Chronic Obstructive Pulmonary Disease (COPD)
- Part 2 -

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

With advanced COPD 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) . The final stage of COPD is respiratory failure that kills the patient.

Asthma and COPD

Very often individuals with COPD, even their attending physicians, may suspect that what they are facing is asthma. COPD and asthma can manifest similar symptoms. However it should be noted that they are different diseases:
o In COPD there is permanent damage to the inner layer of the respiratory pipes and lung tissues. The narrowed airways are fixed, and so breathlessness becomes chronic (persistent). Treatment to open up the airways is therefore limited.
o In asthma there is inflammation in the airways which makes the muscles in the airways contract causing the airways to narrow. The symptoms in asthma tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.
o An ongoing coughing with plenty of phlegm (sputum) is more likely to be COPD than be asthma.
o Waking at night with breathlessness or wheeze is common in asthma but uncommon in COPD.
o COPD is rare before the age of 35 whilst asthma is common in individuals under 35.
o In asthma there is more likey to have some history of allergies, eczema (allergic skin disorder) and hay fever (allergic fever).

However asthma and COPD both are common, and some people do have both conditions together.

Diagnosis of COPD and investigations thereof

In early or mild degree COPD, examination of the chest may not reveal anything. The examining doctor may hear some wheeze or some extra abnormal sound of air passing through fluid through the stethoscope when put on the chest if chest infection is present. Or there may be signs of over-inflation of the chest and excessive air trapped in the chest (emphysema) in spite of the patient attemting to beathe all the air out. This is because the airways are obstructed; as a result air finds it difficult to get in or out of the chest, both ways.

1 Spirometry

It is the commonest test used to help diagnose the condition. This test measures the amount or volume of air that an individual can blow out. Its study can reveal if some degree or severe degree of obstruction is present or not. Individuals with COPD can not blow out a normal volume of air from their chest as the air remains trapped inside the chest. The increase of trapped air in the chest inflates it further and further resulting into emphysema which further leads to breathlessness.

Xray Chest is a must to exclude the suspicion of lung cancer or TB if there be any. Modern health care providers are always too careful and they try to see to it that nothing misses out. So a high resolution CT scan of the chest is also done usually for a more accurate diagnosis and further study of the possible whereabouts in the days to come for the patient.

Blood Test to find the haemoglobin level and analyses of blood gases are also important to know whether the person, concerned, is having adequate oxygen in his or her body. The breathlessness results in lack of oxygen, if the level is too low as can be seen in the haemoglobin as an index and other findings like polycythemia; adequate precaution like admission in the hospital to combat the lack of oxygen (hypoxia) is to be taken up.

A Pulse Oximeter clipped at the finger especially during oxygen therapy is important to monitor the level of oxygen as well as the pulse rate.

Complications of COPD and their outlook

Heart Failure: Lack of oxygen in the blood and changes in the lung tissue can cause increased pressure in the blood vessels and lungs; eventually a strain on the heart muscle and finally leading to heart failure. This leads to further worsening of breathlessness and fluid retention (pulmonary oedema)

Respiratory Failure is the final stage of COPD. At this point the lungs are so damaged that carbon dioxide (CO2) builds up in in the blood stream.

Treatment of COPD

Best thing to do is to stop smoking and consult a physician, that too, a chest physician. Immunization against viral infections during cold months, regular exercises, to lose weight if obese, regular follow-ups are necessary. A general idea is that the physician may prescribe therapy according to the stage of the disease:
o Short-acting bronchodilator inhalers (drugs that correct the narrowing of the respiratory pipes).
o Long-acting bronchodilator inhalers.
o Steroid inhalers.
o Bronchodilator tablets.
o Mucolyting medicines (drugs that reduce the stagnant mucous secretions in the respiratory pipes and lung tissue).
o Steroib tablets.
o Combat against chest infections and exacerbations.
o Oxygen, maybe home oxygen for palliation (just for support not for cure at the end stage) or oxygen in the hospital. Great care is needed with oxygen therapy because too much oxygen can actually be harmful in persons with COPD.

Concluded....