What is COPD? | Respiratory Doctor London

Overview

Chronic Obstructive Pulmonary Disease (COPD) is a long-term, progressive lung disease that makes breathing difficult due to airflow obstruction. COPD typically involves two primary conditions: emphysema, where the air sacs in the lungs (alveoli) are damaged, and chronic bronchitis, where the lining of the airways becomes inflamed and produces excess mucus. Both conditions contribute to breathing difficulties, and symptoms tend to worsen over time. COPD is common among older adults and is closely linked to smoking and exposure to environmental irritants, although it can also result from genetic factors.

Symptoms and Causes

Early Symptoms:

Shortness of breath during physical activities, such as climbing stairs or exercising
Wheezing during exhalation
Excess mucus production, particularly in the mornings
A mild, persistent cough
Frequent need to clear the throat, especially in the morning

As COPD progresses, the lungs become more damaged, and symptoms become more noticeable and constant:

Shortness of breath even without physical activity
Chest tightness or discomfort
Fatigue and decreased energy levels
A more severe, persistent cough
Frequent respiratory infections like colds and bronchitis
Swelling in the ankles, feet, or legs (common in later stages)
Unexplained weight loss in advanced stages

Causes

Smoking: The primary cause of COPD is long-term smoking, responsible for 75%–90% of cases. Both current and former smokers are at high risk.
Environmental exposure: Long-term exposure to irritants like dust, fumes, chemicals, and air pollution can damage the lungs. Workplace environments with poor air quality also increase the risk.
Genetics: Around 5% of COPD patients have a genetic condition called alpha-1 antitrypsin deficiency, which affects lung function. A family history of COPD or asthma can also increase risk.
Age: COPD primarily affects older individuals, with diagnosis commonly occurring after the age of 40.
Other risk factors: Frequent respiratory infections during childhood, passive smoking (secondhand smoke), and pre-existing lung conditions like asthma also contribute to developing COPD.

Diagnosis

Diagnosis of COPD involves evaluating symptoms, medical history, and conducting specific tests to assess lung function and confirm airflow obstruction.

Spirometry: A key diagnostic test for COPD, spirometry measures how much air you can inhale and exhale and how quickly. This test helps determine the severity of airflow obstruction.
Chest X-ray or CT scan: These imaging tests can detect emphysema, lung damage, or other conditions that may cause symptoms similar to COPD.
Blood tests: These may be performed to check for alpha-1 antitrypsin deficiency or measure oxygen levels in the blood.
Arterial blood gas analysis: In advanced cases, this test measures oxygen and carbon dioxide levels in the blood to assess how well your lungs are functioning.

Treatments

Although COPD is a progressive disease that cannot be cured, treatments focus on managing symptoms, slowing disease progression, and improving quality of life.

1. Medications:

Bronchodilators: These medications relax the muscles surrounding the airways, making it easier to breathe. Bronchodilators help relieve shortness of breath and reduce chest tightness.
Glucocorticosteroids: Anti-inflammatory medications can be prescribed to reduce airway inflammation, further improving airflow. These are often used in combination with bronchodilators for more severe cases.
Antibiotics: In cases where bacterial infections, such as pneumonia or bronchitis, exacerbate COPD symptoms, antibiotics may be prescribed.

2. Oxygen Therapy:

In advanced stages of COPD, when blood oxygen levels are low, supplemental oxygen may be provided via a mask or nasal tubes. Oxygen therapy can improve breathing and reduce strain on the heart.

3. Pulmonary Rehabilitation:

This is a comprehensive program that combines exercise, education, and support to improve lung function and overall well-being. Pulmonary rehabilitation helps patients better manage symptoms, maintain physical activity, and improve quality of life.

4. Surgery:

Bullectomy: If large, abnormal air spaces (bullae) form in the lungs due to emphysema, they can be surgically removed to improve lung function.
Lung volume reduction surgery: In severe cases, sections of damaged lung tissue may be surgically removed to allow the healthier parts of the lung to function better.
Lung transplant: In end-stage COPD, when other treatments have failed, a lung transplant may be considered for suitable candidates.

5. Lifestyle Modifications:

Smoking cessation: Quitting smoking is the most critical step in slowing disease progression.
Avoiding irritants: Minimizing exposure to air pollution, dust, and chemicals can help prevent exacerbations.
Vaccinations: Regular flu and pneumonia vaccinations can help prevent infections that worsen COPD symptoms.

By adhering to a personalized treatment plan, many people with COPD can manage their symptoms effectively and maintain a reasonable quality of life.