Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease causing persistent airflow limitation.

COPD is a long-term, irreversible condition that obstructs airflow to the lungs, primarily due to inflammation and damage to lung tissue.

It is one of the leading causes of morbidity and mortality globally.

The disease significantly affects quality of life, often leading to disability and premature death.

It includes two primary conditions: chronic bronchitis and emphysema.

Impact in India

In India over 55 million COPD patients found in last year accounting for approximately 32% of global COPD deaths

COPD is the second leading cause of death and disability in India after ischemic heart disease.

Global impact

Over 300 million people worldwide suffer from COPD.

It is the third leading cause of death globally, contributing to 3.23 million deaths annually.

COPD in India and Globally impact

Causes

COPD develops due to long-term exposure to irritants that damage the lungs and airways, causing inflammation, and limiting air flow.

The major causes of COPD mention below.

1. Smoking

• Smoking is the most significant risk factor for COPD. Nearly 85–90% of cases are attributed to smoking.

2. Environmental Pollution

• Prolonged exposure to air pollutants, such as dust, chemical fumes, and industrial smoke also damage your lungs.

3. Genetic Factors

• Alpha-1 antitrypsin deficiency, a genetic condition, predisposes individuals to early-onset COPD.

4. Workplace Hazards

• Long-term exposure to irritants like coal dust, silica, or grain dust is associated with COPD.

5. Infections

• Frequent childhood respiratory infections can impair lung development and increase COPD risk later in life.

Symptoms

Chronic Obstructive Pulmonary Disease (COPD) symptoms include:

Common Symptoms:

· Chronic Cough

· Excessive Mucus (Sputum) Production

· Shortness of Breath

· Wheezing

· Chest Tightness

· Frequent Respiratory Infections

· Fatigue

· Cyanosis

· Unintentional Weight Loss

· Swelling in Ankles, Feet, or Legs

Stages and Symptom Progression

Diagnosis

The diagnosis of COPD involves a combination of medical history, physical examination and specialized tests to confirm the condition and assess its severity.

1. Medical history:

Ongoing symptoms such as chronic cough, sputum production, and shortness of breath.

A history of smoking or exposure to both indoor and outdoor air pollutants.

A family history of respiratory diseases or alpha-1 antitrypsin deficiency.

2. Spirometry (Primary Diagnostic Test)

• Gold standard for COPD diagnosis.

• Measures lung function and airflow limitation.

• Key Indicators:

  • FEV1 (Forced Expiratory Volume in 1 Second): Reduced in COPD.

  • FVC (Forced Vital Capacity): Total amount of air exhaled.

  • FEV1/FVC Ratio: A value below 70% confirms airflow obstruction.

· Based on spirometry results, COPD is classified into four stages

3. Imaging test:

A. Chest X-ray

A chest X-ray is commonly used to visualize lung structures. It can show hyperinflation, indicating trapped air in the lungs, and a flattened diaphragm, which suggests reduced lung capacity. These signs may indicate conditions like chronic obstructive pulmonary disease (COPD).

B. CT Scan:

A CT scan provides detailed cross-sectional images of the lungs. It is particularly useful for assessing lung damage, such as emphysema, by revealing damaged air sacs and structural abnormalities, aiding in the diagnosis and management of respiratory conditions.

4. Blood Tests

Here are some important tests that are often used to diagnosis COPD:

A. Arterial Blood Gases (ABG):

This test measures the levels of oxygen and carbon dioxide in your blood. It's a great way to see how well your lungs are doing their job in exchanging gases. It can tell your doctor if you’re getting enough oxygen or if carbon dioxide is building up, which might indicate more severe lung issues.

B. Alpha-1 Antitrypsin Levels:

This test checks for a specific protein that protects your lungs. Low levels of this protein can suggest a genetic risk for lung diseases, including COPD, particularly emphysema.

C. Complete Blood Count (CBC):

A CBC can show signs of infection or inflammation that could complicate your COPD.

D. Sputum Culture:

If you notice a change in your sputum like increased production or a different color then sputum culture will done. This test helps identify any infections that could be affecting your lungs.

Treatment

Treating Chronic Obstructive Pulmonary Disease (COPD) is all about making life easier and more comfortable for those affected. Here’s a closer look at the various treatment options available:

1. Medications: -

· Bronchodilators: These are inhalers that help open up your airways, making it easier to breathe.

· Corticosteroids: These medications help reduce inflammation in the lungs, making it less likely for your symptoms to worsen. They were usually prescribed for those with moderate to severe COPD.

· Phosphodiesterase-4 Inhibitors: This type of oral medication can help reduce inflammation in the lungs and relax the airways for those with more advanced COPD.

2. Oxygen Therapy:-

· If your oxygen levels drop too low, your doctor might recommend using supplemental oxygen. This can help you breathe easier, especially during daily activities.

3. Lifestyle Changes:

· Quit Smoking: If you are a smoker, this is the single most important step you can take. Stopping smoking can significantly slow the progression of the disease.

· Healthy Diet and Exercise: Eating well and staying active can boost your overall health and help your lungs function better.

Prevention

Preventing Chronic Obstructive Pulmonary Disease (COPD) is all about taking proactive steps to protect your lungs and overall health. Here are some effective step to reduce the risk of developing COPD:

1. Quit Smoking:

· Smoking is the leading cause of COPD, so finding support to quit whether through counseling or medications can make a huge difference.

2. Avoid Secondhand Smoke:

· Try to avoid places where people smoke and encourage those around you to be smoke-free.

3. Limit Exposure to Pollutants:

· Both indoor and outdoor air pollution can contribute to lung damage. Try to minimize exposure to irritants such as dust, chemical fumes, and strong odors. Use air filters in your home and wear masks if you are in environments with high levels of dust or chemicals.

4. Maintain a Healthy Lifestyle:

· Eating a balanced diet rich in fruits, vegetables, and whole grains can boost your immune system and overall health.

· Regular exercise is also important to helps improve lung function and strengthens your body, making it better able to cope with respiratory challenges.

Complications

COPD can lead to several complications that affect health and daily life.

1. Frequent Respiratory Infections:

· Individuals with COPD are more susceptible to colds and pneumonia.

2. Respiratory Failure: Advanced

· COPD may lead to a failure of the lungs to provide adequate oxygen or remove carbon dioxide.

3. Heart Problems:

· COPD increases the risk of heart disease, including heart attacks, due to the strain low oxygen levels put on the heart.

4. Pulmonary Hypertension:

· This condition occurs when blood vessels in the lungs narrow, making it harder for the heart to pump blood, leading to symptoms like breathlessness.

5. Increased Lung Cancer Risk:

· There is a higher chance of developing lung cancer among those with COPD, particularly in smokers.

6. Weight Loss and Muscle Weakness:

COPD may cause unexpected weight loss and muscle weakness, making everyday activities more difficult.

7. Depression and Anxiety:

Psychological impact due to reduced quality of life.

Risk Factor Distribution in COPD Cases

Questions and Answers

Q1: Is COPD curable?

A: No, COPD is a chronic and progressive condition. However, symptoms can be managed effectively with treatment.

Q2: Can non-smokers develop COPD?

A: Yes, non-smokers exposed to environmental or occupational pollutants, or those with genetic predisposition, can develop COPD.

Q3: How is COPD different from asthma?

A: COPD is usually caused by long-term exposure to harmful substances and is not fully reversible, while asthma is typically triggered by allergens and often reversible with treatment.

Q4: What is the role of diet in COPD management?

A: A diet rich in antioxidants and anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, can support lung health.

About author

Himanshu Paneru is the founder and author of DOC NOTE MASTER,

a platform dedicated to sharing insightful articles on medical topics

and education. Currently pursuing a master’s degree in Medical

microbiology at Netaji subhash chandra bose sybharti medical

college Dehradun, Uttarakhand. Himanshu combines his academic

knowledge with a passion for writing.

References:

Ashwani verma et al. Prevalence of COPD among population above 30 years in India: J Glob Health. 2021 Aug 21;11:04038. doi: 10.7189/jogh.11.04038

Dhruv M Shah , Ravish M Kshatriya , Rajiv Paliwal Comparison of demographic, clinical, spirometry, and radiological parameters between smoking and non-smoking COPD patients in rural Gujarat, India: J Family Med Prim Care. 2021 Sep 30;10(9):3343–3347. doi: 10.4103/jfmpc.jfmpc_87_21