CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) :

As the name suggests this is a chronic disease of the lung that slowly develops over a period of time and causes difficulty in breathing because of the limitation of airflow in the pulmonary system.

 

COPD :

COPD is a condition that includes three diseases which are :

1) Chronic bronchitis: it is a condition in which the person will suffer from a cough for more than six months.

2) Emphysema: it is also a chronic condition in which the normal anatomy of the lungs are damaged and it causes difficulty in oxygen exchange.

3) Small airway disease: It includes damage to the small bronchioles.

RISK FACTOR:

1) SMOKING: it is well known that smoking is dangerous for the lungs which can lead to many diseases and COPD is one of the major diseases caused by smoking.

2) INFECTION: Respiratory tract infections are risky in those patients who are suffering from COPD as these infections can lead to the production of more phlegm which leads to more difficulty in breathing.

3) HYPER RESPONSIVE AIRWAY: In some people, airway response to any small trigger can be more compared to others, and in cases of COPD many patients develop hyperresponsive airway which leads to breathing difficulty.

4) AIR POLLUTION: countries with more air pollution have an increasing rate of people getting respiratory problems and later on developing COPD. 

5) OCCUPATIONAL CAUSES: some people work in conditions that have a negative impact on the respiratory system like working around irritant chemicals, coal mines, and poultry workers.

6) PASSIVE SMOKING: people around smokers are also at increased risk of developing smoking-related problems as they also inhale the smoke. Similarly, pregnant ladies who have the habit of smoking can lead to improper lung growth of the fetus which can cause respiratory problems in the babies after birth.

PATHOGENESIS:

As the name suggests COPD ( chronic obstructive pulmonary disease ) is an obstructive disease that causes difficulty in airflow in the lung and leads to breathing difficulty.

Obstruction in the small airway and emphysema plays a major role in the development of this disease.

Narrowing of the small airway because of hyperplasia (increase in the size of the organ because of an increase in the number of the cells), accumulation of the mucus because of increased production, and decreased secretion from it.

A person smoking for a long time gets his lungs exposed to harmful chemicals from the cigarette which causes inflammation of the airway sac and also recruitment of immune cells like macrophages and neutrophils in the lungs.

Macrophages and neutrophils release chemicals like MMP ( metalloproteinase ) and serine proteinases. These chemicals are known to produce a damaging effect on the lungs.

After the damage is done, repairing of the damaged airways starts but repairing is done ineffectively and results in distortion of the shape of alveoli, bronchi, and other related parts of the lungs.

In COPD the lungs trap some of the air due to distortion of the shape of the lung matrix and this causes hyperinflation of the lungs. Due to hyperinflation, the lungs reach close to the abdominal wall and because of this the positive abdominal pressure during inspiration is not applied effectively and this causes difficulty in inspiration.

Oxygen exchange between the lungs and blood is also hampered as the normal anatomy of the lung is changed and also due to the accumulation of secretions from the lungs.

These factors together cause difficulty in breathing.

CLINICAL FEATURES:

1) Chronic cough and sputum production is seen in the patient.

 

2) Breathlessness on walking is noticed as the disease progresses.

3) Fever, sweating, weight loss is seen as a sign of intoxication.

4) The patient can complain of increasing difficulty in breathing in works that involve lifting the hand above and the same person can do other works that don’t involve lifting the hand like pushing something as it involves the use of accessory muscle of respiration by the patient.

5) In severe conditions, patients can find difficulty in completing the sentence in one breath.

6) In COPD patients, because of hypoxia, the patient’s hand can be warm as blood flows more times than normal to supply oxygen to the cells and this extra blood flow produces increased kinetic energy which leads to a warm hand.

7) Wheezing can be heard on auscultation.

8) Barrel shaped chest is a classic sign of a patient with COPD.

9) The use of accessory muscles during respiration can be seen in patients with COPD.

10) Cyanosis (bluish discoloration) of lips and nails.

11) Pink puffers: Patients suffering from emphysema are called pink puffers are thin and don’t have signs of cyanosis at rest.

12) Blue bloaters: Patients who suffer from chronic bronchitis are prone to cyanosis.

13) Weight loss is common in COPD patients as they can get breathless while eating too.

INVESTIGATION:

1) Complete blood count can show an increase in the hemoglobin and packed cell volume.

2) A decrease in erythrocyte sedimentation rate.

3) Increase in neutrophils.

4) Leucocytosis.

5) Increase in coagulation factor.

6) Eosinophilia.

7) α1 antitrypsin deficiency should be checked in all patients with COPD.

8) Arterial blood gas analysis is measured.

9) Spirometry

10) Chest x-ray can show hyperinflation of the lung, the presence of bullae in the lungs.

11) High-resolution CT (HRCT)  is useful in COPD cases.

12) ECG: Right atrial enlargement (peaked P wave – P pulmonale ) is seen, right axis deviation, dominant R wave in V1.

13) Echocardiography: It can show tricuspid regurgitation and an increase in the end-diastolic volume.

PREVENTION:

1) Quitting smoking is the first important step towards the prevention of harmful lung diseases including COPD.

2) Keep the weight under control as an obese person generally has more breathing difficulty.

3) Proper exercise can improve the breathing capacity of the lungs.

4) People working in jobs in dusty environments should try to cover the nose with a mask and if that is not working then they should consider changing jobs that don’t damage their lungs anymore.

5) Avoid alcohol as they also can cause lung damage.

TREATMENT:

1) Patients are given oxygen therapy if oxygen saturation falls below the normal level.

2) Bronchodilators like ß adrenoreceptor agonists, antimuscarinic drugs (anticholinergic drugs), theophyllines, and phosphodiesterase type 4 inhibitors.

3) Corticosteroids

4) Antibiotics in case of infection should be given by doctors if needed.

5) Influenza vaccines are generally given by the doctors to the patients with COPD.

6) Lung volume reduction surgery can be performed to improve the breathing of the patient

7) A lung transplant can be performed if a person is not improving with the medical treatments available.

Natural products which can have some beneficial effects on our body and in turn also can help in improving lung function are:

1) Ginger has been found to have a beneficial effect on our body and can help in fighting against lung disease.

2) Giloy juice can be tried.

3) Green tea is rich in antioxidants and they can help too.

4) Green vegetables and fruits should be included in the diet on a regular basis.

5) Turmeric has an antiseptic ability and can be tried with lukewarm water or milk.

6) Indian gooseberry has been found to have a beneficial effect in providing relief from cough.

STAY HEALTHY AND STAY FIT.