The guidelines define chronic obstructive pulmonary disease as a state marked by airflow limitation that is not fully reversible, progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. What a mouthful! To put it simply, in COPD, the flow of air into and out of the lungs becomes very tight and impaired. In COPD, the airways become progressively narrower or tighter, making breathing difficult. This also gives a person the sensation of the lungs being heavy and full of air.
Emphysema, on the other hand, results from the destruction of the alveoli (the small compartments or air sacs of the lungs), resulting in poor absorption of oxygen and poor release of carbon dioxide. The enlargement of the alveoli also leads to pooling of secretions that may be difficult to cough out and easily become infected with bacteria. Another change that happens in COPD is increasing reactivity of the airways, leading to symptoms of airway tightness and wheezing similar to asthma.
The main culprit causing COPD is noxious gases.
Among the noxious gases, cigarette smoke is the most common cause. Smoking accounts for as much as 90% of the risk of having COPD. As of 2013, the number of current smokers in the Philippines is around 25.4%. Add to this statistic the people exposed to second-hand smoke. Exposure to pollutants on a long-term basis, commonly as a result of occupational exposure (e.g. among public utility vehicle drivers or traffic enforcers) is another cause. Both in the rural and some urban settings, chronic exposure to smoke from cooking fires and other burning materials are also causes of COPD, even in non-smokers. Rare causes of COPD include people with deficiencies in a protein called alpha-1-antitrypsin, HIV, and rare connective tissue diseases like Marfan syndrome.
What happens to a person with COPD?
At the start, symptoms are often ignored because of the insidious course. People start out with a persistent cough, often with phlegm production. Other conditions like allergies or viral infections are often blamed for the cough. As months go by, coughing persists or recurs intermittently. Shortness of breath may occur with bouts of wheezing. COPD suffers start to modify their daily activities as a result of the shortness of breath. Infections, or other noxious gases may trigger “sudden” or acute episodes of worsening of breathing, which may need treatment in the clinic or hospital. Eventually, if there is continuous exposure to the noxious stimuli, damage progresses, leading to breathlessness even at rest.
Okay, so does your persistent coughing and shortness of breath worry you? Do you smoke? You have to see your doctor for further examination and testing. A formal determination of COPD is made with spirometry. This test involves blowing into a computerized instrument at hard and as long as you can, so that the speed and volume of your exhaled breath, and other parameters can be computed.
What can be done for COPD?
The first thing to do is to stop further exposure to noxious gases, STOP SMOKING. Inhaled medications called bronchodilators, aim to relax the airways and relieve some of the breathlessness. Other medications that help relax the airways include oral xanthine derivatives and phosphodiesterase inhibitors. Corticosteroids help relieve the inflammation that underlies COPD. Some drugs come in convenient combinations (e.g. inhaled beta-agonist + inhaled steroids). Antibiotics may need to be given in situations where infections are triggering worsening of the symptoms.
Patients with severe COPD may need to stay on prolonged or even continuous oxygen therapy. In some extreme cases, surgery to reduce lung volumes or lung transplantation may be a rare option. Because of the progressive and debilitating nature of COPD, it is prudent to also discuss end-of-life issues, especially for those with very severe disease. Vaccination against influenza and pneumococcal pneumonia is very important in reducing infections that can cause COPD exacerbations.
Hopefully, with all of the measures government and the healthcare sector is doing, the number of people having their breaths taken away will start going down. Oh…did I forget to say STOP SMOKING?