Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)

Wednesday 27th of September 2017

What is It and How to Treat It?

Chronic Obstructive Pulmonary Disease (COPD) affects hundreds of thousands of people every year. In the USA, it is the 3rd prevailing cause of death. The WHO estimates that the world situation with COPD tends to be similar to that in the USA. Below you will find the most important information about COPD.

Definition and Causes of the Disease

Chronic obstructive pulmonary disease is an independent disease that manifests itself by difficulties with breathing caused by the limited ingress of air through the respiratory system. This condition occurs because of the lung tissue inflammation. In many countries, COPD term includes 2 main diseases – emphysema (damaging of alveoli) and chronic bronchitis (inflammatory processes in the bronchi). So it is the umbrella term including progressive diseases of the lungs. The condition is not contagious, that is it cannot be transferred from one individual to another.

In case of COPD, the ingress of air flow into the lungs is worsened due to the following factors:

  • airways become less elastic;
  • some walls between a number of air sacs are broken down;
  • inflammation and thickening of the walls;
  • the lungs produce more mucus, which may create clogs in the airways.

The prevailing cause of the disease is tobacco smoking. Most patients with COPD are smokers. However, 25 per cent of patients are non-smokers & have never had this bad habit. Bad environment factors, such as air pollution, may contribute to the development of the ailment. Rare genetic disorder called α1-antitrypsin deficiency (or A1AD) may also lead to COPD occurrence.

Symptoms & Signs of COPD

As a rule, the disease is noticed when a person already feels a significant shortness of breath.

Therefore, it is necessary to know the main symptoms of COPD at initial stages of its development:

  1. Cough. This symptom appears first and has episodic manifestations. Then it becomes daily.
  2. Sputum. It appears after the transition of cough to a constant state. At the initial stages of the disease, sputum is most often observed in the morning. A patient has to clear his throat immediately after waking up in the morning. Purulent sputum (yellow/green color) is a sign of exacerbation of the ailment.
  3. Shortness of breath. The symptom marks the transition of the disease to the next stage. Initially, dyspnea appears only with physical exertion, exacerbated by acute respiratory diseases. With the progression of the disease, shortness of breath increases, limiting the physical activity of the patient. In case of severe course of the disease, it transforms into respiratory failure.

Other possible signs & symptoms of the ailment are as follows:

  • frequent colds & acute respiratory diseases;
  • chronic fatigue, energy deficiency;
  • feeling of tightness in the chest;
  • cyanosis bluish discoloration of fingernails or/and the lips;
  • bodyweight loss (in severe stages of the disease);
  • morning headaches;
  • swelling of lower extremities.

COPD Stages

There are 4 stages (grades) of the ailment – A, B, C, and D. Let’s define them.

  • Stage A. Individuals experience short of breath while exercising and periodically suffer from cough.
  • Stage B. Patients have short of breath, permanent cough and mucus. They often stop while walking to regain their breath. Exacerbations of the disease occur no more than once a year.
  • Stage С. Most symptoms of the previous stage are observed but exacerbations are more frequent and more severe. With increased fatigue, doing exercises becomes quite a challenge.
  • Stage D. Persons suffer from constant breathlessness. This leads to significant limitation of everyday activity and may even lead to lethal outcome.

Treatment Guidelines

Unfortunately, COPD is incurable. According to WHO recommendations, to prevent the development of the disease, it is very important to stop smoking. Different forms of treatment can help improve the symptoms and enhance the quality of life of males & females suffering from this disease. For example, drugs that promote the dilation of the main respiratory passages in the lungs can relieve patients from shortness of breath.

The Global Initiative for Obstructive Lung Disease (GOLD) has developed guidelines for treatment the disease. The last edition of GOLD was released in 2017. According to the newest guidelines, almost all people who suffer from more than occasional shortness of breath should be treated with long-acting bronchodilators. These may be long-acting β adrenoceptor agonist drugs (also known as LABA), long-acting muscarinic antagonists (LAMA, which were earlier known as anticholinergic drugs), or both of them. Individuals who have persistent symptoms of the ailment are recommended to take 2 bronchodilators or a complex drug with two active agents with broncholytic effect.

Use Ventolin Inhalers

Ventolin InhalerShort-acting bronchodilators may be applied if a person doesn’t suffer from persistent COPD symptoms. For example, Ventolin (a beta-agonist inhaler with salbutamol main agent) works well in many people who suffer from COPD with reversibility of airway obstruction. After the use of inhaled Ventolin, the effect occurs rapidly, the onset of it is in 5 min, maximum level is attained in 0.5-2 hrs. (75% of the maximum action is achieved within 5 min). The duration of Ventolin effect is 4 to 6 hrs. In addition, Ventolin is available in the form of nebules, which may be used in hospitals or by people having nebulizers at home.

Other drugs for COPD treatment are represented by inhaled corticosteroids and PDE4 inhibitor tablets.

  1. Inhaled steroids. These may be beclomethasone, flunisolide, mometasone, etc. According to GOLD guidelines, inhaled steroids shouldn’t be used as a sole treatment of the condition. Combined medicaments contained corticosteroids and long-action β-agonists (such as Symbicort) are appropriate remedies for people suffering from exacerbations of the disease in case of using long-acting broncholytic meds.
  2. PDE4 inhibitors. These drugs (for example, roflumilast) are considered supplementary therapy for those having chronic bronchitis and severe COPD symptoms despite using inhaled broncholytic steroids.

Therapy should be chosen by a healthcare professional depending on the stage of the disease.

For example, stage A may be treated with short- or long-acting broncholytic drugs, while the last stage requires individual approach, often several medications, and using antibiotics in some cases.

Risk Factors and Prevention

The obstructive lung disease can be prevented. As stated earlier, the main cause of the development of COPD is the harmful effect of tobacco smoke. This effect may be caused by smoking or passive smoking (inhalation of air with the content of tobacco smoke by a non-smoker). If a smoker has asthma, the risk of COPD development increases.

Other risk factors include:

  1. indoor air pollutants;
  2. dirty outdoor air;
  3. harmful working conditions (saws, exposure to chemicals, various vapors, etc.);
  4. frequent infectious ailments of the lower respiratory tract in childhood;
  5. age (the condition develops over years and usually manifests itself
  6. adenovirus infections and vitamin C deficiency (possible factors)
  7. genetic factors.

Before 20th century, the disease was more common among males. However, with increasing smoking in developed countries and the increased risk of exposure to indoor air pollutants in low-income countries (due to the use of solid fuels such as coal for cooking & heating), the condition now affects males & females almost evenly.

So how to prevent such an unpleasant disease? Quit smoking if you have this bad habit, avoid passive smoking, protect yourself from the harmful effects of chemicals and the polluted environment.

For example, minimize using disinfectants cleaners. Scientists have found, that the disinfectants enlarge the risk of COPD occurrence by 22%.

Also, you should eat healthy food. According to researchers, proper nutrition significantly reduces the possibility of the disease development.

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