COPD

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that reduces airflow to the lungs, leading to persistent breathing difficulties.

COPD encompasses two main conditions:

• Chronic bronchitis: Characterized by persistent inflammation of the inner lining of the bronchi, resulting in mucus buildup and airway obstruction.
• Emphysema: Marked by irreversible damage to the air sacs (alveoli) at the ends of the bronchi in the lungs, impairing oxygen exchange.

Most individuals with COPD experience both pulmonary emphysema and chronic bronchitis, though one condition is often more prominent.

COPD affects hundreds of millions of people worldwide and ranks among the top three causes of death globally. While it is currently incurable, appropriate medical treatment and lifestyle modifications can improve quality of life and help mitigate complications associated with the disease.

The primary signs and symptoms of COPD include:

• Dyspnea (difficulty breathing).
• Mild persistent cough that may or may not produce mucus (sputum).
• Chronic sputum production.
• As the disease progresses, difficulty breathing may limit the ability to perform daily activities.
• Exacerbations (episodes of symptom worsening), often triggered by respiratory infections.
• Worsening of coexisting conditions, especially cardiovascular diseases, metabolic syndrome, osteoporosis, muscle disorders, depression, anxiety, and lung cancer.
• Other symptoms may include a feeling of chest tightness, constant fatigue, and wheezing (a whistling sound in the chest), which may be heard by the person or detected by a doctor during auscultation.

Smoking is responsible for over 80% of cases of emphysema, chronic bronchitis, and other chronic lung diseases, making it the primary cause of COPD. Most individuals with COPD are current or former heavy smokers.

Another known cause of COPD is a rare, inherited deficiency of the protein alpha-1 antitrypsin, which normally protects the lungs. People with this deficiency often develop severe emphysema at an unusually early age, often before age 30 or 40.

In addition, frequent or prolonged exposure to air pollution, chemical fumes, and dust can contribute to COPD development. Respiratory infections in early life may also increase the risk, particularly when combined with other risk factors.

A primary care doctor can diagnose COPD by evaluating the patient’s medical and personal history along with a physical examination.

COPD should be suspected in individuals who have a persistent cough, sputum production, or dyspnea, particularly if they have been exposed to cigarette smoke or other air pollutants over an extended period.

The definitive diagnosis is made using spirometry, a lung function test. During this test, the person blows forcefully into a spirometer both before and after using a bronchodilator medication. The spirometer produces a curve that helps determine the degree of airflow obstruction in the lungs, confirming COPD and assessing its severity, which also guides treatment options.

A chest X-ray can assist in differentiating between chronic bronchitis and emphysema and help rule out other potential lung diseases.

While COPD cannot be cured, effective medical management and healthy lifestyle habits can improve quality of life, increase physical activity tolerance, and reduce the risk of complications.

COPD treatment is personalized and based on four key factors:

1. Severity of airflow obstruction: Classified as mild, moderate, severe, or very severe.
2. Intensity of symptoms and exacerbations: Assessed through tools like the mMRC (Modified Medical Research Council) Dyspnoea Scale, ranging from Grade 0 to 4, or the Chronic Respiratory Questionnaire (CRQ).
3. Blood eosinophil count: Helps determine whether adding an inhaled corticosteroid to the bronchodilator regimen might be beneficial.
4. Presence of other diseases.

The main goals of the treatment are:

1. Reduce symptoms: Alleviate discomfort, enhance exercise capacity, and improve overall well-being.
2. Reduce risks: Lower the likelihood of disease progression, acute exacerbations, and premature death.

The main treatment options for COPD are:

1. Medication: Combination therapies are often used to manage COPD symptoms effectively. Common medications include:
   • Bronchodilators: These relax and widen the airways, helping more oxygen reach the lungs. Inhalers are generally the preferred form of bronchodilators. Types include:
     • Short-acting beta-2 agonists (SABAs): such as salbutamol and terbutaline, primarily used in asthma but also in COPD under specific circumstances.
     • Long-acting beta-2 agonists (LABAs): such as salmeterol, formoterol, and vilanterol.
     • Long-acting muscarinic antagonists (LAMAs): such as tiotropium, aclidinium, and glycopyrronium.
   • Inhaled corticosteroids (ICS): such as beclomethasone, budesonide, and mometasone. These reduce inflammation in the airways and are often combined with bronchodilators.
   • Combination Inhalers: Include combinations like LABA + LAMA or LABA + LAMA + ICS for patients with more advanced COPD.
   • Antibiotics: Used to treat bacterial infections during exacerbations and, in some cases, to prevent infections in high-risk patients.
   • Oxygen Therapy: For severe hypoxemia (low oxygen levels), long-term oxygen therapy improves survival and quality of life.
2. Vaccines: Vaccines help prevent respiratory infections that can worsen COPD. Recommended vaccines include:
   • SARS-CoV-2 (COVID-19).
   • Influenza (annually, before flu season).
   • Pneumococcal (usually a one-time dose).
   • Tdap (tetanus, diphtheria, and pertussis) for those unvaccinated in adolescence.
   • Shingles vaccine.
   • Respiratory Syncytial Virus (RSV) vaccine, recommended for people over 60 or those with chronic heart or lung diseases.
3. Exercise:
   • Aerobic and resistance exercises, supervised by medical professionals, can improve endurance and strength without increasing lung function but can improve oxygen usage.
   • Breathing exercises: Strengthen respiratory muscles and assist in clearing mucus.
4. Nutrition and hydration:
   • A balanced diet is crucial to maintain strength and prevent infections. Smaller, frequent meals may help those who experience breathlessness while eating.
   • Hydration is essential, with a recommended intake of at least eight glasses of water per day to keep mucus looser, aiding in effective coughing.
5. Lifestyle and Preventive Measures:
   • Avoid smoking and exposure to secondhand smoke.
   • Avoid contact with sick individuals.
   • Seek medical attention at the first sign of infection.
   • Always breathe through your nose to allow warmer air to enter the lungs. In the middle of winter, use a scarf to cover your mouth and nose.
   • On days with high pollution levels, due to high ozone or other contaminants, stay indoors with windows closed.
   • Avoid inhaling dust, car exhaust fumes, paint, aerosols, and similar substances.
   • Use a humidifier if the home air is dry.
   • Check inhaler technique with a healthcare provider to ensure proper medication use.

For advanced cases, surgical options like lung volume reduction or interventional bronchoscopy may be considered to alleviate severe symptoms.

Future therapies and clinical trials are ongoing, potentially offering new treatment options to improve quality of life for people with COPD.

Preventing COPD is possible by reducing exposure to tobacco smoke in all areas of life—this includes family settings, schools, medical consultations, and public health and legislative efforts.

Creating a smoke-free environment is the most effective way to prevent this disabling disease. This is particularly important for individuals at higher risk, such as those with other chronic conditions or those showing early respiratory symptoms, even if lung function tests are still normal.