Chronic Obstructive Pulmonary Disease (COPD): All You Need To Know

What is COPD?

COPD, which stands for Chronic Obstructive Pulmonary Disease, is a lung disease acquired by individuals who are exposed to risk factors that damage their lungs in the long term. This results in the organ’s progressively deteriorating function, which is normally irreversible. 

One of the most important facts about COPD is that it can cause lung damage, which makes breathing more difficult as the condition progresses. Doctors often categorize COPD stages based on certain tell-tale symptoms, along with results from several test,  including spirometry, which measures two things:

• Forced Vital Capacity (FVC) – measures how much air you can be exhaled after taking a deep breath.
• Forced Expiratory Volume (FEV-1) – measures the volume of air you can expel forcibly within one second.

COPD is identified in patients who have one or more of the conditions related to the disease: chronic bronchitis and emphysema, which are both conditions that limit breathing capacity. 

While COPD is an irreversible, incurable condition, its progression is treatable and manageable. Knowing important facts about COPD, including the risk factors and causes, could help you manage or avoid the condition altogether.

Causes and Risk Factors

COPD is primarily caused by tobacco smoke and other pollutants that affect the function of the lungs. Some other important facts about COPD are the following possible causes:

• Inhaled indoor pollutants (ashes from charcoal, chemical fumes)
• Low outdoor air quality
• Recurring lower respiratory infections

According to various studies, up to 90% of COPD patients are smokers. In the Philippines, the prevalence of COPD in adults was recorded at 14% among adults, making the disease one of the top 10 causes of death among Filipinos in 2016. Still, there is a need to raise awareness about the important facts about COPD in order to educate the public on how to prevent it.

This highlights smoking as the main cause of COPD, with the two primary conditions associated with COPD also primarily seen in chronic smokers:

• Chronic bronchitis – involves the inflammation or swelling of the bronchial tubes, which leads to more mucus build-up along your airway. This hampers the airflow to and from your lungs.
• Emphysema – involves the damage or destruction of the lung’s air sacs, called alveoli, which absorb the oxygen from the air you breathe and expel carbon dioxide when you exhale. Damaged and destroyed alveoli can limit the lung’s elasticity and affect how much oxygen can be absorbed into your bloodstream, giving you a feeling of breathlessness as the condition progresses.

What You Need to Know About Emphysema

People who are at risk of COPD are mostly those who smoke on a daily basis or encounter pollutants at work that would cause these conditions. Factors which may make you more susceptible to COPD are:

• Exposure to secondhand tobacco smoke
• History of asthma
• Regular exposure to hazards such as heavy dust, air pollution, or certain chemicals
• Age, as COPD is more prevalent in individuals aged 40 onwards
• Rare genetic disorder (lack of a genetic protein called Alpha 1 antitrypsin)

Signs and Symptoms

COPD symptoms don’t usually manifest until the condition worsens.

Some signs and symptoms include:

• Persistent long-term cough with sputum
• Breathlessness or a feeling of always being short of breath, even when at rest
• Uncharacteristic wheezing or squeaking upon breathing
• Tight feeling in the chest when breathing

These signs and symptoms can develop slowly and gradually, often being mistaken for seasonal sickness. It can also be related to other illnesses and as such, might not be diagnosed until it has progressed later on. This is why it’s important to be aware of the important facts about COPD along with risk factors to make it easier for your physician to diagnose your condition.

Diagnosis

Individuals who present with the above symptoms and have been exposed to several of COPD risk factors are considered suspected cases. These cases are then confirmed through various diagnostic tests:

• Spirometry, which is a test to see how much air your lungs can hold and how much you can blow out
• Chest X-rays to determine your lung’s physical condition
• CT scans to rule out lung cancer or to determine if surgery is needed
• Arterial blood gas test to measure how efficient your lung is in bringing oxygen into your body and carbon dioxide out
• Other laboratory tests to confirm whether or not you have other underlying illnesses or genetic disorders (such as the lack of alpha 1 antitrypsin)

Your physician will be able to gauge your condition in one of several stages based on the severity of your symptoms, which will be used to prescribe treatments that will work best at a specific stage. This measurement of the stages of COPD is called the GOLD System, developed by the Global Initiative for Chronic Obstructive Lung Disease, which the World Health Organization established in 1997.

These stages vary on certain factors: spirometry results, the severity and prognosis of the condition, and any pre-existing health problems that might affect recovery from COPD, and are classified under four stages:

• GOLD 1, or Mild COPD; You will likely have very minimal symptoms and mistake your conditions as being related to other illnesses
• GOLD 2, or Moderate COPD; Symptoms are more apparent, and you may experience minor difficulty breathing at this point
• GOLD 3, or Severe COPD; Where your lungs are at less than half capacity and are more prone to infections and diseases
• GOLD 4, or Very Severe COPD; You’re likely experiencing shortness of breath even during rest, with your lungs functioning at less than 30 percent of their capacity

Treatment

While COPD is not curable, there are a number of treatment options meant to manage symptoms and improve the quality of life of patients with COPD. 

These include prescribed lifestyle changes, as well as medications used to ease the symptoms and delay the onset or worsening of your condition. In extreme cases, surgical options may also be prescribed, such as bullectomy, lung volume reduction (LVRS) and lung transplantation.

Lifestyle changes

Generally, the first thing your physician will encourage you to do is to quit smoking if you still are, or avoid contact with people and environments that expose you to tobacco and other pollutants known to cause COPD.

Because COPD is irreversible, avoiding risk factors early on upon diagnosis will greatly improve your outlook. A strict rehabilitation program might also be included, where you will have to follow strict diet and exercise programs meant to keep you active and healthy.

Medications

For moderate cases or those progressing into the more severe stages of COPD, medical intervention may be needed. These may include some of the following:

• Inhalers that may have bronchodilators, corticosteroids, or both, to help with breathing difficulties
• Antibiotics, for patients who might gain bacterial infections due to their conditions
• Flu or pneumonia vaccines, to help you avoid contracting these conditions which might worsen COPD
• In severe cases, Oxygen therapy, which will help improve the breathing quality of patients that have severely reduced lung capacity. 

Surgery options

For severe cases of COPD, doctors might suggest the possibility of surgery to address the root cause of COPD in your lungs:

• Bullectomy, which is a procedure to remove large spaces that may form when your alveoli get sufficiently damaged and collapse
• Lung volume reduction surgery to remove necrotic or dead lung tissue
• Lung transplant, to replace a nonfunctioning lung with a healthy one.

These procedures also have their own risks, and might not be applicable for all COPD patients. At the end of the day, the best way to manage this illness is to keep away from risk factors such that your chances of developing COPD or worsening an existing condition becomes lower.

Prevention and Management

Aside from knowing important facts about COPD, adopting certain lifestyle changes can help prevent and manage COPD. Some examples are the following:

• Avoiding smoking or stopping immediately if you are, since this is maintly the most important risk factor of COPD.
• Managing your environment. Keep your indoor air quality clean by avoiding the use of chemicals that might affect air quality, or avoiding the use of solid fuel indoors such as charcoal, etc.
• Wearing necessary protection if you need to be in contact with possible contaminants
• Keep a healthy, consistent exercise routine
• Have regular check-ups and monitor your lung health

As with any illness, managing one’s exposure to risk factors will help minimize the risk of conditions that might eventually lead to COPD.

For those living with the condition, always remembering the important facts about COPD and keeping a positive mindset and a disciplined approach can help control and manage symptoms in order to improve overall health.