseases, COPD typically has a clear cause and a clear path of prevention and majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke or to stop smoking now


Indeed! Its necessary to be the change you want to see in the community. So start inculcating healthy lifestyle in your daily routine and then motivate community to follow you. The change in the lifestyle of community is also equally important i.e just for instance if you dont smoke but your friend (second-hand smoker) in neighborhood is chain smoker whose smoke can easily affect you. Hence, we need to fight against this disease as healthy community and not just being a healthy individual.


References


https://www.health.com/


https://www.healthgrades.com/


https://www.nationaljewish.org/


https://www.clinicbarcelona.org/


https://www.medicalnewstoday.com/


https://www.everydayhealth.com/


https://www.alpha1.org/


https://www.radiologyinfo.org/


https://lunginstitute.com/


https://www.vectorstock.com/


https://lungfoundation.com.au/


https://lunginstitute.com/


https://www.webmd.com/


http://www.ncbi.nlm.nih.gov/



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