An Overview on COPD

Chronic obstructive pulmonary disease is a group of diseases that affect a patient’s ability to breathe well. It is associated with damage to the structure of the lungs due to prolonged exposure to harmful substances. 

Patients with COPD experience persistent coughing, wheezing, and dyspnoea, amongst other symptoms. This condition is common and can be treated by targeting the symptoms experienced by patients.

Medical Channel Asia speaks with Professor Paul Jones from the Department of Respiratory Medicine at St George’s, the University of London as he shares his years-long experience treating patients with COPD. 

What is Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease, otherwise known as COPD, is a group of diseases that collectively result in problems related to breathing due to the blockage of airflow within the respiratory system. The airflow limitation associated with COPD can ultimately result in tissue destruction due to chronic inflammation in the lungs, which can then result in coughing, the production of sputum, and breathlessness. 

Symptoms of COPD 

The symptoms of COPD may get progressively worse over time and can include the following:

1. Continuous breathlessness that limits the patient’s activities   
2. Persistent cough with phlegm 
3. Chest infections
4. Tightness in the chest
5. Difficulty breathing in 
6. Wheezing 
7. Fatigue 

How does COPD affect Asians? 

While COPD is a global health concern, it presents more in Asian communities than in their western counterparts, and it has increased mortality in men4. While there are limitations in acquiring accurate epidemiologic studies in Asia, a study found that the prevalence of COPD was 6.2% in the Asia-Pacific region.

COPD results in breathing difficulties and can be categorised as follows:

1. Damage and narrowing of the airways—this can be seen in chronic bronchitis which occurs due to swelling of the bronchi in the lungs due to continuous irritation, causing them to narrow, subsequently leading to coughing and the production of sputum. In chronic bronchitis, the cilia present in the bronchi are damaged. Bronchitis is classified as chronic if it persists for more than 3 months.  
2. Damage to the lung tissue—this can be seen in emphysema, which occurs when the alveolar air sacs in the lungs are damaged, leading to breathing difficulties. In emphysema, the walls of the alveoli become damaged which diminishes their ability to participate in the gaseous exchange, therefore affecting the rate of oxygen transfer from the lungs to the bloodstream. 

What causes COPD? 

While some individuals may inherit COPD, most others are diagnosed due to persistent exposure to the following:

1. Cigarette smoke (including second-hand smoke). Smoking has been found to be one of the main causes of COPD. 
2. Chemical fumes such as those from cadmium, silica dust, welding fumes, and isocyanates have been associated with COPD. 
3. Dust including grain and flour, or coal dust. 
4. Pollution or other environmental irritants 
5. Genetic issues associated with the lungs, such as an alpha-1 antitrypsin deficiency 

What treatment options are available for COPD? 

While there is presently no cure for COPD, treatment as well as early diagnosis aims to slow the progression of symptoms a patient experiences. The main aim of treating COPD patients is to improve their quality of life and reduce the symptoms they experience. Non-pharmacological treatment includes lifestyle modifications such as smoking cessation.  Pharmacological treatment of COPD includes the following:

1. Bronchodilators relax the muscles surrounding the lungs 
2. Corticosteroids (inhaled or oral)  to reduce inflammation 
3. Antibiotics to manage infections 
4. Oxygen therapy (depending on the severity of the disease, this might include a nasal cannula or mechanical ventilation)
5. Routine influenza vaccinations 
6. Pulmonary rehabilitation 
7. Surgical intervention, including lung transplants in advanced cases where pharmacological intervention alone might not improve the patient’s quality of life

While a patient’s prognosis is largely linked to their compliance with their treatment plan. However, patients might have a poor prognosis in circumstances where they also have other comorbidities.

Conclusion 

COPD is largely a preventable disease and even when it is diagnosed, its progression can be slowed by increasing community education to teach the importance of:

• Cessation of smoking
• Importance of compliance with treatment plans 
• Leading continuously active lifestyles