Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (or COPD), also called chronic obstructive bronchitis as well as pulmonary emphysema, is a chronic, difficult to treat lung disease characterized by narrowing of the bronchi - bronchial obstruction. Bronchial obstruction is almost irreversible (in contrast to bronchial asthma in which bronchial narrowing is reversible). COPD is one of the most common chronic diseases. It affects about 200 out of 100 000 inhabitants. It is more common in men.

Causes

There are several specific factors that lead to COPD: smoking, environmental pollution, frequent viral infections, immune disorders, obesity, alcoholism and etc. In most cases there are two or more factors that contribute to COPD. Genetic predisposition can be significant too. The most important cause of COPD is smoking. 90 percent of COPD patients are smokers.

The noxious particles mentioned above cause excessive inflammation of the lungs. The inflammation harms the bronchi and alveoli. As a result, bronchial reactivity disorders occur - the bronchi narrow, spasm, often get clogged with inflammatory secretion, therefore, the alveolar wall eventually gets thinner, the structure of the alveoli becomes destroyed and they expand. That results in a developing pulmonary fibrosis (scarring of the lungs) and emphysema (lung tissue dilation, increased lung inflation, rigidness, and completely disrupted function). Pulmonary blood vessels are affected too.

Signs and symptoms

The disease usually starts in middle or older age (40 - 70 years). Of course, the inflammation usually occurs much earlier, but initially the disease usually does not cause any symptoms. The first signs of COPD are cough and sputum. Later the respiratory function gradually decreases, shortness of breath slowly occurs, but the patient adapts to it by becoming less active. The dyspnea is expiratory - it is more difficult to exhale than to inhale.

Clinically COPD usually manifests in exacerbations and remissions. Exacerbations are usually provoked by bacteria or viruses, co-morbidities, weather changes and etc. Shortness of breath, cough, and fever occur during the exacerbation. Such patient's condition is severe, he/she is sitting bent forward, as it is easier to breathe this way. The skin becomes bluish because of the lack of oxygen, breathing is shallow. Often patients in such condition are treated in intensive care units.

When COPD progresses, the chest becomes barrel - shaped and rigid. As the respiratory failure worsens, remissions become shorter and exacerbations become more frequent. Pulmonary blood supply disorder causes pulmonary hypertension and right ventricular failure. These patients usually die of terminal respiratory failure, heart failure, or a contributed infection - pneumonia.

Diagnostics

  • COPD is suspected during inspection and examination. During the patient's lung auscultation, dry, various timbre rales are heard.  The heart sounds are weakened because of the increased lung inflation.
  • X-ray may show pulmonary fibrosis, increased inflation (emphysema), pulmonary hypertension and right heart ventricle enlargement (only one or more of these symptoms are possible). It is important that at the initial stage of the disease X-ray image does not show any changes. An exacerbation may have signs of pneumonia.
  • Respiratory function tests - spirometry - show almost irreversible obstructive type respiratory disorder.
  • Blood gas analysis shows decreased oxygen and increased carbon dioxide levels.
  • Blood tests show increased amounts of red blood cells and hemoglobin - the body's reaction to the continuous lack of oxygen.

Treatment

The progression of the disease can only be stopped by quitting smoking. Medications used to treat COPD:

  • Bronchodilatators: beta-mimetics (salbutamol, salmeterol), anticholinergics (Ipratropium Bromide). These drugs are usually inhaled. There also are oral ones - methylxanthines.
  • Glucocorticoids - hormonal anti-inflammatory drugs. Inhaled (beclomethasone) and injected (methylprednisolone) glucocorticoids are used to treat COPD.
  • Exacerbations are treated with antibiotics.
  • Mucolitics (acetylcysteine, ambroxol) are used to thin the mucus. Their effectiveness has not been proved yet. The mucus is effectively thinned by large fluid consumption.
  • Oxygen therapy - if the respiratory failure is severe.
  • Physiotherapy and respiratory gymnastics are also used. It is essential to maintain a healthy diet, eat vitamin-rich foods.

Prognosis

The disease is continuously progressing, and smoking, older age, comorbid diseases and cardiac failure worsens its prognosis. People suffering from severe COPD averagely live less than 6 years.

   

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