Chronic Obstructive Pulmonary Disease (COPD)

COPD as the name implies, is a chronic airway disease causing airflow limitation either due to destruction of alveoli which are the gas exchanging units in the lungs (emphysema) and/or recurrent and chronic inflammation of the airways (chronic bronchitis).

This causes Lung disease by producing obstruction to airflow during breathing leading to breathlessness, reduced capacity to work, and gradual deterioration of overall health.
Moreover, because of the chronic nature of this disease, Lung capacity and reserves go down and the patient becomes prone to frequent chest infections leading to Respiratory Failure.
In advanced cases the quality of life of the patient becomes poor, associated with reduced life expectancy.
Respiratory failure in COPD called Acute exacerbation of COPD (AE-COPD) is a life-threatening condition requiring hospitalization in I.C.U. and even the need for support by artificial ventilation.

Main causes of COPD:

Smoking – The most common cause of COPD
Second-hand smoke exposure
Allergy to dusty environment
Genetic factors
Environmental Pollution

Common Symptoms:

Chronic cough associated with mucopurulent sputum
Breathing difficulty more so with simple work
Wheezing
Feeling of tightness in the Chest
Easy Fatiguability

Emphysema:

Emphysema is restricted to the alveoli or air sacs where actual gas exchange occurs.
It is typically characterized by thinning and overexpansion of the lung tissue in this region
The lung loses its elasticity and these lung areas expand and relax in an abnormal manner.
This leads to poor gas exchange and increased work of breathing

Chronic bronchitis:

Bronchitis typically affects the airways particularly the terminal bronchioles.
These airways are inflamed leading to flow limitation and wheezing.
Bronchitis can be acute or chronic. Acute onset is generally caused by a virus and usually last up to three weeks responding to home care.
The condition of recurrent inflammation of these very airways is termed Chronic Bronchitis

Diagnosis of COPD:

Pulmonary Function Test (PFT).
Chest X- Ray or CT as per requirement
Arterial Blood Gas (ABG) for measurement of levels of CO2 (Carbon Di Oxide) and O2 ( Oxygen) in Blood if Physician feels the need

Treatment of COPD:

Smoking cessation is the single most important intervention to slow the rate of lung function decline, regardless of disease severity
Chronic medication which includes Bronchodilators selected based on symptoms and severity with the goal of improving symptoms and functioning and reducing exacerbations
Pulmonary rehabilitation program including exercise for all patients with functional impairment
Supplemental Oxygen Support by means of Oxygen Cylinder or Oxygen Concentrator at home in advanced cased with low resting Oxygen Saturation of less than equal to 88%
Non Invasive Ventilation with BILEVEL or DUAL PRESSURE mode , at home can be added to conventional therapy which can be very effective in addressing breathlessness, improving oxygenation, reduction of Carbon Di Oxide level and preventing Acute Exacerbations.

References

01 : Global Initiative for Chronic Obstructive Lung Disease (GOLD). “Global Strategy for the Diagnosis, Management and Prevention of COPD, 2015.” Goldcopd.com. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Sept2.pdf (accessed November 9, 2015)

02 : McKenzie DK et al. The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003. Med J Aust. 2003;178(6):S15-29.

03 : Brill SE and Wedzicha JA. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014;9:1241–1252.

04 : Galli JA et al. Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD. Respir Med. 2014;108(5):722-8.