Chronic Obstructive Pulmonary Disease

OPD is primarily a disease of adult. It is chronic disease which is affecting the population with alarming rate. It is a significant cause of morbidity and mortality worldwide. COPD ranked as the sixth leading cause of death in 1990 in the world. It is projected to become the fourth leading cause of death worldwide by 2030, due to an increase in smoking rates and demographic changes in many countries. In India median prevalence rates were assessed as 5% for male and 2.7% for female subjects of over 30 years of age.

Chronic Obstructive Pulmonary Disease (COPD) is not one single disease but an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis./p>

COPD is not just simply a "smoker's cough", but a under-diagnosed, life threatening lung disease that may progressively lead to death.

Main risk factors for COPD

  • Tobacco smoking
  • Indoor air pollution (such as biomass fuel used for cooking and heating)
  • Outdoor air pollution
  • Occupational dusts and chemicals (vapours, irritants, and fumes)

    Smoking

    The primary cause of chronic obstructive pulmonary disease (COPD) is tobacco smoke (including second-hand or passive exposure). WHO estimates that in 2005 5.4 million people died due to tobacco use. Tobacco-related deaths are projected to increase to 8.3 million deaths per year by 2030.

    Other risk factors

    About 3 billion people worldwide use biomass and coal as their main source of energy for cooking, heating, and other household needs. In these communities, indoor air pollution is responsible for a greater fraction of COPD risk than outdoor air pollution. Biomass fuels used by women for cooking account for the high prevalence of COPD among non-smokers. Indoor air pollution resulting from the burning of wood and other biomass fuels is estimated to kill two million women and children each year.

    Other risk factors for COPD include occupational dusts and chemicals (such as vapours, irritants, and fumes) and frequent lower respiratory infections during childhood.

    Symptoms

    Diagnosis of COPD should be considered in any patient who has symptoms like

    • Chronic cough
    • Sputum production
    • Breathlessness, difficult or laboured breathing
    • History of exposure to risk factors for the disease

    OChronic cough and sputum production often precede the development of airflow limitation by many years. Because COPD develops slowly, it is most frequently diagnosed in people aged 40 years or over.

    Diagnosis of COPD

    Spirometry

    Diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed by a simple test called spirometry, which measures how deeply a person can breathe and how fast air can move into and out of the lungs. spirometry is the gold standard as it is the most reproducible, standardized, and objective way of measuring airflow limitation. FEV1/FVC < 70% and a post-bronchodilator FEV1 < 80% predicted confirms the presence of airflow limitation that is not fully reversible.

    Where spirometry is unavailable, clinical symptoms and signs, such as abnormal shortness of breath and increased forced expiratory time, can be used to help with the diagnosis.

    COPD Management

    • The goals of effective COPD management are to:
    • Prevent disease progression
    • Relieve symptoms
    • Improve exercise tolerance
    • Improve health status
    • Prevent and treat complications
    • Prevent and treat exacerbations
    • Reduce mortality

    Important management strategies

    These include pharmacologic and non-pharmacologic measures like:

    • Smoking cessation
    • Drug therapy- Bronchodilator treatments using 2-agonists, anti-cholinergics often in the inhalers form and theophylline, or combination of one or more of these drugs.
    • Vaccinations 
    • Pulmonary Rehabilitation
    • Long-term oxygen therapy 
    • Lung transplantation.
    • Health Education to cope illness

    Prevention of COPD and its complications

    The best strategy is to stop smoking and avoiding exposure to other risk factors. Early diagnosis and regular treatment with multiple approach reduce exacerbation and maintain better quality of life.

    References:

    • Global strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease-2010 update.
    • Guidelines for Management of Chronic Obstructive Pulmonary Disease (COPD) in India: A Guide for Physicians (2003)
    • COPD: The Unrecognized Epidemic in India.SK Jindal. PGIMER, Chandigarh

    (Dr. Amit Kumar Murar)
    Medical Officer
    IIT Hospital