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COPD - Symptoms, Causes, Types, Diagnosis, Treatment

Updated: Sep 1, 2021

Chronic Obstructive Pulmonary Disease, commonly referred to as COPD, is a group of progressive lung diseases. Symptoms may be mild at first, beginning with intermittent coughing and shortness of breath. As it progresses, symptoms can become more constant to a point where it can become increasingly difficult to breathe. Lungs rely on the natural elasticity of the bronchial tubes and air sacs for exhalation of air. COPD causes them to lose their elasticity and over-expand, which leaves some air trapped in the lungs during exhalation. More than 11 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), according to the American Lung Association. Another 12–24 million may have the condition without realizing it. Untreated, COPD can lead to a faster progression of the disease, heart problems, and worsening respiratory infections.

Early symptoms:

At first, symptoms of COPD can be quite mild such as:

  • Occasional shortness of breath, especially after exercise

  • Mild but recurrent cough

  • Phlegm formation

Symptoms can get progressively worse such as:

  • Shortness of breath, after mild forms of exercise like walking up a flight of stairs.

  • Wheezing.

  • Chest tightness.

  • Chronic cough, with or without mucus.

  • Excessive Phlegm formation.

  • Frequent colds, flu, or other respiratory infections

In later stages of COPD, symptoms may also include:

  • Fatigue

  • Swelling of the feet, ankles, or legs

  • Weight loss

What causes COPD?

It is typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Current or former smokers or people who have had frequent exposure to other irritants are at a greater risk for developing COPD. These irritants can include second-hand smoke, air pollution, workplace fumes, sawdust, or other aerosolized particles. People with COPD are at an increased risk of developing heart disease, lung cancer, and a variety of other conditions. In about 1% of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin (AAT). it is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver and lungs.

There are two main forms of COPD:

Chronic bronchitis, which involves a long-term cough with mucus. In this condition, the bronchial tubes become inflamed and narrowed and the lungs produce more mucus, which can further block the narrowed tubes. The cause of chronic bronchitis is usually long-term exposure to irritants that damage the lungs and airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause chronic bronchitis. Exposure to other inhaled irritants can contribute to chronic bronchitis. These include second-hand smoke, air pollution, and chemical fumes or dust from the environment or workplace.

Who is at risk for chronic bronchitis?

  • Smokers- This the main risk factor. Up to 75 percent of people who have chronic bronchitis smoke or used to smoke.

  • Long-term exposure to other lung irritants, such as second-hand smoke, air pollution, and chemical fumes and specks of dust from the environment or workplace.

  • Most people who have chronic bronchitis are at least 40 years old when their symptoms begin.

  • Genetics-This includes alpha-1 antitrypsin deficiency, which is a genetic condition.

  • Emphysema, which involves damage to the lungs over time. This lung disease causes the destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse during exhalation, impairing airflow out of the lungs. The main cause of emphysema is long-term exposure to airborne irritants, including Tobacco smoke, Marijuana smoke, Air pollution, chemical fumes, and dust.

Factors that increase the risk of developing emphysema include:

  • Smoking -Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.

  • Age- Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

  • Exposure to second-hand smoke

  • Occupational exposure to fumes or dust

  • Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants such as car exhaust, increases the risk of emphysema.

How to diagnose COPD ?

  • Spirometry-The most effective and common method for diagnosing COPD is spirometry. It is also known as a pulmonary function test or PFT. This easy, painless test measures lung function and capacity.

  • This test is the most effective because it can determine COPD before significant symptoms appear. It can also help the doctor track the progression of COPD and monitor the effectiveness of treatment.

  • The bronchodilator reversibility test-This test combines spirometry with the use of a bronchodilator, which is the medicine to help open up the airways.

  • An arterial blood gas test will measure the levels of oxygen and carbon dioxide in the blood. This measurement can indicate the severity of the condition and whether the patient may need oxygen therapy.

  • CT-Scan is recommended if the symptoms are being caused by another condition such as heart failure.

  • Electrocardiogram (ECG or EKG) test will be taken to determine if the shortness of breath is being caused by a heart condition as opposed to a lung problem.

How is COPD treated?

  • Inhalers- These devices delivers medicine directly into the lungs. The commonly prescribed medicines are bronchodilators, which help the patient to breathe better by relaxing and widening the airways; corticosteroids, which help to reduce the inflammation in the airways; mucolytics, which make the mucus thinner; steroids and antibiotics.

  • If there is not enough oxygen in the blood, the patient may need supplemental oxygen. Oxygen therapy can improve quality of life and is the only COPD therapy proved to extend life.

  • Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice, and counseling.

  • Surgical options include Lung volume reduction surgery, where the surgeon removes small wedges of damaged lung tissue from the upper lungs; Lung transplant and bullectomy, where large air spaces in the lungs are destroyed.

BiPAP/CPAP therapy for COPD:

People with copd have difficulty in inhaling and exhaling air. Treatment procedures will reduce the progression and symptoms of copd, because there’s no remedy for this condition. Device based treatment include BiPAP (Bi-level Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure), have been shown an effective management tool for chronic obstructive pulmonary disease. These are the kind of non-invasive ventilators indicated for the people who have trouble in breathing. As copd develops, patient suffers severe with their intense symptoms over a time.

If the patient have difficulty in breathing, bipap machine pressurize the air to a higher level than the surrounding air through a tube, which get into the lungs, so it helps a person to inhale the oxygen easily and remove carbon-di-oxide effectively. This helps them to breathe more easily either in sleeping or with flare-up symptoms.

Cpap supply continuous flow of pressurized air into the tube which pushes against any blockage in the airway, so that lungs can receive enough oxygen.

In the case of cpap, pressure value is pre-determined and remains constant for the complete respiratory cycle. The respiratory activity is carried out completely by the patient. During bipap, higher and lower pressure is maintained during inspiration and expiration respectively. Bipap is used when positive airway pressure is needed along with pressure support. Thus bipap supports inhalation, and directly reduce the respiratory work of the patient and improves respiratory distress more effectively.

Bipap has the potential advantages over cpap in assisting respiration for copd patients. Cpap assist patient with one sort of pressure, while bipap aids with two distinct pressure for both inhalation and exhalation.

The notable benefits of both bipap and cpap are the reduction in the need of intubation and mortality rate. For the patient with moderate and severe copd, doctors recommends bipap or cpap depending on the patient status to help a person breathe easily.

CPAP/BiPAP therapy
CPAP/BiPAP Therapy | Source: CPAP Guide









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