Prescriptions

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/

Overactive bladder (OAB) results in frequent, unexpected bathroom urges that can be challenging to control. You can experience frequent urges to pee during the day and at night, as well as involuntary urination (urgency incontinence).

OAB is also called “spastic bladder” or “irritable bladder” that affects many individuals across the globe.

It can be physically and emotionally taxing to have a bladder condition, affecting your daily activities. It can be annoying; at worst, it can be crippling. when urine incontinence is involved, it can also lead to anxiety, embarrassment, and even despair.

OAB may also have an impact on your relationships with your friends and family. In addition, your sleeping pattern may be disturbed due to frequent urination,. Moreover, if there is a leak of urine, you could be more prone to infections, like urinary tract infections (UTIs).

What causes overactive bladder (OAB)

The signals involved in emptying a bladder are complex. Normally, urine from the kidneys flows into the bladder. The sphincter muscle functions as a faucet and regulates urine flow while the bladder expands to hold the urine. As the bladder fills, nerve signals are sent to the brain that prompts the urge to urinate. The brain sends the signal to the bladder to hold on until a person consciously decides to go. Urine is emptied out of the bladder through conscious contraction of the bladder muscle.

With OAB, nerve signals between the brain, spinal cord, and bladder are not functioning well. There may be abnormalities with the urethra, bladder, or urinary sphincter. The bladder may contract without voluntary control, or the urethral sphincter may not be closing properly or resisting the flow of urine from the bladder, leading to leakage.

Possible causes of overactive bladder include:

• Brain or spinal cord problems (e.g., stroke or multiple sclerosis)
• Diabetes mellitus
• Urinary tract infections (UTI)
• Bladder tumors, polyps, or stones
• Hormone changes in women going through menopause
• Drinking excessive amounts of caffeine or alcohol
• Side effects of certain medications (e.g., water pills)
• Decreased cognitive functioning due to aging
• Inadequate emptying of the bladder

What are the symptoms of overactive bladder (OAB)

The overactive bladder symptoms are as follows:

• You have the sudden desire to urinate that is hard to control
• Involuntary loss of urine right after an urgent need to urinate (urgency incontinence)
• Urinating more often, typically eight or more times in 24 hours
• Getting up in the middle of the night during sleeping hours more than two times to urinate (nocturia)

How do you diagnose an overactive bladder (OAB)

When you have consulted your symptoms with your healthcare provider, they will typically do an assessment immediately. They could also suggest a specialist, like a urologist, who specializes in diagnosing and treating patients with OAB.

Most of the time, OAB can be confirmed with the following to rule out any underlying conditions:

• Medical history
• Physical examination (e.g., rectal exam and pelvic exam)
• Urine study to screen for an infection, blood traces, or other problems
• Comprehensive neurological assessment that may detect sensory or reflex problems

Additional testing may be performed in more complicated cases. These tests will help healthcare providers gain more knowledge of the lower urinary tract’s structure and function. These tests could consist of the following:

• Urodynamic tests evaluate how well your bladder is working and whether it can consistently empty fully.
  • Ultrasound (bladder scan) to assess how much urine is left in your bladder after you urinate or if the bladder is emptying well
  • Uroflowmeter to monitor voiding volume and rate
  • Cystometry to check how well the bladder is functioning. It is indicated to check for problems with the filling and emptying of the bladder. Also, it is used to identify if you have uncontrollable muscular spasms or a rigid bladder that cannot hold urine under low pressure.

How to treat overactive bladder (OAB)

Once you have been diagnosed with OAB, patients can explore potential treatments with their doctor. Discussing will aid in your understanding of the root of your issue and the possible benefits of various therapies. In addition, your doctor will discuss any potential side effects associated with a given course of treatment.

The following are the overactive bladder treatments or strategies:

Behavioral Therapies are the most effective method for controlling OAB and have no harmful side effects.

• Pelvic floor muscle rehabilitation (Kegel’s exercise) helps strengthen the pelvic floor muscles and urinary sphincter, preventing the involuntary contractions of the bladder.
• Biofeedback, a mechanism in which sensors are attached to your body to help you receive information about your body and make subtle changes
• Weight loss
• Schedule urination, which helps you develop a regular routine to urinate, and does not rely on the urge
• Intermittent catheterization, in which a device is inserted in the urethra to help you empty your bladder if the bladder cannot do so by itself
• Absorbent pads, which helps protect you and your clothing from leakage
• Bladder training, which helps you hold in the urine until you are ready

Medications

Numerous pharmacological therapies are effective in treating OAB. Your doctors can provide you with advice on what medications might be best for you depending on your symptoms, your other medical problems, the prescriptions you are currently taking, and the adverse effect profile of medicines.

• Vaginal estrogen therapy to help strengthen the muscles and tissues in the urethra and vaginal area

The symptoms of an overactive bladder can sometimes be relieved by taking medications that relax the bladder like:

• Tolterodine (Detrol)
• Oxybutynin (Ditropan XL), (Oxytrol), or (Gelnique)
• Trospium
• Solifenacin (Vesicare)
• Fesoterodine (Toviaz)
• Mirabegron (Myrbetriq)
• Bladder injections
• OnabotulinumtoxinA helps relax the muscles

Nerve stimulation

The symptoms of OAB can be improved by controlling the nerve impulses to your bladder.

• Percutaneous tibial nerve stimulation (PTNS)

This procedure transmits electrical impulses from the tibial nerve to your spine, where it connects to control the bladder.

Surgery

Surgery is only used to treat OAB in cases where the symptoms are severe and other treatments are ineffective. The intention is to lessen bladder pressure and increase the capacity of the bladder to hold urine.

• Bladder removal

Conclusion

Overactive bladder is characterized by a sudden, intense urge to urinate that is challenging to put off, including frequent urination, nocturia, and urinary incontinence.

With OAB, some individuals can have a profound effect on their quality of life. OAB disrupts the ability to accomplish daily tasks and curtails social functions such as work, travel, physical activity, sleep, and sexual function.

However, it is essential to be aware that symptoms of OAB can be effectively treated. These treatments can range from behavioral therapies, medications, minimally invasive procedures, and surgery.

Although it may seem odd to discuss something so personal with your doctor about bladder problems, seeking medical assistance is the first stage of treatment to overcome this medical condition.