What is COPD?
COPD, also known as chronic obstructive pulmonary disease, is a long-term lung problem that encompasses a variety of illnesses that impair breathing and impede airways. The most common progressive lung conditions are emphysema and chronic bronchitis.
Emphysema causes damage to the lungs’ air sacs, causing them to become less elastic and less effective at exchanging oxygen and carbon dioxide.
In chronic bronchitis, the lining of the airways become inflamed, causing excessive mucus production. Once bronchitis becomes persistent and unresponsive to treatment, it becomes chronic.
Although our data about COPD is extrapolated from studies that followed patients for only a short period of time (5-10 years), we know in fact COPD develops slowly over several decades.
How does COPD affect your lungs?
With COPD, the lungs’ small air sacs and airways lose the ability to expand and contract because of damage. In addition, the walls of the airways become irritated and inflamed and produce mucus, limiting airflow.
If left untreated, COPD can worsen, causing cardiac issues and increase incidence of respiratory infections.
Note that this condition is not contagious, and there are several factors that can trigger it.
What causes COPD?
Most people who are at high risk of having COPD conditions are as follows:
- Middle-aged adults (40 years old or older) with a history of tobacco smoking
- Prolonged exposure to heavy amounts of secondhand smoke
- Exposure to toxins (fumes or chemicals) at home or in the workplace
- Long-term exposure to air pollution
- Genetic factor (a rare condition in which there is a lack of alpha-1 antitrypsin protein)
- Usage of a cooking fire regularly without enough ventilation
- Family history of COPD
- History of severe asthma
COPD SYMPTOMS
Breathing becomes more difficult with COPD. Usually, signs and symptoms of COPD include shortness of breath, persistent cough, and coughing up thick mucus. As it exacerbates, the symptoms may become more frequent to the point that breathing may become more challenging. Symptoms vary depending on COPD stages.
Stage I: Initial Symptoms
- Periodically having breathing problems, especially after exercising
- A mild yet persistent cough (productive or dry cough)
- Frequently needing to clear your throat, especially in the early morning
Stage II: Moderate Symptoms
- Shortness of breath after exertion
- Difficulty sleeping
- Wheezing during exhalations
- Chronic persistent cough with or without mucus
- Lack of energy
Stage III: Severe Symptoms
- Coughing and shortness of breath have increased in intensity
- A lot of flare-ups
- Lung infections (recurrent colds, bronchitis, or pneumonia)
- Chest tightness
- Wheezing when doing daily tasks
- Legs, ankles, or feet swelling
Stage IV: Very Severe Symptoms
- Stage 3 symptoms become more severe
- Shortness of breath is present, even when a person is resting
- Weight loss
- Delirium
- Barrel chest
- Increased heart rate
- Hypertension in the pulmonary artery
COPD DIAGNOSIS
There isn’t a single test for this lung problem. Symptoms, a physical examination, medical history, and the findings from diagnostic tests all contribute to the diagnosis. Tests may include:
- Chest exam to assess breathing with a stethoscope
- Chest X-ray to look for problems in the lungs
- CT scan detailed scan to identify lung problems
- Spirometry to assess lung function
- Arterial blood test to check the oxygen levels in the blood
- Diffusing capacity (DLCO) to measure how well your lungs exchange oxygen and carbon dioxide
Other tests may include confirming and determining the severity of chronic obstructive pulmonary disease:
- Electrocardiogram (ECG)is to identify whether a heart disease rather than a lung problem is the source of the shortness of breath.
- Peak flow test, the score measures how quickly you can exhale and can tell you if your airways are congested.
- Sputum tests determine the cause of your breathing difficulties.
- Pulmonary function tests check your ability to breathe in and out and see if your lungs are supplying your blood with enough oxygen.
4 Stages of COPD
There are four stages of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD), which issues international guidelines for COPD care.
According to the GOLD system, COPD is categorized with a number from Grade 1 to Grade 4, and a letter from Group A to Group D. This classification will let your doctor know how much of your airway is obstructed, as determined by spirometry.
A spirometer measures forced vital capacity (FVC), the total amount of air you can exhale at once. Also, it will help assess forced expiratory volume in 1 second (FEV1), the amount of air you can forcefully release in the first second.
- GOLD COPD Grade 1 Mild FEV1 is 80% or higher
- GOLD COPD Grade 2 Moderate FEV1 is between 50% and 79%
- GOLD COPD Grade 3 Severe FEV1 is between 30% and 49%
- GOLD COPD Grade 4 Very severe FEV1 is less than 30%
Note that the diagnosis of COPD patients is confirmed if the FEV1/FVC is less than 70%.
COPD treatment
Keep in mind that this lung condition has no known treatment, but COPD management can slow disease progression, relieve symptoms, and keep you out of the hospital. Necessary actions can be taken to lessen symptoms and prevent the condition from getting worse.
One of the most effective methods for preventing or slowing the progression of chronic obstructive pulmonary disease is to stop smoking. Stay away from smoke and other air pollution which can irritate your lungs.
Lifestyle changes should be the first line of treatment to reduce symptoms, avoid complications, and generally halt the spread of the disease. Your physician may consider drug treatments and other therapies:
- Medicines that quickly open the airways, reduce inflammation and swelling, and treat infection
- Supplemental oxygen if needed
- Pulmonary rehabilitation treatment program (breathing exercises, conserving energy, and eating habits)
- Vaccines to prevent lung infection
- Surgery (if conditions become severe and other treatments do not work)
What is COPD exacerbation?
COPD exacerbations, also known as flare-ups, happen when respiratory symptom worsens. Exacerbations may require oral corticosteroids, antibiotics, or even hospitalization and might last for days or even weeks. In the later stages of COPD, exacerbations tend to happen more frequently as your lung function deteriorates. Permanent lung damage can develop each time it occurs.
COPD exacerbations are usually caused by a viral or bacterial lung infection. However, it can also be caused by factors that make breathing harder, like smoking, exposure to smoke, or air pollution. Make sure to watch out for symptoms of exacerbation including:
- Frequent coughing, wheezing, or breathing difficulties than usual
- Mucus changes (color, thickness, or quantity)
- Fatigue that lasts for more than one day
- Swelling in legs or ankles
- Trouble sleeping
- Being on oxygen and trouble catching your breath
Patients can also lower the risk of exacerbation by doing the following:
- Following the treatment plan
- Take your medicine regularly
- Automate prescription refills
- Keep loved ones and friends informed
- Avoiding triggers
- Avoid tobacco smoke
- Quit smoking
- Household dust
- Pollution
- Getting vaccinated
- Flu or pneumonia vaccine
COPD medications
Medicines for COPD can aid in controlling the symptoms of COPD and avoiding life-threatening consequences. Treatment can help reduce and manage symptoms, prevent complications, and generally stop the progression of the disease.
Your doctor may prescribe you to use:
- Short-acting bronchodilators (e.g., Albuterol)
Bronchodilators open and loosen tight airways as quickly as possible when breathing becomes more difficult than usual. They can ease respiratory symptoms such as coughing and shortness of breath for four to six hours.
- Long-acting bronchodilators (e.g., Salmeterol)
It helps keep airways relaxed for up to 12 hours. Regular use may lessen COPD flare-ups and assist in enhancing lung function.
- Corticosteroids (e.g. Budesonide)
Steroid inhalers aid in decreasing the inflammation of the airways. They can also help reduce exacerbation.
- Antibiotics
Antibiotics kill the bacteria causing the infection (e.g., pneumonia) to prevent the worsening of COPD symptoms. Patients with COPD are more likely to develop more severe pneumonia, increased hospital admissions, and worse outcomes.
Apart from this regimen, Trelegy Ellipta is an inhaler used as a maintenance treatment for patients with moderate to severe COPD.
Activities of daily living that are essential to preserving the quality of life are significantly affected by COPD symptoms such as difficulty breathing, sputum production, wheezing, and chest tightness.
It is important to let your healthcare provider know if you experience these symptoms and stop smoking. Proper COPD care can enhance your functional abilities, exercise tolerance, and improve your quality of life, preventing potentially fatal complications associated with COPD.
References
June 30, 2023. Basics About COPD. https://www.cdc.gov/copd/basics-about.html
January 24, 2024. COPD Causes and Risk Factors. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
January 15, 2024. Four stages of COPD. https://gaapp.org/diseases/copd/four-stages-of-copd/
