Chronic Obstructive Pulmonary Disease (COPD)
- Part 1 -

Prof JC Sanasam *

Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed cross-section of the bronchioles and alveoli. Figure B shows lungs damaged by COPD. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls
Pix - Wikipedia/National Heart Lung and Blood Institute

Symptoms of COPD typically begin in people aged over 40 who have smoked for 20 years or more. A ‘smoker’s cough’ tends to develop first. Once symptoms start, if you continue to smoke, there is a decline of your health over several years. You tend to become more and more breathless. In time your mobility and general quality of life may become poor due to increasing breathing difficulties.

Stopping smoking is the most important treatment. If the affection to the lung-tissue has not advanced much, stopping smoking may cure the disease early. However, if the condition becomes severe, then heart failure develops.

(Note: heart failure does not mean the heart stops beating, which is called cardiac arrest or heart arrest. Heart failure occurs when the heart does not pump blood well enough)

Chronic Obstructive Pulmonary Disease (COPD) is a general term (an umbrella term) which includes the conditions: chronic bronchitis and emphysema. COPD is the preferred appropriate name. Because both chronic bronchitis and emphysema can cause obstruction (narrowing) of airways. Chronic bronchitis and emphysema commonly occur together too. The term COPD is used to describe airflow obstruction due to chronic bronchitis, emphysema, or both.

(Chronic bronchitis: chronic means persistent. Bronchitis is inflammation of the inside layer/membrane of the breathing pipes/bronchi.

In the United Kingdom it is estimated that about three million people have COPD. Many of the cases in this analysis are of mild cases. This is because many people, in the early stages, put up with the early symptoms of cough or mild breathlessness without seeing their doctor. Most people see doctors, only when symptoms get worse. COPD mainly affects people over the age of 40 and becomes more common with increased age. It is more common in men than in women.

Causes of Chronic Obstructive Pulmonary Disease:

Smoking is the cause in the vast majority of cases. There is no doubt about this. The membrane lining of the airways (the inner layer of the hollow tubes for the breathing air to pass through) becomes inflamed and damaged; the commonest cause is smoking. About 3 in 20 peole who smoke one packet of cigarettes (20 sticks) per day, and 1 in 4 people who smoke 40 sticks per day develop COPD if they conttinue to smoke in spite of discomfort in the chest. For all smokers, the chances of developing COPD are between 1 in 10 and 1 in 4.

Polluted air and pollution of the surrounding at the working place are also causative factors, or make the disease worse. Smoking and air pollutants, their combination-effect, due to occupational exposure increases the chance of developing COPD.

A small number less than 1 in 100 of COPD may be due to certain hereditary or genetic disorder where protein deficiency is found to be evident; this type of disease involves other organs too like liver and blood. People who have never smoked rarely develop COPD. However passive smoking remains a potential cause.

Symptoms of chronic obstructive pulmonary disease:

o Cough is usually the first symptom. It is productive with plenty of phlegm (sputum) as the beginning of symptoms. The episodes may come and go initially, then gradually may become persistent (chronic). In the beginning the cough might be considered as smoker’s cough. It is when the breathlessness begins that people often become concerned. • Breathlessness (shortness of breath) and wheeze (breathing with difficulty producing a hoarse hissing or whistling sound) may occur when the affected person exerts only for example during scrambling on a flight of stairs or lifting a weight. These symptoms tend to become gradually worsened over the few years if the affected person continues to smoke. Difficulty in breathing may eventually become quite distressing.

o Sputum and stagnation of secretions start to form as the damaged airways make a lot more mucus than normal. The person with this illness will tend to cough up a lot of sputum each day.

o Super-addition of Chest Infection is very common when one suffers from COPD. Worse degree of cough with distressing coughing up larger amount of sputum with excacerbation of breathlessness will be heightened when infection sets on. Mild degree feverishness to obvious fever may appear leading to severe weakness. Sputum usually turns yellow, green, bluish during chest infection. Chest infections may be caused by bacteria or viruses. Bacteria which can be killed with antibiotic medication are the causes of chest infection about 1 in 2 or 3 exacerbations of COPD. Viruses which cannot be killed with general antibiotics usually are the common causes of such exacerbations in winter months. The common cold virus frequently causes such exacerbations.

o Weight loss, tiredness, ankle swelling are some of the associated vague symptoms.

Chest pain and coughing up blood (haemoptysis) are not common features of COPD. Occasionally blood streaked sputum however may be experienced.

To be continued....