WHAT IS COPD?
Chronic Obstructive Pulmonary Disease is a term used to describe progressive lung diseases such as emphysema, chronic bronchitis and refractory asthma. (Copdfoundation.org, 2018) These conditions are characterised by the narrowing and inflammation of airways and air sacs in the lungs. This is particularly important in individuals with COPD as this airway narrowing and inflammation leads to lung tissue damage, resulting in the persistent concerning symptoms.
Figure 1: Comparison of a healthy lung to a lung of an individual with COPD illustrating the difference in structure. (British Lung Foundation, 2018)
SYMPTOMS
Commonly include: (nhs.uk, 2018)
- Increased breathlessness – particularly during periods of activity
- Frequent coughing – may be accompanied by mucus
- Persistent wheezing
- Frequent chest infections
- Chest tightness
A lot of these symptoms may be related to other respiratory issues such as asthma – where airways narrow in the presence of certain triggers – anaemia and heart failure. For this reason, it is important to speak to a GP if any of these symptoms persist.
CAUSES
COPD occurs when the lungs become inflamed and narrow as a result – due to the inhalation of pollutants. Those over the age of 35 who have a history of smoking are most at risk of developing this disease (British Lung Foundation, 2018) as well as those who work in areas where they may be exposed to harmful lung irritants.
Smoking:
Smoking is the most important risk factor in determining COPD cause as it is responsible for 40-70% of cases (Sharifabad, 2018). It is important to note that not every smoker will develop COPD in their lifetime however the chemicals found in tobacco smoke can cause an inflammatory response in the tissues, leading to long-term lung damage.
Environmental Factors:
The risk of developing COPD may increase due to inhalation of certain harmful pollutants, dust and fumes. Long-term exposure to these chemicals in the workplace or at home can seriously affect an individual’s risk of developing lung diseases.
Genetic Factors:
There are cases of individuals who have never smoked and have not been exposed to harmful pollutants over an extended period of time yet have still developed COPD. A known genetic risk factor for emphysema 2 is Alpha-1 Antitrypsin Deficiency (AATD) and this protein deficiency can contribute to COPD in some individuals (Copdfoundation.org, 2018).The absence of the Alpha-1 Antitrypsin protein results in white blood cells attacking the lungs and therefore causes lung tissue damage. However, it is important to note that as not all individuals with COPD have AATD and some have never smoked, it is highly likely that there are other genetic predispositions to developing this disease.
DIAGNOSIS
In order to correctly diagnose COPD and rule out other potential diseases, a range of tests must be carried out.
Spirometry:
This is a simple test that usually consists of the inhalation of a bronchodilator (to widen airways) and then breathing into a machine called a spirometer. The machine calculates two values: FEV1– the forced expiratory volume, i.e. “the amount of air exhaled in the first second of blowing” – and FVC – the forced vital capacity, i.e. “the amount of air exhaled in one entire breath”. These values are critical in diagnosis as COPD sufferers will typically have a FEV1/FVC ratio of less than 70% and the FEV1percentage is a good indicator of the severity of airway obstruction (Copdfoundation.org, 2018). This test can also be used to determine the severity of COPD and is a useful tool in establishing a treatment protocol.
Blood Tests:
Blood tests may be carried out in order to test for other conditions that may present similarly to COPD such as anaemia (low iron levels) and polycythaemia (high red blood cell concentration in the blood). Blood tests can also be used to determine the presence of an Alpha-1 Antitrypsin deficiency as the presence of this may increase the risk of developing COPD.
Other tests:
Figure 2: X-ray imaging to show the comparison of a healthy lung to a lung of an individual with COPD. (Khan, 2018)
TREATMENT
Due to the irreversible nature of COPD, many of the treatments available focus on controlling the symptoms and slowing down the progression of the disease. (Cdc.gov, 2018)
The most effective treatments include: (nhs.uk, 2018)
- Quitting smoking
- Inhalers
- Medication
- Supplemental oxygen
- Surgery
Exercise and Pulmonary Rehabilitation:
It is important to stay active as this will have a positive impact on general health and wellbeing while preventing de-conditioning due to lack of exercise (nhs.uk, 2018). A doctor may recommend an initial exercise tolerance test – this is important in assessing the level of activity to be prescribed and aids in creating a tailored programme for each individual. In moderate to severe cases, individuals may be referred to a Pulmonary Rehabilitation Programme.
The programme is tailored to each individual and involves breathing retraining, exercise training, COPD education and psychological and emotional support (Cleveland Clinic, 2018).
A basic exercise routine will be divided into 3 stages:
- Stretching
- This can be counted as a warm-up and focuses on slowly raising the heart rate and improving flexibility and range of motion in preparation for the work out.
- Conditioning phase
- This involves cardiovascular activity to strengthen the heart and lungs while also burning calories. Over time, this type of activity can improve breathing and lower heart rate and pressure. It is important to monitor the intensity of activity at this stage while considering any tiredness and shortness of breath.
- Strengthening
- This phase focuses on repeated muscle contractions to gradually improve the health and strength of the respiratory muscles.
It is important to have fun while exercising! A range of activities will reduce the chances of becoming bored and having a “buddy” to exercise with while keeping a record of activity can help to stay motivated (Cleveland Clinic, 2018).
SUPPORT
Being diagnosed with COPD can be quite overwhelming for many individuals however it is important to know that there are specialist support networks that offer help to those who need it. Individuals may choose to speak to their nurse or GP. Others may find it more helpful to speak to trained counsellors, psychologists or specialist helplines.
For more support, visit:
- COPD360SOCIAL – an online community run by the COPD Foundation which aims to connect patients, caregivers and healthcare providers (Copdfoundation.org, 2018)
- Breathe Easy local support groups – run by the British Lung Foundation (British Lung Foundation, 2018)
References
Cdc.gov. (2018). CDC – Basics About COPD- Chronic Obstructive Pulmonary Disease (COPD). [online] Available at: https://www.cdc.gov/copd/basics-about.html [Accessed 11 Nov. 2018].
nhs.uk. (2018). Chronic obstructive pulmonary disease (COPD). [online] Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/ [Accessed 11 Nov. 2018].
Cleveland Clinic. (2018). COPD Guidelines For Exercise & Pulmonary Rehab | Cleveland Clinic. [online] Available at: https://my.clevelandclinic.org/health/articles/9450-copd-exercise–activity-guidelines [Accessed 12 Nov. 2018].
Sharifabad, M. (2018). COPD – Symptoms, diagnosis and treatment | BMJ Best Practice. [online] Bestpractice.bmj.com. Available at: https://bestpractice.bmj.com/topics/en-gb/7 [Accessed 13 Nov. 2018].
British Lung Foundation. (2018). What is COPD?. [online] Available at: https://www.blf.org.uk/support-for-you/copd/what-is-it [Accessed 12 Nov. 2018].
Copdfoundation.org. (2018). What is COPD? | Signs and Symptoms. [online] Available at: https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx [Accessed 11 Nov. 2018].
Khan, A. (2018). Emphysema Imaging: Overview, Radiography, Computed Tomography. [online] Emedicine.medscape.com. Available at: https://emedicine.medscape.com/article/355688-overview [Accessed 15 Nov. 2018].
