Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is an umbrella term for people with chronic bronchitisemphysema, or both. With COPD the airflow to the lungs is restricted (obstructed). COPD is usually caused by smoking. Symptoms include cough and breathlessness. The most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucolytic (mucus-thinning) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms.

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What is chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a general term which includes the conditions chronic bronchitis and emphysema. COPD is the preferred term, but you may still hear it called chronic obstructive airways disease (COAD).

  • Chronic means persistent.
  • Bronchitis is inflammation of the bronchi (the airways of the lungs).
  • Emphysema is damage to the smaller airways and air sacs (alveoli) of the lungs.
  • Pulmonary means ‘affecting the lungs’.

Chronic bronchitis or emphysema can cause obstruction (narrowing) of the airways. Chronic bronchitis and emphysema commonly occur together.

How common is chronic obstructive pulmonary disease?

COPD is common. It is one of the commonest reasons for the hospital visit. A hospital-based study done by NHRC to evaluate the prevalence of non-communicable diseases in Nepal found that 43 % of patients were suffering from COPD. It is more common in men than women. COPD accounts for more time off work than any other illness. A flare-up (exacerbation) of COPD is one of the most common reasons for admission to hospital (1 in 8 admissions is due to COPD).

What causes chronic obstructive pulmonary disease?

Smoking is the cause in the vast majority of cases. There is no doubt about this. The lining of the airways becomes inflamed and damaged by smoking. About 3 in 20 people who smoke one packet of cigarettes (20 cigarettes) per day, and 1 in 4 people with 40-per-day cigarettes, develop COPD if they continue to smoke. For all smokers, the chances of developing COPD are between 1 in 10 and 1 in 4. 

Air pollution and polluted work conditions may cause some cases of COPD, or make the disease worse. The combination effect of occupational exposure to air pollutants and smoking increases the chances of developing COPD. A small number of people have a genetic (hereditary) risk of COPD due to very rare protein deficiencies that can lead to lung, liver and blood disorders. (The condition is called alpha-1-antitrypsin deficiency). Less than 1 in 100 cases of COPD are due to this. However, people who have never smoked rarely develop COPD. (Passive smoking remains, however, a potential cause.)

What are the symptoms of chronic obstructive pulmonary disease?

  • Cough is usually the first symptom to develop. It is productive with sputum (phlegm). It tends to come and go at first, and then gradually becomes more persistent (chronic). You may think of your cough as a ‘smokers cough’ in the early stages of the disease. It is when the breathlessness begins that people often become concerned.
  • Breathlessness (shortness of breath) and wheeze may occur only when you exert yourself at first. For example, when you climb stairs. These symptoms tend to become gradually worse over the years if you continue to smoke. Difficulty with breathing may eventually become quite distressing.
  • Sputum – the damaged airways make a lot more mucus than normal. This forms sputum (phlegm). You tend to cough up a lot of sputum each day.
  • Chest infections are more common if you have COPD. A sudden worsening of symptoms (such as when you have an infection) is called an exacerbation. Wheezing with cough and breathlessness may become worse than usual if you have a chest infection and you may cough more sputum. Sputum usually turns yellow or green during a chest infection. Chest infections can be caused by bacteria or viruses. Bacteria (which can be killed using antibiotics) cause about 1 in 2 or 3 exacerbations of COPD. Viruses (not killed with antibiotics) are a common cause of exacerbations too, particularly in the winter months. The common cold virus may be responsible for up to 1 in 3 exacerbations.
  • Other symptoms of COPD can be more vague. Examples are weight loss, tiredness and ankle swelling.
  • Chest pain and coughing up blood (haemoptysis) are not common features of COPD. It is possible to have slightly blood-streaked sputum when you have a chest infection. However, chest pain, blood in the sputum or coughing up just blood, should always be reported to a doctor. This is because other conditions need to be excluded (like angina, heart attack or lung cancer).

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