Full form of COPD is Chronic Obstructive Pulmonary Disease.
COPD – Chronic Obstructive Pulmonary Disease
COPD (an acronym for chronic obstructive pulmonary disease) is a progressive lung disease that, over time, makes it difficult to breathe. It is an independent disease characterized by a partially irreversible restriction of airflow in the respiratory tract, which, as a rule, is steadily progressive. And provoked by an abnormal inflammatory reaction of lung tissue to irritation by various pathogenic particles and gases.
The pathological process begins in the bronchial mucosa: in response to exposure to external pathogenic factors. The function of the secretory apparatus changes ( hypersecretion of mucus, changes in bronchial secretions), an infection joins. A cascade of reactions leading to damage to the bronchi, bronchioles and adjacent alveoli develops.
Important things to consider
- COPD is chronic. In other words, you have to live with it every day.
- It can cause severe long-term disability and premature death.
- There is no known cure for COPD, but it is often preventable and treatable.
- COPD is also known as chronic bronchitis or emphysema.
With COPD, the airways in the lungs become inflamed and swollen, and the tissue where the oxygen is exchanged is destroyed. The flow of air in and out of the lungs decreases. When that happens, less oxygen enters the tissues of the body and it becomes more difficult to get rid of the residual carbon dioxide. As the disease worsens, it becomes more difficult to stay active due to difficulty in breathing.
When taking the history, attention should be paid to the analysis of individual risk factors. Since the combination of risk factors accelerates the progression of the disease.
- To assess smoking as a risk factor, the smoker index (IR) is used, expressed in pack-years:
- IR (pack * year) = (number of cigarettes smoked per day * smoking experience (years)) / 20
- IR for more than 10 pack-years is a significant risk factor for developing COPD
What are the symptoms of COPD?
Many people do not experience symptoms of COPD until they reach advanced stages of the disease. Sometimes people think that it is difficult for them to breathe or that they are less able to do the things they usually do because they are just getting old. But the difficulty in breathing is never normal.
If you experience any of these or think you may be at risk for COPD, it is important to talk with your doctor.
- Chronic cough is the earliest symptom of the disease. It is often underestimated by patients, being expected when smoking and exposure to pollutants. In the early stages of the disease, it appears sporadically, but later it appears daily, and occasionally it appears only at night. Outside the exacerbation, cough is usually not accompanied by sputum separation. Sometimes a cough is absent in the presence of spirometric evidence of bronchial obstruction
- Difficulty breathing when performing daily activities (dyspnea). Dyspnea occurs approximately 10 years after coughing and is noted initially only with considerable and intense physical exertion, aggravated by respiratory infections. Dyspnea is often mixed type, less often expiratory. In later stages, dyspnea varies from feeling short of air during normal physical exertion to severe respiratory failure. And over time becomes more pronounced. It is a common cause of going to a doctor.
- Frequent respiratory infections
- Bluish color of the lips or under the nails (cyanosis)
- The production of a large amount of mucus (also called phlegm or sputum). Phlegm is a relatively early symptom of the disease. In the initial stages, it is allocated in a small amount, as a rule, in the morning, and has a slimy character. Purulent, profuse sputum – a sign of exacerbation of the disease.
Who is at risk for COPD?
Early detection of COPD is the key to effective treatment and control. Talk to your doctor about your risk of COPD if any of the following happens:
- Smoke or have a history of smoking. About 80 to 90 percent of all cases of COPD are caused by cigarette smoking. Cigarette smoke can weaken the defense of your lungs against infections, narrow the airways, cause swelling in the respiratory passages and destroy the pulmonary alveoli. COPD mortality rates are highest among smokers, they develop airway obstruction and shortness of breath more quickly. However, cases of occurrence and progression of COPD are also observed in non-smokers. Dyspnea appears at about 40 years in smokers, and 13–15 years later in non-smokers.
- It is exposed to air pollution. Air pollution, as well as irritating dust and fumes, especially at work, can also cause COPD.
- He who has an alpha-1 deficiency. A small number of people have a rare form of COPD that is known as emphysema associated with alpha-1 deficiency. This form of COPD is caused by the inherited lack of a protective protein in the blood.
- The most harmful occupational factors are dust containing cadmium and silicon. In the first place in the development of COPD is the mining industry. High-risk professions: miners, builders in contact with cement, metallurgical workers (due to evaporation of molten metals). And the pulp and paper industry, workers engaged in the processing of grain and cotton. Smoking increases the adverse effects of dust.
- In favor of the role of heredity indicates the fact that not all smokers with great experience become sick with COPD. The most studied genetic risk factor is the rare hereditary deficiency of α 1 -antitrypsin (A1AT). It inhibits serine proteinases in the systemic circulation.
Centrilobular emphysema in COPD, macro preparation
The basis is the inflammatory process affecting all the structures of the lung tissue: bronchi, bronchioles, alveoli, pulmonary vessels. Morphological changes are characterized by epithelial metaplasia, destruction of epithelial cilia, hypertrophy of mucus-secreting submucous glands.
The proliferation of smooth muscles in the respiratory tract wall. All this leads to hypersecretion of mucus, the appearance of sputum, a violation of the drainage function of the bronchi.
There is a narrowing of the bronchi as a result of fibrosis. Damage to the lung parenchyma is characterized by the development of centrilobular emphysema, changes in the alveolar-capillary membrane. And impaired diffusion capacity, leading to the development of hypoxemia.
Respiratory muscle dysfunction and alveolar hypoventilation lead to chronic hypercapnia, vascular spasm. Pulmonary artery remodeling with thickening of the vascular wall and a decrease in the lumen of the vessels. Pulmonary hypertension and vascular damage leading to the formation of a pulmonary heart.
Progressive morphological changes of the lungs and associated disorders of the respiratory functions lead to the development of cough, sputum hypersecretion, respiratory failure.
Differential diagnosis with bronchial asthma
An important role in the differential diagnosis of these clinics and the results obtained in the study of respiratory function. A characteristic sign that makes it possible to clinically suspect a disease is the nature of dyspnea.
In bronchial asthma, shortness of breath occurs 5–20 minutes after exercise or a provoking stimulus. This is due to the autoimmune mechanism of bronchial obstruction in asthma, it takes some time for the mucous edema to occur, and the lumen of the branch narrowed down.
With COPD, dyspnea occurs immediately at the onset of exercise, this is due to the difference in mechanisms of impaired pulmonary ventilation. In contrast to asthma, the chest cannot fall down and a significant amount of air remains in the airways, which makes gas exchange difficult, leading to the onset of shortness of breath
Preventive measures of COPD
- Smoking cessation: Giving the status of non-smoking schools, places of mass stay of people, places of work should be supported by the government, health care organizers and the whole society in general. Quitting smoking is the most cost-effective way to reduce the effects of COPD development factors. According to WHO, smoking cessation is the most important step towards reducing health risks. Studies have shown that 75-80% of smokers want to quit smoking, and every third of them had at least three serious attempts to stop smoking. WHO calls on governments, communities, organizations, schools, families, and individuals to help current smokers to quit. According to research, funds invested in anti-tobacco companies, justify themselves by increasing life expectancy. Anti-tobacco activities include:
- use of skin applicators as a nicotine replacement therapy,
- Consultations of doctors and other medical workers,
- group programs and self-help programs,
- the formation of public opinion in favor of quitting.
- The analysis of anti-tobacco programs in different countries revealed that they increase the life expectancy in the population by an average of 1 year.
- Fighting Professional Factors: The fight against occupational hazards that lead to the development of airway damage consists of two groups of measures:
- reducing the concentration of harmful substances in the air of the working area due to various technological measures;
- the use of effective ventilation – local suction, air showers, and general ventilation;
- providing personal respiratory protection ( as the latest and most unreliable remedy )
Each of these methods prevents harmful substances from entering the human body, thus reducing the risk of developing COPD. It is important to note that the use of personal protective equipment is the most ineffective method of preventing occupational diseases.
For example, a study showed that the use of half-mask respirators by American miners did not significantly reduce the concentration of coal dust in the inhaled air. In this regard, recommendations on the use of ventilation and other technical means of collective protection were developed.
So that the concentration of dust in the breathing zone does not exceed the permissible. And in connection with the identification of the increase in the incidence of miners (after a significant reduction before 1999). It was decided to reduce the MPC for the coal dust and tighten control over dust in coal mines.
The basis of the treatment of an already established COPD is pharmacotherapy. At the current level of development of medicine, drugs can only prevent a worsening of the severity of the condition and improve the quality of life.
But are not able to completely eliminate the morphological changes that have occurred during the development of the disease. The goals of treatment for COPD are as follows :
- prevention of aggravation of the disease,
- relief of symptoms
- improving exercise tolerance,
- prevention and treatment of complications
- prevention and treatment of exacerbations,
- reducing mortality
Various groups of drugs that cause the expansion of the bronchi are used. Mainly due to the relaxation of the smooth muscles of their walls.
- M-holinoblokator, ipratropium bromide (Atrovent) and tiotropium bromide (Spiriva)
- Long-acting β2-agonists: Salmeterol and Formoterol.
For exacerbations of the disease, both local and systemic corticosteroids are used. In the case of severe respiratory failure, an arrest is performed by taking prednisolone tablets at a dose of 10–20 mg per day or by administering a similar dose intravenously.
When using systemic glucocorticosteroids should be aware of their side effects on the body. After arresting the exacerbation, they should be smoothly canceled and the patient transferred to inhaled steroid hormones.
Antibiotics are a necessary component of drug therapy for exacerbation of the disease. Based on the pathogenesis, it is known that emphysema occurs, the outflow of mucus is hampered and, as a result, it stagnates. Accumulated in lung discharge is a favorable environment for the growth of bacteria.
And the natural development of bronchitis, and in some cases – pneumonia. To prevent such complications, patients are prescribed antibiotic groups that predominantly act on the bacterial flora typical of the lung. These include clavulanic acid- protected penicillins, 2nd generation cephalosporins.
In the case of pronounced bacterial aggression, the use of respiratory fluoroquinolones. The introduction of drugs can be done in various ways: through the mouth, intravenously, intramuscularly, inhalation (via a nebulizer ).
Hyperproduction of mucus during the development of COPD contributes to its accumulation in the respiratory tract. Resulting in a favorable environment for the development of a bacterial infection. To avoid this, mucolytic drugs are used, which lead to the dilution of mucus and facilitate its evacuation from the bronchi.
All mucolytics are conventionally divided into 2 groups: drugs of direct and indirect action. Indirect mucolytics affect secretion in the respiratory tract, almost without interacting with mucus that is already secreted into the lumen of the bronchi. Such drugs include Bromhexine and Ambroxol, which is its metabolite.
The basis of the mechanism of action of these drugs is the ability to stimulate the synthesis of surfactant by alveolar pneumocytes ( alveolocytes ) of the second order. It leads to the fractionation of mucus and a decrease in its adhesive properties. For direct action drugs are substances that directly affect the secret in the bronchi.
As a rule, these are enzyme preparations, for example, trypsin and chymotrypsin. They are introduced through the respiratory tract mainly by inhalation. The interaction of the enzyme with mucus leads to its degradation and the loss of its adhesive properties.
It should not be forgotten that in many respects this division into 2 groups is conditional, and many mucolytics combine the clinical effects of both groups. Therapy with mucolytics is an ancillary measure aimed at improving the quality of life of the patient. Preventing the development of a bacterial infection or, if there is one, accelerating the elimination of the source of infection.
Based on the pathogenesis of COPD, the disease is based on chronic inflammation, which ultimately leads to serious morphological changes in the lung tissue.
Glucocorticosteroids are capable of stopping inflammation most effectively, but besides the main one, they have a lot of undesirable side effects. To replace them, drugs have been created that are inhibitors of proinflammatory mediators or their receptors.
An example of such a drug is fenspiride (Erespal). The mechanism of drug action from a pharmacological point of view is as follows: like steroids, it has an inhibitory effect on the activity of phospholipase A2(FLA2). While if corticosteroids inhibit the activity of PLA2 through the induction of the synthesis of a special inhibitor protein.
Then fenspiride blocks the transport of Ca2 + ions necessary for the activation of PLA2. Consequently, at the point of application of the anti-inflammatory action and the effectiveness of the arachidonic acid cascade. Fenspiride is comparable to corticosteroids and, like them, interrupts the formation of both prostaglandins and thromboxane and leukotrienes. However, this fenspirid is not a steroid hormone, so its use is not accompanied by side effects characteristic of steroids.
Conducted clinical studies of the effectiveness of the drug showed that regular use of fenspiride resulted in a decrease in respiratory symptoms and an improvement in the quality of life of patients.
Currently, surgeries for COPD are predominantly palliative. The most common removal is large bullae in bullous emphysema. In cases where they cause severe shortness of breath, hemoptysis, and are foci of persistent infections.
Operations to reduce the volume of the lungs with severe emphysema have not been studied enough and are not recommended for implementation. Positive clinical effects showed lung transplantation, the indication for such an operation is FEV 1 25% or less. According to statistics in foreign clinics, operational lethality is 10-15%, a three-year survival rate of 60 %.
Physician tactics at the outpatient and hospital stage
In most cases, patients with COPD primarily turn to the district physician with complaints of cough and shortness of breath. When treating such a patient to a district physician, it is necessary to exclude acute pathologies, such as bronchitis and pneumonia.
In some cases, in the early stages of the disease, the correct diagnosis is rather difficult to set. If after 7-14 days from the patient’s treatment no positive dynamics is observed, then the patient should be referred for a pulmonologist consultation.
The task of the pulmonologist at the outpatient stage is to determine the presence and severity of respiratory disorders, as well as their correction. The main task of the doctor at the outpatient stage is the selection of adequate supportive therapy and the provision of regular follow-up.
Physical training is the basis for the rehabilitation of patients with COPD. It should be noted that the main problem that reduces the quality of life in these patients remains severe shortness of breath and low exercise tolerance. To eliminate these deficiencies, a complex of special aerobic loads was developed.
It is aimed at improving the efficiency of the musculoskeletal system and the respiratory system. However, it should be noted that these rehabilitation measures are effective only in combination with adequate medical therapy and their effectiveness is relatively small.
The prognosis is conditionally unfavorable, the disease is steadily, slowly progressing, the ability to work with the development of the disease steadily lost. Adequate treatment only significantly slows down the development of the disease, up to periods of stable remission over several years. But does not eliminate the cause of the development of the disease, nor the morphological changes that have been formed.
Management of the disease
An important part of controlling your COPD is learning to talk with your doctor and other health professionals about how you are feeling, how to take your medications and other medical treatments. Another important part of controlling your COPD is finding help from others who share your disease and many of the same experiences. Here are three tips to help you manage your COPD.
- The administration of medications is the key.
- Many people can live optimally with COPD and avoid exacerbations or outbreaks when they take their medication regularly and in the right way. You can work with your doctor to create a control plan. Be sure to take your medications as directed.
- Look for social support.
- Living with COPD can make you feel lonely. It has been shown that social support improves the quality of life in patients with COPD. Either through a support group in person or online, you can help yourself and others cope with this disease.
- Treat your lungs well.
- Taking care of your health and lungs can help you manage your COPD and feel your best. Ask your doctor about pulmonary rehabilitation to help increase your strength. If you smoke, leave the habit as soon as possible. Avoid lung irritants such as secondhand smoke, pollution or dangerous chemicals. Avoid crowds and make sure you are up-to-date with your shots.