Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease or COPD, is a general term used for conditions that obstruct air passages and/or result in the damage of small air sacs or alveoli.  This results in progressive difficulty in breathing. 

COPD can be chronic bronchitis or emphysema.  

Chronic bronchitis is persistent inflammation of the bronchi, leading to recurrent cough with production of large amount of sputum. When cell linings are irritated, small hair-like structures called cilia usually trap and eliminate the irritant.   When irritation crosses a certain limit, the cilia ceases to function efficiently, leading to accumulation and production of large amounts of mucus, clogging air passages and resulting in the heavy cough associated with bronchitis.  Bronchitis is said to be chronic when it is continuous for 3 months and occurs for 2 years in a row. 

Emphysema is progressive destruction of the lung tissue with loss of elasticity of alveoli.The walls of alveoli becoming inelastic and enlargedThis enlargement of the air sac combined with narrowing of air passages traps air in the alveoli therefore carbon dioxide- oxygen exchange is limited.This causes increased carbon dioxide and inefficient oxygenation. As lung damage worsens, breathing is impaired to the point of life-threatening. Low blood oxygen can cause increased pulmonary artery pressure and can result in right sided heart failure. This lung damage is irreversible.

Causes: 

1. Smoking

2. Air pollution

3. Industrial and chemical fumes

4. Repeat lung infections

5. Hereditary genetic deficiencies

6. Occupational hazards

7. Heavy use of lung such as playing wind instruments

8. Young children exposed to smoke

Diagnosis: 

• Patient History and examination is required by medical personnel. 

• Sputum sample, blood samples- such as arterial blood gases, chest x-ray, spirometry and pulmonary function tests. 

Treatment: 

The goal of the treatment is to treat airway inflammation and bronchospasm, decrease airway resistance and to improve oxygenation.  Treatment is according to the severity of the disease, which can be assessed by the result of pulmonary function tests.

Classification 

Mild

FEV1/FVC <70%  + FEV1> 80%

Bronchodilators can be used as needed

Moderate

FEV1/FVC <70% FEV1<80%

Short acting bronchodilators when needed and long acting bronchodilators

Severe

FEV1/FVC <70% FEV1<50%    

Short acting and long acting bronchodilators plus inhaled steroids

Very Severe

FEV1/FVC <70% FEV1<30%

Short acting and long acting bronchodilators plus inhaled steroids + oxygen therapy

If there are symptoms of severe disease plus with an acute exacerbation, antibiotics may be added to the regiment. 

Treatment
In mild or acute cases, decongestant such as pseudoephedrine and pain control may be required. Steam inhalation may also help in relieving symptoms. Decongestants should not be used for more than three days. Antihistaminics can be used to treat allergies. For severe pain and yellowish discharge, antibiotics may be needed to be added to the regiment. Surgery may be needed to drain sinuses and in extremely severe cases, hospitalization with IV antibiotics may be needed.

Prognosis 

FEV1 is the best predictor of survival;  the higher the FEV1, the better the survival.

Smoking cessation is the only definitive way of slowing progress of the disease.