What causes COPD?
Most people with COPD are at least 40 years old and have some history of smoking. The longer and more tobacco products you smoke, the greater your risk of COPD.
In addition to cigarette smoke, cigar smoke, pipe smoke, and secondhand smoke can also cause COPD. Your risk of COPD is even greater if you are diagnosed with asthma and have the habit of smoking.
Long-term exposure to air pollution, inhaling dust, and exposure to chemicals and fumes in the workplace can also cause COPD.
In developing countries, homes are often poorly ventilated, forcing families to breathe fumes from burning fuel used for cooking and heating. The mingling odour of tobacco smoke with this can cause serious issues.
There may be a genetic predisposition to developing COPD. Up to an estimated 5% trusted source of people with COPD have a deficiency in a protein called alpha-1 antitrypsin.
This deficiency causes the lungs to deteriorate and can also affect the liver. There may be other associated genetic factors at play as well.
There’s no single test for COPD. Diagnosis is based on symptoms, a physical exam, and diagnostic test results.
When you visit the doctor, be sure to mention all of your symptoms. Tell your doctor if:
you’re a smoker or have smoked in the past
you’re exposed to lung irritants on the job
you’re exposed to a lot of secondhand smoke
you have a family history of COPD
you have asthma or other respiratory conditions
you take over-the-counter or prescription medications
Exam and tests
During the physical exam, your doctor will use a stethoscope to listen to your lungs as you breathe. Based on all this information, your doctor may order some of these tests to get a more complete picture:
Spirometry, which is a noninvasive test to assess lung function. During the test, you’ll take a deep breath and then blow into a tube connected to the spirometer.
Imaging tests, like a chest X-ray or CT scan. These images can provide a detailed look at your lungs, blood vessels, and heart.
An arterial blood gas test. This involves taking a blood sample from an artery to measure your blood oxygen, carbon dioxide, and other important levels.
These tests can help determine if you have COPD or a different condition, such as asthma, a restrictive lung disease, or heart failure.
Treatment for COPD
Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.
If your blood oxygen level is too low, you can receive supplemental oxygen through a mask or nasal cannula to help you breathe better. A portable unit can make it easier to get around.
Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have a form of severe emphysema.
One type of surgery is called bullectomy. During this procedure, surgeons remove large, abnormal air spaces (bullae) from the lungs.
Another option is lung volume reduction surgery, which removes damaged upper lung tissue. Lung volume reduction surgery can be effective at improving breathing, but few patients undergo this major and somewhat risky procedure.
Lung transplantation is an option in some cases. Lung transplantation can effectively cure COPD, but has its many risks.
There is a less invasive method of improving the efficiency of airflow in people with severe emphysema called endobronchial valves (EBV), which are one-way valves that divert inspired air to healthy lungs and away from non-functioning, damaged lungs.
In 2018, an EBV device called the Zephyr Endobronchial ValveTrusted Source was approved by the FDA and has been shown to improve lung function, exercise capacity and quality of life for patients living with emphysema.
Certain lifestyle changes may also help alleviate your symptoms or provide relief.
If you smoke, quit. Your doctor can recommend appropriate products or support services.
Whenever possible, avoid secondhand smoke and chemical fumes.
Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
Talk to your doctor about how much exercise is safe for you.
Medications for COPD
Medications can reduce symptoms and cut down on flare-ups. It may take some trial and error to find the medication and dosage that works best for you, but these are some of your options:
Medicines called bronchodilators help loosen tight muscles in your airways. They’re typically taken through an inhaler or nebulizer. Short-acting bronchodilators last from 4 to 6 hours. You only use them when you need them. For ongoing symptoms, there are long-acting versions you can use every day. They last about 12 hours. For people with COPD who experience shortness of breath or trouble breathing during exercise, the American Thoracic Society strongly recommends a long-acting-beta-agonist (LABA) combined with a long-acting muscarinic antagonist (LAMA).
These bronchodilators work by relaxing tightened muscles in the airways, which widens your airways for better air passage. They also help your body clear mucus from the lungs. These two types of bronchodilators can be taken in combination by inhaler or with a nebulizer.
Diet recommendations for people with COPD
There’s no specific diet for COPD, but a healthy diet is important for maintaining overall health. The stronger you are, the more able you’ll be to prevent complications and other health problems.
Choose a variety of nutritious foods from these groups:
Ø Vegetables, fruits, grains, protein, dairy
Also, remember to go easy on the salt. It causes the body to retain water, which can strain breathing.
Ø Liquid Drink plenty of fluids. Drinking at least six to eight glasses of non-caffeinated liquids a day can help keep mucus thinner. This may make the mucus easier to cough out.
Ø Limit caffeinated beverages because they can interfere with medications. If you have heart problems, you may need to drink less, so talk to your doctor.
Maintaining a healthy weight is important. It takes more energy to breathe when you have COPD, so you might need to take in more calories. But if you’re overweight, your lungs and heart may have to work harder.
If you’re underweight or frail, even basic body maintenance can become difficult. Overall, having COPD weakens your immune system and decreases your ability to fight off infection.
A full stomach makes it harder for your lungs to expand, leaving you short of breath. If you find that this happens to you, try these remedies:
Clear your airways about an hour before a meal.
Take smaller bites of food that you chew slowly before swallowing.
Swap three meals a day for five or six smaller meals.
Save fluids until the end so you feel less full during the meal.
Living with COPD
COPD requires lifelong disease management. That means following the advice of your healthcare team and maintaining healthy lifestyle habits.
Since your lungs are weakened, you’ll want to avoid anything that might overtax them or cause a flare-up. Here’s a list of things to consider as you adjust your lifestyle.
Avoid smoking. If you’re having trouble quitting, talk to your doctor about smoking cessation programs. Try to avoid secondhand smoke, chemical fumes, air pollution, and dust.
Work out. A little exercise each day can help you stay strong. Talk to your doctor about how much exercise is good for you.
Eat a diet of nutritious foods. Avoid highly processed foods that are loaded with calories and salt, but lack nutrients.
Treating other conditions. If you have other chronic diseases along with COPD, it’s important to manage those as well, particularly diabetes mellitus and heart disease.
Clean house. Clear the clutter and streamline your home so that it takes less energy to clean and do other household tasks. If you have advanced COPD, get help with daily chores.
Be prepared for flare-ups. Carry your emergency contact information with you and post it on your refrigerator. Include information about what medications you take, as well as the doses. Program emergency numbers into your phone.
Find support. It can be a relief to talk to others who understand. Consider joining a support group. The COPD Foundation provides a comprehensive list of organisations and resources for people living with COPD.
What are the stages of COPD?
One measure of COPD is achieved by spirometry grading.
There are different grading systems, and one grading system is part of the GOLD classification. The GOLD classification is used for determining COPD severity and helping to form a prognosis and treatment plan.
There are four GOLD grades based on spirometry testing: grade 1: mild, grade 2: moderate, grade 3: severe, grade 4: very severe.
This is based on the spirometry test result of your FEV1. This is the amount of air you can breathe out of the lungs in the first second of a forced expiration. The severity increases as your FEV1 decreases.
The GOLD classification also takes into account your individual symptoms and history of acute exacerbations. Based on this information, your doctor can assign a letter group to you to help define your COPD grade.
As the disease progresses, you’re more susceptible to complications, such as:
respiratory infections, including common colds, flu, and pneumonia heart problems high blood pressure in lung arteries (pulmonary hypertension)
lung cancer depression and anxiety
Is there a connection between COPD and lung cancer?
COPD and lung cancer are major health problems worldwide. These two diseases are linked in a number of ways.
COPD and lung cancer have several common risk factors. Smoking is the number one risk factor for both diseases. Both are more likely if you breathe secondhand smoke, or are exposed to chemicals or other fumes in the workplace.
There may be a genetic predisposition to developing both diseases. Also, the risk of developing either COPD or lung cancer increases with age.
In some cases, people don’t learn they have COPD until they’re diagnosed with lung cancer.
However, having COPD doesn’t necessarily mean you’ll get lung cancer. It does mean that you have a higher risk. That’s another reason why, if you smoke, quitting is a good idea. Most people with COPD are 40 years of age or older.
The majority of people with COPD are smokers or former smokers. Smoking is the most important risk factor that can be changed.
COPD is a leading cause of hospitalizations in industrialized countries. In the United States, COPD is responsible for a large amount of emergency department visits and hospital admissions.
What’s the outlook for people with COPD?
COPD generally reduces life expectancy, though the outlook varies considerably from person to person.
• COPD tends to progress slowly. You may not even know you have it during the early stages.
• Once you have a diagnosis, you’ll need to start seeing your doctor on a regular basis. You’ll also have to take steps to manage your condition and make the appropriate changes to your daily life.
• Early symptoms can usually be managed, and certain lifestyle choices can help you maintain a good quality of life for some time.
• People with severe stages of COPD may not be able to care for themselves without assistance. They’re at increased risk of developing respiratory infections, heart problems, and lung cancer. They may also be at risk of depression and anxiety.
• Besides smoking, your outlook depends on how well you respond to treatment and whether you can avoid serious complications. Your doctor is in the best position to evaluate your overall health and give you an idea about what to expect.
DR. B. NITHILAVALLI MBBS., DTCD
Kumaran Medical Center