Question

Chronic Obstructive Pulmonary Disease: What is it? What is the pathophysiology of COPD? What are the symptoms? What causes it? Is there an "inherited" COPD? How is it treated? Can it be prevented? 

Answer 1

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

IT IS A PROGRESSIVE OBSTRUCTIVE LUNG DISEASE THAT CAUSES DIFFICULTY IN BREATHING AND WORSENS OVER TIME

It is characterized by a chronic obstruction of air flow in the lungs. It includes both chronic bronchitis and emphysema.

Pathophysiology

The main events that take place in COPD are -

Loss of elasticity of air sacs (alveoli). This happens in emphysema when air sacs are slowly destroyed. There is reduced recoil which prevents exhalation. Exhalation is then attempted by providing resistance through pursed lips. Less carbon dioxide is exhaled

In chronic bronchitis there is inflammation of the airways. The walls become thick and there is narrowing of the lumen which makes it difficult to breathe. This causes a whistling wheezing sound as air travels through narrow airways. Inflammation also leads to increase mucous production which leads to plugging of the airway.

There is decreased absorption of oxygen

Causes

Any chronic irritant that causes damage to the lungs and airways -

The most common cause of COPD is cigarette smoking

Environmental irritants such as dust, fumes and pollution

Allergies like dust mite and pollen allergies

In certain cases it can be caused by a deficiency of the alpha 1 antitrypsin (AAT).

THIS IS A GENETIC DISORDER AND IT IS INHERITED.

Symptoms

An ongoing/chronic cough accompanied by profuse tenacious mucous which if often frothy in appearance

Dyspnea/difficulty in breathing which is aggravated by the slightest exertion

Wheezing or whistling sound while breathing due to narrowing of the airways

Feeling of tightness of the chest as though the lungs cannot expand

If it is allergic COPD then it is often accompanied by allergic conjunctivitis (inflammation of the conjunctiva which causes redness and itching) and allergic rhinitis (running nose, itching in nostrils, sneezing, sinusitis etc)

Difficulty in lying down preventing sleep

In severe CODP there is -

Swelling of the ankles

Lips or fingers may turn blue due to lack of oxygen in blood

Tachycardia or increased heart rate

Weight loss

Barrel shaped chest (emphysema)

Low endurance

Treatment -

COPD is difficult to cure but it can be managed.

Goals of treatment

To provide symptomatic relief

Take measures that can slow the progress of the disease

Improving lung function

Improving exercise tolerance

Strengthening general immunity to reduce risk of infections

Medication

The main class of medicines used in COPD is bronchodilators along with leukotrienne inhibitors like Montelukast.

In severe cases the bronchodilators can be coupled with inhaled steroids like budecort.

Bronchodilators are of 2 kinds -

- Short acting used in inhalers

- Long acting used systemically

Pulmonary rehabilitation - aims at psychological counselling, nutritional support/correction and an efficient exercise program.

In case of severe COPD oxygen therapy can be considered in which oxygen is administered through a mask or nasal prongs.

This increases ability to perform tasks, sleep better and protects the organs from damage due to lack of oxygen

Surgical treatment

Bullectomy where large inelastic air sacs are removed

Lung volume reduction surgery - damaged tissue is removed

Lung transplant - where the damaged lung is replaced

Yes there is an inherited COPD

- Parents who are prone to respiratory allergies can pass on the allergic diathesis to their offspring which over time results in COPD

- In certain cases it can be caused by a deficiency of the alpha 1 antitrypsin (AAT), an inherited genetic disorder.

Prevention

First and foremost one has to incorporate lifestyle changes

Lifestyle changes include

- quit smoking

- a healthy diet with 40% intake of raw food of varied colors

- vitamins and dietary supplements. People prone to COPD have a Vit B 12 deficiency. Vit D from food and sunlight should be taken. Increase intake of Vit C because it is anti inflammatory in natureavoid allergens if you are allergic(dust mite. pollen etc.)

- practice deep breathing exercises

- have a healthy exercise regime

- handle stress with mindfulness and meditation