If you see a person or are experiencing shortness of breath, difficulty in taking a deep breath, chest tightness, cough, and fatigue that persists even after using bronchodilators, it might be COPD!
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway. Emphysema and Chronic Bronchitis are conditions associated with COPD. The former involves the enlargement of airspaces distal to the terminal bronchioles. At the same time, the latter refers to a chronic cough with expectoration that occurs for three months over two consecutive years.
Risk Factors
The following factors increase the risk of developing COPD:
Genetic predisposition: Alpha-1 antitrypsin deficiency, MMP12 gene, Alpha nicotine Ach receptor, Hedgehog interactivity protein gene.
Age: Above 40 years.
Low birth weight: It may affect lung development.
Exposure to noxious particles: This includes tobacco inhalation (smokers and passive smoking), occupational exposure (coal, crop residues, wood, etc.), and outdoor air pollution.
Socioeconomic status: Studies show an association between poverty and COPD, though the contributing components remain unclear.
Clinical Features
Clinical features include-
Cough with sputum
Chest tightness
Dyspnea (shortness of breath)
Breath sounds: Quiet; crackles or wheezing may accompany.
Pitting edema
Chest X-ray: Hyperlucent lung fields, widened intercostal spaces, and a low, flattened diaphragm.
Barrel-shaped chest
Pulmonary Function Test: Post-bronchodilator FEV1/FVC < 0.7 confirms the presence of COPD, as bronchodilators have limited effect.
Classical Phenotypes
Course | Progressive dyspnea | Intermittent dyspnea |
Sputum | Scanty | Progressive |
Alveolar gas transfer | Reduced | Normal |
X-ray | Attenuated peripheral vessel | Normal peripheral vessel |
Treatment
Modifiable measures: Quitting smoking, using masks in occupational hazards or extreme air pollution, to reduce exposure to noxious air.
Pulmonary rehabilitation: Recommended at all stages and includes:
Patient education: Explaining the condition and the importance of adherence to the program.
Respiratory muscle training: Diaphragmatic breathing, pursed-lip breathing, thoracic mobility exercises, and inspiratory muscle training.
Strengthening and endurance training.
Aerobic exercise: Activities like walking.
Example: Thoracic expansion exercises in a sitting position on a chair.
Clearing airway secretions: Physiotherapy techniques like postural drainage and Active Cycle of Breathing Techniques (ACBT).
Vaccination: Annual influenza vaccination, especially before winter, to reduce the risk of secondary bacterial infections.
Bronchodilators: Limited efficacy but aerosols like salbutamol or rimiterol can help.
Acute exacerbation management:
Antibiotics for secondary infections.
Glucocorticoids: Oral prednisolone reduces symptoms and improves lung function.
Oxygen therapy: Low-concentration oxygen (24-28%) to avoid respiratory depression.
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