Chronic Obstructive Pulmonary Diseases

There is currently no cure for chronic obstructive pulmonary disease (COPD) and it will deteriorate gradually over time. New cases are on the rise globally. Statistics of 2007 indicated that COPD is the fifth fatal disease in Hong Kong. Moreover, it causes heavy burden to the demand for medical services in Hong Kong. According to the Hospital Authority, the hospitalization days of COPD patients ranks third in the total utilization of hospital-bed days in 2007.

Although there is no cure for COPD, the condition can be improved by early treatment. In addition, the cause for COPD is clear, and not smoking or to quit smoking help prevent the disease.

(Special thanks to Dr. Christopher CHAN, Consultant, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital for reviewing the information of this page.)

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COPD refers to the obstruction or narrowing of respiratory tract caused by long-term damage to the respiratory system, resulting in difficulties of the lung to breathe in and out properly. This in turn causes symptoms such as hypoxia (lack of oxygen), breathlessness and coughing. COPD patients may even have difficulties in their normal daily activities.

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Particular attention should be paid to the following significant risk factors of COPD:

  • Smoking
     
  • Passive smoking
     
  • Air pollution
     
  • Indoor pollution
     
  • Long term exposure to fumes and dust in the working environment
     
  • Congenital anti-protein enzyme deficiency
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  • Do not smoke or quit smoking
     
  • Put on personal protection equipment, for example, wear mask if you may inhale fumes and dust during work persistently
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Smoking is confirmed to be the main cause of COPD. It will lower the oxygen level of the body. Tobacco tar and other chemicals produced during the burning of cigarette will damage lung tissues and cause inflammation of the respiratory tract. Veteran smokers are more susceptible to emphysema and chronic bronchitis.

COPD is mainly the condition of airways obstruction caused by emphysema or chronic bronchitis. Emphysema refers to the swelling and damaging of alveoli (air sacs) at the tips of bronchioles, reducing the area available for air exchange and thus a decrease of oxygen supply in the blood and inability to remove carbon dioxide effectively. Chronic bronchitis refers to the inflammation of mucus membranes in the bronchi due to infection or otherwise, causing an increased production of secretion which blocks the airways. This leads to symptoms of coughing and short breath. It should be noted that lung tissues and function cannot recover completely once they are damaged, therefore COPD cannot be cured completely.

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Common symptoms include:

  • Coughing for long term
  • Lots of sputum
  • Shortness of breath, especially during physical exercises
  • Difficult in breathing
  • Decreased physical strength and activity
  • Hypoxia (severe lack of oxygen) with blue discolouration of lips, hands and feet 
        

Early COPD does not have obvious symptoms. But as the lung function is increasingly damaged, patient with moderate to severe stage of disease would experience shortness of breath, decreased activity or even hypoxia.

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If doctor suspects patient have COPD, doctor may arrange part or all of the following examinations for patients: 相片

Pulmonary function test
This is a common way to diagnose COPD. By the data obtained from blowing air into the Spirometry for a few times, patient’s lung capacity and the exhalation speed are shown for diagnosing whether the patient has COPD. Pulmonary function test is also commonly used for assessing the progress of the disease.

Chest X-ray
Chest X-ray can be used for the diagnosis of advanced stage emphysema. Doctor usually uses chest X-ray to examine and rule out other lung or heart diseases, e.g. tuberculosis and lung cancer.

Arterial blood gas analysis
Doctor will take the blood from patient’s artery to analyze the levels of oxygen and CO2 contained in blood. This test has a certain degree of risk and is usually used to patient with more severe COPD to determine whether the patient needs long-term oxygen therapy.

There is another common way to measure the oxygen content. It is done by clipping a small apparatus on the patient’s finger to detect the oxygen content from skin surface. It is done quickly without fuss and wound but cannot provide CO2 level and other data.

Sputum examination
Sputum examination is used to rule out the possibility of other lung diseases, e.g. lung cancer and tuberculosis. When the condition of COPD patient gets exacerbated (i.e. more sputum with pus and difficulty breathing), the sputum can be used for bacterial examination, which helps the diagnosis and treatment.

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The damage to patient’s lung tissues and function cannot be reversed. Thus, COPD cannot be cured.

 

Quit smoking
Quit smoking can ease the coughing and reduce the amount of sputum as well as slow down the deterioration. Patient can get counseling and / or drug therapy to help kick the habit.

Drug therapy
Medication can help improve the condition of patient and mitigate the impact of the disease to the patient’s daily life. Common medication includes:

  1. Bronchodilators: relax the muscles in the ariway, resulting in airway dilatation and ease the symptoms. There are two types of bronchodilators, oral and metered dose inhalers. Metered dose inhaler can deliver the puff of medication into the airway directly. If the inhalation method is correct, the dosage needed can be smaller than that of oral bronchodilator, and also the side effects of medication, e.g. palpitation, shaky hands, sleeplessness, headache, dry mouth and muscle cramp can be reduced.
  2. Steroids: can reduce airway inflammation, but not all patients will get better after using it. Prolonged use of oral steroids may have side effects of weakened immunity and osteoporosis (porous bones); while using spray steroids may cause sore throat and infection of monilia in the throat, but  it has fewer side effects on the whole body than those of oral steroids.
  3. Antibiotics: doctor will prescribe drugs to patient with bacterial infections to control the condition.
  4. Expectorant: thinning sputum for easier expectoration.

Long-term oxygen therapy
Doctor will prescribe long-term oxygen therapy to patient with severe insufficiency of oxygen. After assessment by doctor and therapist, patient should install oxygen concentrator and carry light and portable equipment when going out. Patient should follow doctor’s instructions on using the appropriate concentration of oxygen and should not adjust it on his/her own discretion.

Pulmonary rehabilitation treatment
It can reduce the need for hospitalization and improve the quality of life. The treatment generally includes teaching of skills of controlling asthma, breathing exercise, methods of removing sputum (e.g. expectoration posture and skills), coordination of respiration and body movements, physical exercise, methods saving physical strength, stress managing skills and recommendations for diet. Pulmonary rehabilitation treatment is provided by health care professionals, including doctors, physiotherapists, occupational therapists and dieticians.

Surgery
Some of the patients with severe emphysema may need surgery to remove part of the lungs.

In recent years, there is new surgery treatment with fewer traumas, by using bronchoscope to implant a small valve in a specific bronchus which collapses the corresponding lobe of lung. This method serves the same purpose with removal of a lobe of lung, and to let other lobes have more room to expand so as to alleviate symptoms and enhance the endurance of activities.

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Patients are prone to have bacterial infection in lungs. In addition, COPD patients are prone to have hypertension , heart disease,lung cancer and depression.
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Patient should be aware of the followings:

  • No smoking or quit smoking immediately
  • Symptom management: regular and correct use of drugs in accordance with the direction of doctors. If there are changes in symptoms, e.g. shortness of breath is more intense during nighttime so that patient cannot fall asleep, he/she may increase the dosage of bronchodilators. If there is no improvement or the symptom deteriorates after increase in dosage, patient should consult doctor as soon as possible.
  • Exercise regularly: exercise can train the physical fitness and endurance of patient, but should not be excessive and depend on his/her own circumstances and ability. Patient should consult doctor or physiotherapist if needed.
  • Pay attention to diet: less irritating food, e.g. food which is too cold or too hot;may trigger coughing caused by throat irritation; have low salt, low fat and high fiber diet to reduce the burden on heart and kidneys and enhance the health of lungs.
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