Amongst the various diseases causing breathlessness, one of the most common ones and an easily preventable one, is Chronic Obstructive Pulmonary Disease (COPD). Traditionally, the term COPD refers to include Chronic Bronchitis and Emphysema. It is a disease, which causes permanent, irreversible damage to the airways as well as the lung tissue, making it hard for an individual to breathe. It is a leading cause of morbidity and mortality in adults, worldwide and will remain a challenge for the future.
The burden of COPD is projected to increase in coming decades due to continued exposure to COPD risk factors and the aging of the world’s population. Deaths attributable to COPD have increased sharply. It is currently the fifth leading cause of death but the rate at which its prevalence is increasing; it will soon become the fourth leading cause of death, globally. Hospitalizations attributable to COPD are also sharply increasing and every hospitalization leaves the patient with some further irreversible damage to the lungs. In our country, this progressive disease affects more than 12 million people with a prevalence of respiratory symptoms in 6%– 7% of non-smokers and up to 14% of smokers.
The disease usually occurs as a result of an inflammatory response to various noxious stimuli like tobacco smoke, outdoor and indoor air pollution, pollution from heating and cooking with biomass in poorly ventilated dwellings, organic and inorganic dust and myriad of other agents like chemicals, dust and fumes. The biggest risk factor for COPD is tobacco smoke. Smoking whether it be a bidi, cigarette, pipe, cigar, sheesha or even second hand smoke (passive smoking) is equally harmful. Tobacco smoke contains over 4,000 harmful chemicals, many of which can damage the lungs. Passive smoking can be even worse as two-thirds of the smoke from a cigarette isn't inhaled by the smoker, but enters the air around the smoker, which is then inhaled by the unsuspecting bystanders. Nearly 90% of COPD patients are smokers. Genetic factors play a role in non-smokers, especially.
It is most common in men over 40 years of age. The common symptoms are cough, breathlessness, tightness of chest and wheezing. Wheezing refers to whistling or squeaky sound when an individual breathes. Mild symptoms in the initial period could go unnoticed, as the patients tend to adjust their lifestyle to make breathing easier. They start to restrict their physical exertion like they would take the elevator instead of the stairs, or avoid going for morning walks. Over time, the symptoms progress. The severity of the symptoms will depend on the extent of lung damage. If smoking or the exposure to noxious elements continues then the damage will occur faster. As the disease progresses other symptoms, such as swelling in the ankles, feet, or legs; weight loss; and lower muscle endurance, bluish discoloration of fingers appears.
COPD is linked to various systemic diseases, such as cardiovascular disease, diabetes, osteoporosis and possibly peptic ulcer. Studies suggest that cardiovascular risk should be monitored and treated with particular care in any adult with COPD and that COPD and should be carefully considered in patients with chronic heart failure.
COPD and lung cancer commonly occur in the same patient. The presence of moderate or severe COPD is a significant predictor of lung cancer in the long term.
A clinical examination and a simple test, called spirometry can be used to measure pulmonary or lung function and detect COPD in anyone with breathing problem.
Even if risk factors were avoided today, the toll of COPD would continue for several decades because of the slow development of the disease. Once developed, COPD and its comorbidities cannot be cured and must be treated continuously. The mainstay of therapy is the use of drugs called bronchodilators and steroids from time to time. While, Bronchodilators relax the muscles around the airways, help open the airways and makes breathing easier, steroids are used to control the inflammation. Inhaled steroids with the bronchodilator are given through inhalers for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve the breathing problems or not. Inhalers are preferred over tablets or syrups as the dosage is in micrograms (much less than any other form), the drugs are acting locally and not causing any significant systemic side effects. Domicilary Oxygen therapy and non invasive ventilation (NIV) are often given to patients with advanced disease.
Certain lifestyle changes can help patients feel better, stay more active, and slow the progress of the disease. Regular brisk walk, arm curl and forward arm exercises, calf raising and deep breathing exercises are strongly recommended. A low carbohydrate diet with extra proteins, eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements is also helpful for the health of the lungs.
People who have COPD are at higher risk of pneumonia and can develop severe life threatening complications following a simple influenza infection. All such patients should take the influenza and pneumococcal vaccinations periodically.
Early detection of COPD might change its course and progress. Also, one should try to avoid lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust.
Dr.Nangia was one of the five Physicians from across the globe and the only one from India to be felicitated by her Royal Highness Princess Royal of London on successfully completing the prestigious program of infectious diseases.
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