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Chronic Obstructive Pulmonary Disease (COPD)

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.