Chronic Obstructive Pulmonary Disease is a group of diseases that lead to pulmonary dysfunction, characterized by difficulty in breathing.
Its main cause is smoking, followed by inhalation of pollution and chemicals. COPD is generally made up of chronic bronchitis and emphysema .
It is a progressive disease that mainly affects people over 35 years of age, smokers, former smokers, coal workers, potteries, pizzerias, among others. Rarely, the disease has a genetic cause and affects younger people.
How do the lungs work?
To understand the disease, you have to understand how the lungs work. When you breathe, the air goes down a structure called the trachea, which joins the bronchi.
The air passes through these two tubes and is carried through the bronchioles to the alveoli, small “sacs” of air where the gaseous exchange occurs that guarantees the oxygen levels in the blood.
Diseases that make up COPD
COPD is generally made up of two conditions; chronic bronchitis and pulmonary emphysema.
Chronic bronchitis: inflammation characterized by frequent phlegm cough, in addition to excess mucus production. It is chronic because it affects the patient frequently.
Emphysema: characterized by inflammation and destruction of the alveoli, as well as changes in the functioning of the remaining wells, leaving the lung full of air-retaining holes.
Therefore, the exchange of gases is affected, which contributes to decrease the concentration of oxygen in the blood, while the carbon dioxide remains unchanged.
Other diseases that are also on the COPD spectrum are chronic non-reversible asthma and some types of bronchiectasis.
The disease is also characterized by exacerbations, or periods of crisis when there is sudden worsening of symptoms such as increased cough, sputum and the amount of worsening of normal shortness of breath.
These crises often contribute to the more rapid development of the disease.
When the disease is not treated or even diagnosed, the patient becomes short of breath when performing simple day-to-day tasks, such as walking, climbing stairs, bathing standing, among others. In extreme cases, shortness of breath occurs even when you are at rest.
Causes of COPD
The lung depends on the elasticity of the bronchi to expel air from the body. The loss of that elasticity causes air to be trapped in the lungs, instead of being eliminated naturally. This loss can occur due to the following conditions:
Cigarette, smoke and chemicals
About 85% of COPD cases are caused by smoking, or by cigarette smoke. However, the number of smokers to develop COPD is approximately 20% only.
Similar conditions that directly damage the lung are exposure to pollution and the chemical.
These are the other 15% of COPD patients. They are people who spend a lot of time or work in places with a lot of dust, smoke, secondhand smoke and other irritants.
The condition can be caused by genetic factors that provide deficiency in the enzyme alpha-1-antitrypsin, which helps protect the lung. Thus, this deficiency makes the person more susceptible to lung damage and, consequently, to the development of COPD.
For this reason, the disease can also affect younger people, non-smokers and who have not been exposed to the substances that cause the disease for a long time.
In addition to smoking, some risk factors related to COPD include:
- Passive exposure to cigarette smoke.
- History of tuberculosis.
- Chronic asthma
- Exposure to smoke from cars, chimneys, etc.
- Frequent use of fire for cooking without adequate ventilation.
- Recurrence of lower airway infections as a child.
COPD symptoms start suddenly, usually from the fourth decade of life, with a cough and shortness of breath after exertion.
These symptoms are confused with the effects of age and are therefore ignored. Therefore, the patient can only perceive the problem when it is too late. About 50% of respiratory function is already lost at the time of most diagnoses.
For this reason, it is important to be attentive to the symptoms and their intensities, since they tend to become more intense as time passes.
The following are symptoms of COPD:
- Shortness of breath when performing simple day-to-day tasks, such as walking or doing housework.
- Chronic cough that lasts a long time or comes and goes often.
- Increased production of mucus (catarrh), which is expelled by coughing. In some cases, the cough may be accompanied by blood.
- Ease of contracting respiratory infections.
The intensity of the symptoms depends on the size of the lung damage. If the patient continues to smoke or is exposed to harmful substances, the damage increases and the symptoms become more intense.
This happens in most cases, and the symptoms that come and go end up getting stronger than the last time they were present.
What is the difference between COPD and asthma?
Some symptoms of asthma are very similar to those of COPD, and therefore many people may end up confusing the diseases. At an anatomical level, the two diseases are similar, but have an extremely important differentiating factor: reversibility.
In COPD, the airways are permanently narrowed, and bronchodilator medications help only to a limited extent, as the damage is not reversible.
Meanwhile, asthma is characterized by temporary narrowing of the airways, which usually occurs when the patient is exposed to irritants, such as dust, pollen, and smoke.
In the case of asthma, medicines help to open the airways completely, so that the patient can breathe normally. Furthermore, there is, in asthma, the destruction of the alveoli.
It is important to remember, however, that some types of asthma, chronic and irreversible, can be within the spectrum of COPD.
How is COPD diagnosed?
Typically, the diagnosis of COPD is made through the patient’s history and various physical examinations.
The doctor, usually a general practitioner, may wonder if the patient smokes, if he works or worked in places where there is a lot of smoke and noxious substances that may have been inhaled for a long time.
History of respiratory tract infections and family health history may also be asked.
In order to diagnose COPD, a GP may refer the patient to a pulmonologist, a specialty who deals with diseases of the respiratory tract.
Physical exams are:
It is one of the main tests that aid in the diagnosis. Its function is to measure lung volume, flow, and capacity. The test consists of inhaling deeply and exhaling, with the mouth, as hard as possible, into a tube connected to a device called a spirometer.
To carry out spirometry, the following is calculated:
- Forced Vital Capacity (FVC).
- Forced expiratory volume in one second (FEV1).
The results are expressed as a percentage of what was expected, according to the normal values regarding the sex, age and height of the patient. Thus, spirometry helps to classify the degree of COPD into:
Grade 0: normal lung function at risk despite chronic cough and sputum.
Grade I: mild COPD demonstrates mild airflow limitation (with FEV 1 / FVC less than 70%, but with FEV 1 greater than 80% of predicted). Generally presents chronic cough and expectoration. At this stage, the patient may have no idea that their lung function is impaired.
Grade II: Moderate COPD Airflow limitation worsens (with FEV 1 greater than 50% and less than 80% predicted), causing progression of symptoms such as shortness of breath. Exacerbations are normally seen from this stage.
Grade III: severe COPD When there is severe airflow limitation (with FEV 1 less than 30%) or the presence of respiratory failure, and the clinical signs of right heart failure. Thus, the quality of life is quite detrimental, and exacerbations can constitute a threat to life.
Chest imaging exams
The doctor should order conventional X-rays or CT scans of the chest region. These tests can show signs of COPD or other conditions that may be causing the symptoms, and it is important to make sure it is not another disease.
Blood gas tests, such as oximetry, which measures the rate of oxygen gas in the blood, may be done. Such tests can show gas rates and show an increase in carbon dioxide, a sign that helps with the diagnosis.
In general, laboratory tests are not used to diagnose COPD. However, in some cases, tests may be ordered to make sure that it is not another condition.
In the case of patients with a family history of alpha-1-antitrypsin deficiency, laboratory tests are responsible for the correct diagnosis of the disease.
Differential diagnoses are diseases that can be confused with COPD, even after performing various tests and, therefore, many times need further tests to be sure.
Some diseases that can be confused with COPD are:
- Congestive heart failure
Is COPD Curable? Which is the treatment?
Unfortunately, COPD is a disease that causes irreversible damage to the lungs and therefore has no cure.
The treatment seeks to increase the survival of the patients, in addition to guaranteeing quality of life even with the obstacles provided by the disease. Some of the recommendations are:
The first step for smokers is to quit smoking. There are several programs, public and private, that seek to assist in overcoming the vice. In the market there are also products that help to stop: chewing gum, pills, adhesives, among others.
Medical supervision at this stage is very important, and depending on the case, some doctors may indicate the use of antidepressants to help in the process.
When necessary, the patient can receive oxygen therapy, which consists of the medical application of oxygen. This therapy prevents carbon dioxide poisoning due to high levels of it in the bloodstream.
Respiratory rehabilitation physiotherapy
Having lost much of their lung function, patients may need physical therapy for respiratory rehabilitation.
Due to irreversible damage, the patient will not fully regain respiratory function, but physical therapy can help him to make the most of his breathing capacity.
Mechanical ventilatory support
Machines like BiPAP are alternatives for people with severe respiratory failure. These devices “push” the air into the lungs, so that breathing is facilitated and the change of gases, for the removal of carbon dioxide from the system.
COPD patients are more likely to get respiratory infections and therefore it is very important to get vaccinated against flu and pneumonia often. The contraction of such conditions could lead to serious complications for the patient.
Volume reducing surgery
In some people, bulking surgery can be done. This procedure consists of removing the most affected areas of the lung, which helps in the function of the healthiest areas.
For a very small number of people, a lung transplant may be an alternative. When the patient does not improve with any of the treatments and a compatible lung is available, this is an option to consider.
Medicines for EPOC
The pharmacological treatment of COPD depends on the severity of the disease and consists of bronchodilators, corticosteroids (for a limited time) and antibiotics during acute attacks (exacerbations).
Medications can be oral, in the form of tablets or capsules, or inhaled, as a dry powder.
Controlled and emergency medications
For the treatment of COPD, there are two types of medications: controlled and emergency.
Prescription medication must be taken every day and does not promote immediate relief and is responsible for maintaining long-term respiratory function.
Already emergency medications are used for attacks (exacerbations), and unblock the airways in about a minute.
Controlled medications should not be given up for emergency medications only when necessary, as this can lead to further damage to the respiratory system.
- Bromide ipratropium .
- Tiotropium bromide.
- Terbutaline sulfate.
- Formoterol Fumarate.
- Indacaterol maleate.
Never self-medicate or stop using a medication without consulting a doctor. Only he will be able to say which medicine, dosage and duration of treatment is the most suitable for his specific case.
The information contained in this site is only intended to inform, not intended, in any way, to replace the guidance of a specialist or serve as a recommendation for any type of treatment.
Always follow the instructions in the package leaflet and, if symptoms persist, seek medical or pharmaceutical advice.
Living with COPD
Living with COPD may seem impossible, since the disease causes many limitations due to shortness of breath.
However, there are some steps that can be taken to prevent the disease from developing more quickly and lessen the discomfort caused by the symptoms. These are some of the recommendations:
It is important not to be inactive, as it could further damage your respiratory function, as well as easily trigger emotional disorders such as depression . Some tips are:
- Ask your physical therapist how far you can walk each day.
- Increase your walking time little by little from time to time, according to your breathing capacity.
- When you feel short of breath during walks, do not speak, as the act of speaking uses more air.
- Expel air slowly through your mouth when walking, so your lungs are empty when you breathe in again.
- Do not do exercises that require a large lung capacity to perform.
- Do simple and light exercises, as developing muscle strength helps in breathing capacity. If necessary, consult your physical therapist to define a physical exercise routine.
To improve the quality of life, some adaptations in routine, at home, at work and wherever necessary may be necessary.
- Ask for help when you need it, don’t waste air unnecessarily.
- Avoid very hot or very cold weather.
- Avoid living with smokers.
- Avoid barbecues and other festivities with high concentrations of smoke.
- Reduce air pollution in the house, getting rid of irritants.
- Rearrange your home so essential environments and objects are easily accessible.
- Plan your days better to make sure you have plenty of time to rest and catch your breath when needed.
Breathe clean air
With reduced breathing capacity, it is not only the amount of air that counts, but also the quality of the air breathed. Therefore:
- If you smoke, seek professional help to quit smoking.
- Ask other people not to smoke near you.
- Avoid air pollution caused by cars.
- Always prefer to take walks in parks or places with clean air, never in busy streets where many cars pass.
- If you live in a busy place, close the windows and use air purifiers and humidifiers to ensure the quality of the air inside the house.
- Avoid leaving the house when it is very hot or very cold.
Proper nutrition is essential to fight any disease, but it can bring various benefits to COPD patients. This is due to the fact that the food that gives the energy that moves the lungs, and that factors such as obesity make breathing more difficult.
Some tips for eating well with COPD include:
- Eat small meals and snacks that guarantee energy, but do not cause you to feel “hot”, as large meals impair your breathing for a time.
- Drink plenty of water during the day, as the ingestion of fluids helps in the dissolution and elimination of mucus (catarrh).
- Choose healthy proteins, such as milk, cheese, eggs, meat, fish, and grains.
- Also, have a preference for healthy fats, such as olive oil, canola, among others.
- Limit the amount of sweets, avoid cakes, cookies and soda.
- If necessary, avoid foods that help produce gas, such as beans, cabbage, and carbonated drinks.
- If you are overweight, plan a routine that helps you lose weight with a physical therapist and nutritionist.
Good sleep is also essential for maintaining health. However, COPD can present various obstacles at that time, as it causes shortness of breath (apnea), in addition to the fact that some medications can cause difficulty sleeping or even require nocturnal doses.
Some safe suggestions for better sleep are:
- Tell the responsible doctor that you have trouble sleeping. He can tailor treatment so that you can get better quality sleep.
- Before sleeping, do some relaxing activity, like taking a warm bath or reading a book.
- You will go to bed at the same time every day.
- Do not use over-the-counter medications that help you sleep, as they can cause adverse reactions, interact with other medications, and even make your breathing worse.
How to prevent COPD?
The best way to prevent COPD is not to smoke, or to quit smoking as soon as possible.
In addition, people who work in places where there is a lot of air pollution must be aware of the amount of pollution inhaled and, if necessary, change professions to maintain physical integrity.
COPD, although not as well known as cancer and AIDS, is becoming an increasingly well-known disease in the world. Therefore, it is important that more people are aware of this disease and know how to prevent it.