Generality
Chronic obstructive pulmonary disease (known in English as COPD, Chronic obstructive pulmonary disease ) is a progressive disease that affects the bronchi and lungs.
COPD is characterized by an airflow limitation, which tends to worsen over time, making breathing difficult
Initially, COPD can occur with dyspnea, even after minor efforts, and cough with the presence of phlegm.
At the moment, there is no effective cure, but different treatments are available to control symptoms and avoid dangerous complications.
What's this
- Chronic obstructive pulmonary disease, also called chronic obstructive pulmonary disease (COPD), is a pathology of the respiratory system, characterized by an irreversible obstruction of the airways (bronchi and lungs).
- COPD is associated with a state of chronic inflammation, which leads to excessive mucus production, a thickening of the bronchial walls and destruction of the lung parenchyma ( emphysema ).
- In the long term, the consequence of this pathological process is a real remodeling of the bronchi, which causes a substantial reduction in respiratory capacity ( chronic obstructive bronchitis ).
Causes
Chronic obstructive pulmonary disease is due to the combination of various insults, which add up over the years damaging the bronchi and lungs.
In the presence of COPD, the air enters and exits with difficulty from the airways, which are restricted, because their walls tend to be thickened and edematous (swollen) due to the contraction of the small muscle cells that surround them or due to accumulation of mucous secretions.
The most important cause of chronic obstructive pulmonary disease is tobacco smoke, in particular cigarette smoke (minus cigar and pipe), which accelerates and accentuates the natural decay of respiratory function.
COPD typically begins in adulthood and those affected are almost always smokers for many years.
Other factors involved in the development of COPD are:
- Passive smoke (promotes inhalation of gas and particulate matter);
- Exposure to irritating particles, fumes and vapors, to dust and chemical substances, both at home and in the work environment (for example: silica or cadmium and fuel combustion products for the kitchen or for heating).
- Air pollution (environmental smog and fine dust, motor vehicle emissions, stoves, air conditioning systems, etc.);
- Respiratory disorders (asthma and bronchial hypersensitivity);
- Airway infections (bronchitis, pneumonia and pleurisy).
Individual factors include some genes believed to be associated with the onset of COPD. At present, alpha-1 antitrypsin deficiency, a hepatic protein that has a protective effect on the elastic fibers of the pulmonary alveoli, has been reported to be significant.
Any factor that negatively affects lung development during pregnancy or infancy can also contribute to chronic obstructive pulmonary disease.
Symptoms, signs and complications
The development and progression of COPD takes several years. Usually, symptoms appear more quickly in people who continue to smoke. In any case, COPD results in a substantial reduction in respiratory capacity.
At the onset, chronic obstructive pulmonary disease manifests itself with two typical symptoms:
- Dyspnea ;
- Productive cough .
Dyspnea is described as an increased effort to breathe or wheeze during physical efforts, even modest ones (eg, walking). In general, this manifestation appears gradually over several years and in more serious cases it can even limit normal daily activities.
Often, the cough is more intense in the morning and characterized by chronic mucus production (ie with phlegm for 3 or more months a year, for 2 consecutive years). Sputum can be extremely dense and difficult to eliminate.
Compounding this clinical picture is the increased susceptibility to respiratory infections of viral, bacterial or fungal origin. These infections tend to heal slowly and can cause relapses accompanied by aggravated symptoms. As COPD progresses, these episodes tend to become increasingly frequent and can induce an important inflammatory response.
The exacerbation of COPD is a sudden event, usually caused by an infectious cause that causes a rapid worsening of respiratory symptoms. This condition can be a medical emergency.
Over the years, the patient with COPD can develop:
- Wheezing and chest tightness, especially after exertion;
- Weight loss (also due to reduced appetite);
- Morning headache (sign of hypercapnia or nocturnal hypoxemia);
- Lack of energy;
- Swelling in ankles, feet or legs.
The most advanced forms of the disease can be complicated by:
- pneumothorax;
- Pulmonary hypertension;
- Frequent episodes of acute systemic decompensation;
- Right heart failure;
- Acute or chronic respiratory failure.
Warning! Go immediately to the doctor (or in the emergency room) in case of sudden worsening of the symptoms or if you have the impression of not being able to breathe.
Diagnosis
In case of breathing difficulties and an increase in the frequency of typically winter illnesses (colds, flu and bronchitis), it is advisable to consult a doctor. Even chronic cough and expectoration can precede bronchial obstruction by many years.
If a COPD is suspected, the pulmonologist visits the patient and collects a series of anamnestic information about the habit of cigarette smoking or the presence of other risk factors, the quality of the breath and the frequency of episodes of bronchitis. During the physical examination, the doctor also evaluates the pathologies possibly associated with COPD, such as cardiovascular diseases, osteoporosis, metabolic syndrome and depression.
Instrumental investigations and other examinations
The main diagnostic tool for chronic obstructive pulmonary disease is spirometry, which allows the measurement of residual lung capacity, the amount of air a person can breathe out and the time it takes to do so. Spirometry consists of blowing into a rubber or cardboard tube connected to a spirometer.
The spirometric measurements - basic and after administration of a bronchodilator drug - used to diagnose COPD are:
- Forced Vital Capacity (FVC) : expresses the maximum volume of air that can be forcibly inhaled and exhaled after a complete breath;
- Forced expiratory volume in the first second (VEMS) : measure of how quickly the lungs can be emptied;
- VEMS / FVC ratio : a value less than 70% indicates the presence of a bronchial obstruction.
Other tests that support the diagnosis include:
- Saturimetry and measurement of gases in arterial blood (blood gas analysis) : they are used to assess oxygen levels (in the case of blood gas analysis also of carbon dioxide) in the blood and therefore to indicate possible oxygen therapy;
- Chest X-ray : helps to exclude other diseases that can occur in a similar way to COPD;
- Thoracic CT : can reveal anomalies not visible to the X-ray and can also suggest the presence of concomitant or complicating diseases, such as pneumonia or pulmonary neoplasms. CT is also useful for ascertaining the extent and distribution of emphysema.
COPD stadiums
To establish a therapeutic plan, it is essential to define the severity level (mild, moderate or severe) of COPD, determined based on the results of spirometry and based on the intensity of the symptoms.
In particular, the following stages of chronic obstructive pulmonary disease can be distinguished:
- Mild (stage 1) : chronic cough and sputum production are common. Respiratory function is slightly reduced.
- Moderate (stage 2) : disease characterized by a more consistent reduction in respiratory capacity and dyspnea in the event of exertion; both cough and bronchial secretions are frequent. Healing from bronchitis or a cold sore can take several weeks.
- Severe (stage 3) : cough with bronchial secretions becomes more frequent and wheezing makes it impossible to carry out some activities of normal daily life, such as walking and climbing stairs.
- Very serious (stage 4) : breathlessness is present even at rest and makes it impossible to carry out the simplest activities of normal daily life, such as eating, washing and dressing. Exacerbations become more frequent and more serious; increases the risk of hospitalization and death.
Therapy
At the moment, there is no effective cure that can restore the respiratory function lost by COPD patients. However, therapeutic interventions are available to alleviate symptoms and improve tolerance to efforts.
Treatment consists of bronchodilators, corticosteroids and, when necessary, oxygen therapy and antibiotics.
Another objective of this series of treatments consists in preventing the progression of the disease and limiting exacerbations.
drugs
From the earliest stages of the disease, basic therapy involves inhalation of long- acting bronchodilators . These drugs help the patient recover part of the ability to perform daily activities, reducing the feeling of shortness of breath. The greatest efficacy is obtained with early intervention and following therapy regularly.
In association with bronchodilators, anticholinergics and phosphodiesterase-4 inhibitors may be prescribed, while, in severe or acute forms, anti-inflammatories, such as cortisone and its derivatives, may be used, but should not be used for long periods due to side effects.
To prevent exacerbations, patients with COPD are recommended to undergo regular vaccinations against influenza and pneumococcal pneumonia. These infectious diseases could in fact aggravate already severely impaired lung function.
In addition to inhalation therapies, in exacerbations of chronic obstructive pulmonary disease we also resort to the administration of:
- Corticosteroids systemically (in tablets or intravenously);
- Antibiotics;
- Mucolytic.
Supportive therapy
Alongside drugs, patients with Chronic Obstructive Pulmonary Disease may be given other therapeutic options to support respiratory activity, including:
- Oxygen therapy (administration of pure oxygen);
- Non-invasive mechanical ventilation (with facial mask).
Patients with chronic obstructive pulmonary disease are also advised to:
- Control the weight, in order not to strain the respiratory system further with excess pounds;
- Practice a series of specific exercises to keep the breathing muscles active and improve exercise tolerance.
Prognosis
About 50% of patients with severe chronic obstructive pulmonary disease die within 10 years of diagnosis. Fortunately, the disease is largely preventable and treatable (but not curable).
To improve one's quality of life and prevent the illness from getting worse, it is important to take the prescribed medications and undergo regular medical checks.
Prevention
To prevent the onset and evolution of chronic obstructive pulmonary disease it is of fundamental importance to reduce the overall exposure to tobacco smoke, dust in the professional environment and to pollution of indoor and outdoor environments.
In everyday life, patients with COPD can benefit from some tricks:
- Keep the room in which you are staying clean and well ventilated (on days of heavy air pollution, however, it is advisable to stay indoors, with the windows closed);
- Avoid active and passive cigarette smoking;
- Keep fit by doing regular exercise (eg walking) and following a healthy and balanced diet.
