Chronic Obstructive Pulmonary Disease (COPD) Essence

Chronic Obstructive Bronchitis or «Smokers Cough»

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory respiratory system disease that occurs under various environmental factors influence, foremost of which is smoking. The disease is characterized by steady progression and gradual decrease in lung function with chronic respiratory insufficiency development.

COPD usually begins after 40 years. However, the earlier occurrence is possible in case of a genetic defect and long «smoking history».

Chronic Obstructive Pulmonary Disease (COPD) Symptoms

  • cough with mucous expectoration, mostly in morning hours;
  • dyspnea: it is more difficult to exhale than to inhale. At early stages dyspnea appears during exercises, as the disease progresses, it disturbs patients also at rest;
  • during exacerbation period with joined infectious process amount (larger) and quality (becomes purulent) of sputum, dyspnea increase;
  • as the disease progresses, symptoms of other organs and systems (cardiovascular system, muscles, bones) are joined:
  • heart work disruptions;
  • aching heart pains;
  • cyanotic lips and fingertips;
  • changes in fingers and nails: fingers become thicker due to osteophyte, nails – dome-shaped;
  • bone pains;
  • muscle weakness.

Types

COPDAccording to clinical signs combination there distinguish the following types of COPD:

  • emphysematous – thin patients with pink skin, predominant clinical manifestation is dyspnea;
  • bronchial – obese patients with blue skin, predominant clinical manifestation is a cough with sputum;
  • mixed.

Depending on the severity of external respiration function violations there are 4 stages of COPD, which are determined according to spirometry (method of external respiration function examination).

There are the following phases of the disease:

  • stable course;
  • COPD exacerbation (due to joined infection, characterized by increased dyspnea, cough, amount of sputum and change in its quality – it becomes purulent):
    • rare exacerbations;
    • frequent exacerbations (three or more exacerbations a year).

Chronic Obstructive Pulmonary Disease (COPD) Causes

  • Inhalation exposure to causal factors:
    • smoking (both active and passive) – the main factor in the disease development;
    • harmful factors of production – prolonged exposure to dust, vapors, acids, and alkalis, and other chemical particles in the air. COPD most commonly occurs in miners, metallurgists, grinders, and planishers of metal products, arc welders, workers of pulp and paper industry and agriculture, where impact of dust factors are the most aggressive;
    • adverse environmental factors (e. g., smoke from bio-organic fuels combustion).
  • Genetic defect – alpha1-antitrypsin enzyme deficiency (extremely rare).

Diagnostics

  • General examination (general medical examination, lung mediate auscultation to assess breathing properties, detect wheezing).
  • Spirometry (spirography) – main diagnostic method. It allows evaluating airways permeability and lung capacity for unfolding.
  • Test with bronchodilator – spirometry before and after inhalation of the drug, that dilates bronchi. It is used to assess bronchoconstriction reversibility.
  • Body plethysmography – method of external respiration function assessment, which allows identifying all lung volumes and capacities, including those that are not identified by spirography.
  • Chest X-ray, in unclear cases – computed tomography. Methods allow assessing the severity of structural changes in lungs.
  • Sputum test- allows to determine nature and severity of inflammation, in case of exacerbation, the value of this method is in identifying microorganism and determining its sensitivity to antibiotics.
  • General blood count – at later stages increased the level of hemoglobin and red blood cells represent oxygen deficiency in the body. At exacerbation – inflammatory reaction (increased white blood cell count, erythrocyte sedimentation rate acceleration (ESR)).
  • Blood gas composition examination (determination of oxygen and carbon dioxide tension in blood, oxygen saturation assessment).
  • Fiber-optic bronchoscopy – the study that allows to examine bronchial mucosa inside and explore its cellular structure using special apparatus. This method is applied in case of unclear diagnosis to exclude other possible diseases with similar symptoms.
  • Electrocardiography (ECG), echocardiography (echocardiogram, ultrasound of the heart) – to assess functional state of heart and pressure in the pulmonary artery.
  • Also, consultation with pulmonologist is possible.

Chronic Obstructive Pulmonary Disease (COPD) Treatment

Drug-free therapy:

  • smoking cessation is required because significantly it reduces COPD progression and is the key to a more stable course of the disease.
    a balanced diet, rich in proteins.
  • reduced excess body weight.
  • adequate physical activity:
  • walking at a moderate pace;
  • swimming;
  • breathing exercises (according to various methods: inflating balloons, blowing air through a straw, diaphragmatic breathing) – aimed at respiratory muscles training.
  • visit «Schools for COPD patients», where doctors in understandable to patient terms talk about features of the disease, give advice on treatment, physical activity, inform about drugs spectrum and their reception rules, teach how to use inhalers.

Drug therapy:

  • vaccination – pneumococcal, influenza vaccines. The optimal time for vaccination: October – mid-November. Subsequently, effectiveness of vaccination significantly decreases, because possibility that the body has already contacted with viruses and bacteria, activating at this time, is sharply increased, and therefore it can not provide sufficient immune response even after injection;
  • therapy aimed at expanding narrowed bronchi and keeping it in good condition by removing spasm and increased mucus production:
    • M-anticholinergics;
    • beta2-agonists;
    • theophylline.

There are two groups of these drugs: short-acting (effect lasts for 4 – 6 hours) and long-acting, capable of keep bronchi in the normal state within 12 or 24 hours.

Short-acting medications or combination of them are prescribed during the first stage of COPD and at subsequent stages “on demand”, that is, for rapid elimination of any symptoms. If they are not able to control symptoms, long-acting agents are joined.

  • Anti-inflammatory therapy (aimed at eliminating inflammation in a bronchial tree) is added in case of lack of effectiveness of above means:
  • glucocorticosteroid hormones. The main method of drug delivery – inhalation. Hormonal agents in pills are only used at exacerbation in the short-term course, or at severe COPD. Many patients are afraid to take hormones because there is a large number of side effects. Serious side effects (diabetes, hypertension, osteoporosis (reduction of bone mass and impaired bone structure, which leads to bone fragility and increased risk of fractures)) may cause hormones introduced into the body in the form of pills or injection. Inhaled hormones in average doses are deprived of these side effects because they operate at application point – in the bronchial tree. Since at COPD inflammation is chronic, these drugs require long-term, continuous use. To assess the full effect of these drugs is possible only after 3 months of use. Refusal to receive them can transfer the disease to a more severe course. Side effects of inhaled forms of hormones can be: hoarseness and oral candidiasis, which is easily prevented by rinsing mouth after each inhalation;
  • antioxidant therapy – vitamins E, C and A;
  • selective phosphodiesterase-4 inhibitors (more specific for inflammation at COPD, may be used in combination with above drugs);
  • Mucolytic means – contribute to viscous mucus liquefaction and its better discharge.
  • Antibiotic therapy – only at exacerbations (during exacerbation period);
  • Oxygen therapy;
  • Artificial pulmonary ventilation – in severe cases;
  • Substitution treatment with alpha1-antitrypsin, if disease cause is genetic defect that is expressed in its deficiency;

Surgery:

  • removing modified, functionally defective lung areas;
  • lung transplantation – in case of severe COPD.

Complications and Consequences

COPD is a disease with steady progression, which may lead to the following complications:

  • respiratory insufficiency;
  • pneumothorax (air penetration into pleural cavity due to rupture of structurally changed lung tissue with respiratory mechanism violation);
  • pneumonia (lung inflammation);
  • thromboembolism (blood clots with of blood flow violation);
  • bronchiectasis (bronchial deformities with the development of their functional disability);
  • pulmonary hypertension (increased pressure in the pulmonary artery);
  • chronic pulmonary heart (thickening and enlargement of right heart compartment with impaired functional capacity due to increased pressure in the pulmonary artery);
  • chronic cardiac insufficiency;
  • atrial fibrillation (ciliary arrhythmia) – heart rhythm disturbances.

Prevention of Chronic Obstructive Pulmonary Disease (COPD)

Primary Prevention

COPD is a disease that can be prevented. To do this it is necessary:

  • quit smoking;
  • avoid exposure to harmful factors of production and environment (dust, vapors, acids and alkalis and other chemical particles in the air, bio-organic fuels combustion).

Secondary Prevention

It is aimed at the slowing of disease progression:

  • adequate physical activity (aimed at respiratory muscles training): walking in a moderate pace, swimming, breathing exercises (according to various methods: inflating balloons, blowing air through a straw, diaphragmatic breathing);
  • vaccination (to prevent infectious diseases that provoke COPD exacerbation) – pneumococcal, influenza vaccines. The optimal time for vaccination: October – mid-November. In future, vaccination effectiveness is greatly reduced;
  • constant administration of prescribed drugs. COPD is characterized by chronic inflammation, so you must not limit yourself to preparations for bronchi expansion (except for early stages), you must permanently use anti-inflammatory drugs;
  • proper use of inhalers – often lack effect of prescribed drugs appears due to incorrect inhalation technique. Ask your doctor to explain to you how to use an inhaler. The drug should enter strictly a bronchial tree, otherwise the effect of treatment is significantly reduced up to complete absence.

Additionally

Impact of triggering factors (inhalation of cigarette smoke, harmful factors, and environment) leads to the development of an inflammatory process in lung tissue and bronchi. Mucus production in airways increases, bronchi become swollen, spasm appears, which generally considerably narrows bronchial lumen and disrupts air flow in the respiratory tract.

Chronic inflammation over time leads to thickening of bronchial wall and irreversible constriction of their lumen with significant airflow obstruction, its stagnation in lower airways, with the formation of the so-called «air traps».

Along with this, pulmonary inflammation leads to the destruction of interalveolar septa, whereby lungs lose their elasticity and can not sufficiently unfold during inhalation.

Combination of these changes causes the insufficient removal of air from lungs during exhalation, and inferiority of gas exchange, which is reflected in low oxygen saturation of blood.

«Oxygen starvation» of the organism causes the fact that COPD is a systemic disease that affects not only lungs, but many systems and organs, and in absence of proper timely treatment, you can even die from COPD.