What Is COPD (Leyman language)

Chronic Obstructive Pulmonary Disease (COPD) is a disease that makes it hard to empty air out of
your lungs. This is because the airways get smaller leading to airflow obstruction. This can result in
shortness of breath or tiredness because you are working harder to breathe.

Epidemiology

Globally, as of 2010, COPD affected approximately 329 million people (4.8% of the population). The
disease affects men and women almost equally, as there has been increased tobacco use among
women in the developed world. The increase in the developing world between 1970 and the 2000s
is believed to be related to increasing rates of smoking in this region, an increasing population and
an aging population due to fewer deaths from other causes such as infectious diseases. Some
developed countries have seen increased rates, some have remained stable and some have seen a
decrease in COPD prevalence. The global numbers are expected to continue increasing as risk factors
remain common and the population continues to get older.

Kerala

Chronic respiratory disease

Chronic Respiratory Diseases (CRD) mainly includes asthma and chronic obstructive pulmonary
diseases (COPD). As of 2004, chronic obstructive pulmonary diseases (COPD) accounted for COPD is
a term used to include chronic bronchitis, emphysema or a combination of both conditions. 5.2% of
the total NCD burden and 12.2% of the NCD related mortality. In Kerala, 15.3% of the death were
due to respiratory causes of which COPD was the main culprit.(6)An Indian council of medical
research ( ICMR) study on asthma and Chronic conducted between 2006-9 reports that the state has
the highest prevalence of chronic bronchitis in the country. The age adjusted prevalence in the
state (10.1%) was three time the country figure (3.5 %). There was no significant gender
difference in distribution of chronic bronchitis ( males 11%, females 9%).The prevalence was more in
rural areas (13.5%) when compared to urban area ( 5%). Also it was more in lower socioeconomic
class, in smokers and in advanced age group. The study reports a asthma prevalence of 3.1% in the
state, nearly double the country statistics (1.9%). Asthma burden was more among females
(males-2.5, females -3.7) and in those living in rural area( urban -1.9, rural -4.5). (21)

Chronic bronchitis is caused by inflammation and increased mucus (phlegm) in the breathing tubes
(airways). Because of the swelling and extra mucus the inside of the breathing tubes become smaller
causing obstruction in airflow.

Emphysema is caused by damage to the air sacs (alveoli) of the lung. Normally there are more than
300 million air sacs in the lungs. If the walls of the air sacs are damaged they lose their elasticity and
trap air. This causes extra air to remain in the lungs after you breathe out. The extra effort required
to breathe results in shortness of breath.

Most people with COPD are smokers or have smoked in the past. Sometimes COPD is caused by
working or living for many years in an environment where there is exposure to smoke, dust or other
fumes. COPD mostly affects those over the age of 35. An inherited condition called ALPHA – 1 –
ANTITRYPSIN deficiency can also cause COPD but this is quite rare.

Symptoms Of COPD

People can experience COPD in different ways depending on which symptoms trouble them most
and how severe they are. COPD is a progressive illness meaning it has several stages of severity. It
tends to creep up on people slowly. This means it can often be several years before symptoms reach
a level that will make the sufferer go to the GP. Symptoms such as coughing, wheezing and shortness
of breath are often attributed to getting older.

Mild COPD

 Frequent coughing sometimes with mucus (phlegm)

 Mild breathlessness from physical work or brisk walking

Moderate COPD

 Coughing becomes more frequent and more mucus is produced

 Breathlessness occurs more often from activities such as physical work or brisk walking

 A cold or chest infection can last for several weeks

Severe COPD

 Increased coughing and production of mucus

 Difficulty breathing

 You can no longer go to work or carry out household chores

 Difficulty climbing a stairs or crossing a room

 Tire very easily

The earlier COPD is diagnosed and treated the greater the chance of preventing it developing into
severe COPD!

Diagnosis Of COPD

If you answer yes to four or more of the following questions you should visit your doctor and ask to
be tested for COPD

1. Do you cough several times every day?

2. Have you been coughing like this for more than three months?

3. Do you cough up mucus (phlegm) most days?

4. Do you feel breathless from physical work or moderate exercise?

5. Are you a current or former smoker?

6. Do you or have you ever worked in an environment where there is exposure to pollution,
fumes, dust or smoke?

7. Is there a history of lung conditions in your family?

8. Are you over the age of 35?

COPD is diagnosed with a simple and painless breathing test called Spirometry. You will be asked to
breathe as hard as you can into a machine. This measures the amount of air that you can force out
of your lungs in one second and the total amount of air that you can force our of your lungs. From
the results of this test you doctor will be able to tell if your airways have narrowed.
Further diagnostic tests that may be ordered by your doctor include:

Lung Function Tests indicate how much air your lungs can hold and how fast you can blow air in and
out.

Arterial Blood Gas (ABG) is a special blood test that gives more information about your oxygen level
and your breathing. This sample is obtained from an artery and not a vein.

Pulse Oximetry checks the oxygen level in your blood. This is done by placing a small probe on your
finger.

6 Minute Walk Test checks your oxygen need while you walk. It also checks your capacity for
exercise.

Electrocardiogram (ECG) shows the electrical activity of your heart.

Chest – X– Ray provides a picture of your lungs.

Computerised tomography (CAT Scan) is a non invasive, painless medical test that helps physicians
diagnose and treat medical conditions.

Treatment Of COPD

Smoking cessation is the first line of treatment for COPD

There are various types of medication that may be prescribed to treat COPD. Some of these include:

 Bronchodilators

 Corticosteroids

 Antibiotics

 Oxygen therapy

 Vaccinations

 Expectorants

Your medication may be taken in different ways. In order for the medication to work properly, you
must take them as instructed, even when you are feeling better.

Bronchodilators help to relax and open your airways making it easier to breath. Bronchodilators are
either short acting or long acting.

Combination inhalers contain both a reliever and a corticosteroid preventer. The action of the
reliever is to keep the airways open, providing relief. The action of the corticosteroid preventer is to
reduce inflammation in the lungs.

Oral Corticosteroids are high dose anti-inflammatories and can be used during a flare up for a short
period of time. Occasionally some patients require a low maintenance dose.

Antibiotics are used to treat infections caused by bacteria.

Theophyllines are used in some patients who may require further bronchodilation (opening of the
airways).
Expectorants can be used for patients who have excessive production of mucus, however not all
patients benefit from this medication.

Vaccinations prevent lung infection from viruses and bacteria.

Pulmonary Rehabilitation is a multidisciplinary programme which involves doctors, nurses,

physiotherapists, dieticians, occupational therapists, social workers and clinical psychologists. The
programme covers exercise training, nutritional advice, education about your condition and offers
counselling.

Breathing Exercises are a key element in controlling the breathlessness associated with COPD. A
physiotherapist will introduce you to breathing exercises. Pursed Lip Breathing works when you find
it hard to breath. You can learn this now so you will not panic when you feel short of breath.

Research

Infliximab, an immune-suppressing antibody, has been tested in COPD; there was a possibility of
harm with no evidence of benefit.

Roflumilast, cilomilast, and phosphodiesterase 4 inhibitors act as a bronchodilator and as an anti-

inflammatory. They show promise in decreasing the rate of exacerbations, but do not appear to
change a persons quality of life. Roflumilast and cilomilast may be associated with side effects such
as gastrointestinal issues and weight loss. Sleep disturbances and mood disturbances related to
roflumilast have also been reported.

Several new long-acting agents are under development. Treatment with stem cells is under
study. While there is tentative data that it is safe, and the animal data is promising, there is little
human data as of 2017. The human data has shown poor results.

A procedure known as target lung denervation, which involves decreasing the parasympathetic
nervous system supply of the lungs, is being studied but does not have sufficient data to determine
its use. The effectiveness of alpha-1 antitrypsin augmentation treatment for people who have alpha-
1 antitrypsin deficiency is unclear.

Research continues into the use of telehealthcare to treat people with COPD when they experience
episodes of shortness of breath; treating people remotely may reduce the number of emergency-
room visits and improve the person's quality of life.