Chronic Obstructive Pulmonary Disease

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.

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

• Cigarette Smoking
   
• Passive smoking
   
• Air pollution
   
• Indoor pollution
   
• Long term exposure to fumes and dust in the work environment
   
• Congenital anti-protein enzyme deficiency

Smoking is the main cause of COPD and is the risk factor for COPD exacerbations. Smoking reduces oxygen levels in the body, while the chemicals produced when burning cigarettes can damage lung tissue and cause inflammation of the airways. Globally, between 40-73% of COPD mortality is related to smoking tobacco. The risk of smoking tobacco is evident that current and ex-smokers were 3.5 times and 2.9 times more liky to develop COPD than non-smokers

• Do not smoke or quit smoking
   
• Put on personal protective equipment. For example, wear a face mask if you are exposed to fumes and dust during work persistently

It is evident that smoking is the main cause of COPD. Smoking 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. Prolonged 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.

	Common symptoms include:

• Coughing for long term
• Lots of sputum
• Shortness of breath, especially during physical exercises
• Difficulty in breathing
• Decreased physical strength and activity
• Hypoxia (severe lack of oxygen) with cyanosis of lips and skin of 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.

 

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

Pulmonary function test
This is a common method for the diagnosis of COPD. The test involves patient blowing air into the Spirometer for a few times, patient's lung volume and the expiratory rate are then obtained to aid the diagnosis. Pulmonary function test is also commonly used for monitoring 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 Carbon dioxide 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 Carbon dioxide 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 in breathing), the sputum can be used for bacterial tests, which helps the diagnosis and treatment.

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 airway, 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; while using inhaled steroids may cause sore throat and infection of monilia in the throat, but inhaled steroid have fewer side effects on the 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 hypoxia. After assessment by doctor and therapist, patient should install oxygen concentrator, and carry light and portable equipment when going out. Patient should follow doctors' 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 skills on controlling shortness of breath, breathing exercise, methods of removing sputum (e.g. expectoration posture and skills), coordination of respiration and body movements, endurance training, methods on saving physical strength, stress management skills and recommendations for diet. Pulmonary rehabilitation treatment is provided by multi-displinary health care professionals, including doctors, physiotherapists, occupational therapists and dietitians.

Surgery
Some of the patients with severe emphysema may require surgery in order to remove part of the lungs.

In recent years, newer less invasive surgical procedure is also used, which involves implanting a small valve during bronchoscopy procedure into 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 provide more rooms to expand so as to alleviate symptoms and enhance physical endurance.

COPD Patients are more susceptible to bacterial lund infections. In addition, COPD patients are prone to develop hypertension , ischaemic heart disease,lung cancer and depression.

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. increased shortness of breath during nighttime that affect sleeping, patient may increase the dosage of bronchodilators as required. 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; adopt a low salt, low fat and high fiber diet to reduce the burden on heart and kidneys, and enhance the health of the lungs.