Chronic Obstructive Pulmonary Disease (COPD)

Table of Contents

What is Chronic Obstructive Pulmonary Disease COPD?

Chronic obstructive pulmonary disease (COPD) is a common lung disease that creates difficulty in breathing.
COPD is a progressive and devastating respiratory condition that limits the airflow in the lungs and thus making difficult to breathe.
COPD is not only a medical challenge but also a societal challenge with wide range of consequences for the health system and quality of life of a person.
COPD is one of the major causes of mortality and morbidity worldwide. Over 90% of COPD occur in Low-and-Middle Income Countries (LMICs)

There are two leading forms of COPD:

Most people with COPD have a grouping of both illnesses

Smoking is the leading cause of COPD.
In sporadic circumstances, nonsmokers who lack a protein called alpha-1 antitrypsin can also turn into emphysema (type of COPD which is characterized by damaged air sacs i.e. alveoli in the lungs, leading to difficulty breathing).

Chronic cough: cough that persists or more than 2 months are considered to be chronic by the healthcare providers
Gasping or noisy breathing/wheezing: whistling or squeaky sound while breathing.
Excess mucus production: May be noticeable as a “smoker’s cough”
Coughing up blood
Shortness of breath and fatigue: blockage in the air passage makes it difficult to breathe causing shortness of breath and fatigue
Chest stiffness and tightness
Frequent chest infections

COPD occurs mostly in older grownups and can affect individuals in their middle-ages.
It is not common in younger adults.
When people are younger, their lungs are usually in a healthy state. It takes several years for COPD to progress.
There are assured genetic conditions, such as alpha-1 antitrypsin deficiency, that can incline younger people to develop COPD.
The progression of the disease can differ faintly, so it is vital to emphasize potential COPD symptoms instead, the age.

Diagnosis of COPD is based on clinical evaluation and spirometry:

Spirometry is the gold standard for diagnosing COPD. It measures:
- FEV1 (forced expiratory volume in 1 second)
- Forced Vital Capacity (FVC)
- A post-bronchodilator FEV1/FVC ratio < 0.70 confirms airflow limitation.

Other diagnostic tools include:

Chest X-ray or CT scan: to detect emphysema or rule out other conditions
Pulse oximetry and arterial blood gases: to assess oxygenation
Alpha-1 antitrypsin testing: in younger patients or those with a family history

Discontinuation of smoking: Quitting smoking is the only most essential thing a smoker can do to live a longer and improved life.
Reduce contact to secondhand smoking
Staying away from harmful chemicals, dust and fumes at home and work
Coordinated effort of different sectors to support in cleaning up of the environment and air
Heavy taxation on tobacco products
Using clean cooking technologies like LPG and electric stoves
Community awareness and health education on the risks and management of COPD

1: Assess and monitor the disease

Assess the history of exposure to risk factors and the manifestation of airflow restriction
Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.
Use of Spirometry, the gold standard test for the assessment of COPD as it is the most reproducible, consistent, and unbiased way of measuring airflow limitation.

2: Decrease the risk factors and exposure to risk factors

Decrease the total exposure to tobacco smoke, industrial clouds of dust and chemicals, and indoor and outdoor air contaminants
Occupationally induced respiratory disorders can be reduced through different strategies to reduce exposure of dust and gases in the workplace.

3: Coping with COPD

Health education can play a vital part in refining skills, the capacity to cope with the ailment, and health status.
Pharmacotherapy for COPD can be used to decline the signs and complications.
Bronchodilator medications are fundamental to the symptomatic controlling of COPD.

4: Manage exacerbations caused by COPD

Exacerbations of respiratory symptoms necessitating medical intervention are significant clinical events in COPD.
Inhaled bronchodilators and if possible oral, glucocorticosteroids are operational for cures for acute exacerbations of COPD.
Patients undergoing COPD exacerbations with clinical signs of airway infection (e.g., amplified volume and change of color of sputum, or fever) may be benefitted from antibiotic treatment.

Limited resources and medicines in remote areas
Poor infrastructure
Limited knowledge and practice on occupational health and safety
Lack of adequate health workforce
Limited implementation research and development activities in the Low and Middle Income Countries