World COPD Day
COPD: Early Detection, Improved Function
The epidemic of Chronic Obstructive Pulmonary (or lung) Disease (COPD) is like the iceberg that struck the Titanic. We know it’s out there but cannot see the large number of patients who have lungs that are slowly getting injured. Dust, indoor air pollution from smoke due to home cooking and heating fuels, tobacco smoke, hookah, industrial pollution, occupational dusts and chemicals can all cause lung damage. At this time there is no way to reliably increase the amount of lung tissue- so once it is damaged it is lost forever. The bigger problem is that the destruction leaves in its wake severe symptoms- cough, phlegm, breathing difficulty, loss of muscle power, weakness and ultimately can kill the patient. The lung structure is damaged and there is less lung tissue to perform the vital role of supplying oxygen and removing carbon dioxide from the blood.
Since 2002 the Global Initiative for Chronic Obstructive Lung Disease has observed World COPD Day with an aim to raise awareness and improve COPD care globally. The theme for 2016 is ‘Breathe in the Knowledge’.
Early diagnosis can be done when the history suggests COPD. Spirometry, which is a measure of lung capacity will help detect and classify the severity of COPD. Typically patients have shortness of breath or dyspnea which worsens with time, is persistent and gets worse with exercise. Some may have a chronic cough which may be intermittent and sometimes produces phlegm and this may be chronic also.
The presence of a ‘post-bronchodilator FEV1/FVC ratio’ below 70% confirms persistent airflow limitation and thus COPD. In simple terms this is an indicator of the air that a person can blow out in one second as a fraction of all the air they can blow out with a maximum effort. Research has shown that if the fraction is below the 70% threshold the patient has COPD- this is because all the air is not coming out as it should and this because of the structural changes in the lung and air tubes from COPD. The spirometry test is done after giving a ‘bronchodilator’ which relaxes the air tubes and allows a good test to be performed.
COPD is classified based on the spirometry data – for example GOLD Grade 2 is moderate disease and the patient has the FEV1 between 50 and 80% of predicted for that person’s demographic criteria. These predictions for what is normal and what is abnormal are based on large population based studies the have been done over the years to create reference normal values for various groups of people.
The patient with COPD may have exacerbations every so often and this is due to worsening of the baseline limitation in lung capacity. The shortness of breath can also be objectively evaluated by various scales.
The management of this disease is multidisciplinary and involves addressing accompanying diseases like diabetes, weak muscles, heart disease, osteoporosis, depression and lung cancer.
The treatment will depend on the severity of the disease and the goal is to reduce symptoms and reduce risk. Specifically this may involve improving exercise tolerance and treating exacerbations. Various medications which relax the air passages are available and these may be short or long acting. Inhaled medications are preferred as they are more efficacious and have less side effects. Some patients need other medications like steroids. Several other newer medications are available now and research progress has been steady.
Tobacco cessation remains a key factor in prevention of the disease and decreasing exacerbations. In addition, attention to nutrition, use of assisted breathing devices like noninvasive ventilators for management of an exacerbation as well as the role of exercise, oxygen therapy and lung rehabilitation are now part of the comprehensive treatment approach.
In summary COPD is a global killer- in fact predicted to be the fourth largest killer by 2030. It is prevalent around the world – even as high as 19% in some countries. Asthma may became COPD over time and there may be some overlap between both diseases. Imaging with chest x-ray or CT scan may be required. Severe cases of COPD even end up needing lung transplantation. In India the burden of COPD is severe and preventive measures dealing with improvement in the quality of air, tobacco cessation and access to treatment are critical issues needing social efforts and partnership.
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