A B C D E F G H I J K L M N O P R S T U V W

COPD

What is COPD ?

Chronic obstructive pulmonary disease (COPD) is the result of lung damage due to two condions – chronic bronchitis and emphysema. These diseases affect different parts of the lungs. However, they nearly always occur together, which is why they are now usually grouped together in the term Chronic Obstructive Pulmonary Disease (COPD). Sometimes the bronchitis may cause more trouble, with the emphysema being only mild; and sometimes it may be the other way round. COPD used to be much better known by the term 'chronic bronchitis', and many people still use this. The main symptoms are cough, sputum and breathlessness. COPD is common, particularly in older people. It is one of the most important causes of sickness absence, accounting for many millions of days lost from work every year.

How does COPD occur ?

COPD is the result of damage to the lining of the bronchi. The bronchi are series of branching tubes, which carry air from the main windpipe (trachea) to the lung tissues. Mucus builds up in the bronchi, and can easily become infected. This leads to narrowing of the bronchi, and the symptoms of cough, sputum and shortness of breath. In emphysema, the thin walls of the air spaces (alveoli) are destroyed. In chronic bronchitis there is increased production of mucus due to glands in the lining of the bronchi. This means that there is less lung tissue available for oxygen to get absorbed, causing breathlessness. One of the less common causes of emphysema is a hereditary lack of a chemical, or enzyme, that protects the alveoli against damage. This condition is called alpha-1-antitrypsin deficiency.

Why does COPD occur ?

Cigarette smoking is the biggest single cause of preventable death and disease. Although as stated above, some people are born with a tendency to COPD or emphysema, the conditions usually result from the harmful effects of the environment in particular from cigarette smoking. Although fewer people are smoking now, the harmful effects of cigarettes on COPD will be present for many years yet. Sulphur dioxide is another potent cause of lung damage. People who spend much of their lives in polluted environments, particularly great industrial centres, are much more likely to suffer from COPD. Certain occupations are high risk, especially coal mining, where a special sort of COPD called pneumoconiosis used to be common. With better medical supervision now available, this problem occurs less than it used to.

Treatment Involved for COPD

Continuing to smoke will certainly worsen both COPD and emphysema. The most important treatment is to stop smoking. Wherever possible, the best sort of treatment for COPD is to avoid the conditions that brought it about. This means living in a smoke-free and pollution-free environment something that may be easier said than done. General fitness measures and exercise are very important, since they help to maintain the function of the lungs at their best possible level. Antibiotics do not play a major part in the regular management of COPD but they may be required quite often for episodes of acute attacks of COPD due to infections.

For these episodes they are very effective but probably do not have much impact on the underlying problem. Doctors may advise that the patient keeps antibiotics on hand so that they may be started at the first sign of an acute infection (such as a cold, or a change in colour of the sputum). Other drugs, known as bronchodilators, are prescribed when the airways obstruction is partially reversible (as shown by breathing tests). Examples of bronchodilator drugs include Ventolin or Airomir (salbutamol), Bricanyl (terbutaline) and Atrovent (ipatropium). They improve breathing by opening up the narrowed bronchi. Generally though, they are not as helpful in COPD as in asthma, where they are prescribed much more. Oxygen is given for relief of breathlessness, when the condition is severe, or sometimes during an acute infection if symptoms are distressing. Another group of drugs that may help are the inhaled steroids used for asthma. These drugs help people who have an element of asthma. This would mean that some of the obstruction of their air passages may be reversible. To check for this, doctors may do tests before and after the person is administered certain drugs. Examples of inhaled steroid drugs include Becotide (beclomethasone), Flixotide (fluticasone) and Pulmicort (budesonide). The inhaled drugs for COPD are often prescribed together with a large spacer or delivery device (plastic and cone shaped). This device makes it easier to inhale the drug and reduces the amount of drug swallowed.

Sometimes, because high doses of drugs need to be taken, people with COPD will be treated with a nebuliser (a machine that converts the drug into a fine spray). If the condition is advanced, long-term oxygen therapy may be provided at home, for the patient to breathe for prolonged periods of up to 15 hours per day. This is provided through a facemask or tubes (cannula) placed in the nose. It makes it possible for people to live at home who might otherwise have been hospitalized permanently. Oxygen concentrators are now available. These are machines, which can extract oxygen from room air. They have made large oxygen cylinders unnecessary. Physiotherapy to the chest can be very helpful, particularly during acute infections and in rehabilitation training programmes, which improve stamina, strength and fitness.

After Treatment for COPD

The treatment of COPD is lifelong, in terms of avoiding causes and maintaining good health. In this sense there is no after treatment phase. After acute infections, though, there is always a chance of relapse in the early weeks and so careful attention to symptoms will help to spot this.

If COPD is Left Untreated

A gradual worsening of lung function would be expected, particularly if the main causative factors, particularly smoking, could not be avoided or reduced.

Effects on Family of COPD

Support and understanding, as with all problems, will help to make the quality of life better. Physiotherapy can be learnt by your relatives or friends and given at home to help in clearing phlegm from the chest. When oxygen is needed in the home, the family should learn how to maintain the equipment.