Chronic obstructive pulmonary disease (COPD) could easily be dubbed smoker's bane. The condition occurs when your lungs are damaged beyond repair, and most often develops after years of smoking. Breathing difficulties are common, but even before those develop, you may notice a cough that just won't go away, says Prof. Shyam Fernando of the Faculty of Medicine, University of Colombo. This week he tells MediScene about the very real dangers inherent in long term smoking, and when you may need to go to hospital.
What is COPD?
This lung disease damages your lungs, making breathing a difficult, often laborious process. This is because partly obstructed airways - the tubes that carry air in and out of your lungs- are characteristic of this condition and make it difficult to get air in and out.
Cigarette smoking is the single most common cause of COPD and most people who have the condition are either smokers or former smokers. However, you can also get COPD as a result of being exposed to other kinds of lung irritants, like pollution, dust or chemicals, over a long period of time. Being around second-hand smoke (inhaling the smoke from other people's cigarettes - or passive smoking) can also have a detrimental effect on your lungs.
Understanding your lungs
Picture your lungs: the airways branch out like an upside-down tree. At the end of each branch are alveoli - the many small, balloon-like air sacs. Each airway is clear and open in a healthy person. The air sacs are small and delicate, and both the airways and air sacs are elastic and springy. When you breathe in, each air sac fills up with air like a small balloon; when you breathe out, the balloon deflates and the air goes out. In COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out because:
- The airways and air sacs lose their elasticity.
- The walls between many of the air sacs are destroyed.
- The walls of the airways become thick and inflamed.
- Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.
Emphysema and chronic bronchitis
Emphysema is distinctive in that the walls between many of the air sacs in the lungs are destroyed - hence, a few large air sacs replace numerous tiny ones. When compared to healthy air sacs, these large air sacs have less surface for oxygen in the air to get into your blood and carbon dioxide to get out. Such poor exchanges of oxygen and the increased stiffness of the lungs are the main cause for the shortness of breath in COPD
In chronic bronchitis there is thickening and inflammation of the lungs’ airways and an increase in the number and size of mucus-producing cells. This results in excessive mucus production, which in turn contributes to cough, phlegm and difficulty getting air in and out of the lungs. All people with COPD have both chronic bronchitis and emphysema changes in their lungs.
Who is at risk for COPD?
Most people with COPD are smokers or were smokers in the past. COPD is often decades in the making, and it may take years of abusing your lungs before you begin to notice symptoms like shortness of breath. This is one of the reasons that COPD is most often diagnosed in those over 40 or elderly people. However, it is unusual but possible, for people younger than 40 years of age to have COPD.
What is undoubted is that the condition is a major cause of death and illness worldwide. Currently, there is no cure for the disease and the damage to your airways and lungs cannot be reversed. Research has shown that one of the few things that would slow the progress of the disease is quitting smoking. However, there are things you can do to reduce the disability and discomfort caused by COPD. Moreover, COPD is not contagious-you cannot catch it from someone else.
Genes may play a role in developing COPD. In rare cases, COPD is caused by a gene-related disorder called alpha 1 antitrypsin deficiency. People with a family history of COPD are more likely to get the disease if they smoke. The chance of developing COPD is also greater in people who have spent many years in contact with lung irritants, such as air pollutants, chemical fumes, vapours and dust.
Signs and symptoms of COPD
- Sputum (mucus) production
- Shortness of breath, especially with exercise
- Wheezing (a whistling or squeaky sound when you breathe)
- Chest tightness
A cough that doesn't go away and coughing up lots of mucus are common signs of COPD. These often occur years before the flow of air in and out of the lungs is reduced. However, not everyone with cough and sputum production goes on to develop COPD, and not everyone with COPD has a cough, though most do.
The severity of the symptoms depends on how much of the lung has been destroyed. If you continue to smoke, the lung destruction is faster than if you stop smoking.
Most often, doctors take a medical history, do a physical examination and request breathing tests and X'rays of the chest before diagnosing a patient with COPD.
How is COPD treated?
While COPD cannot be cured, quitting smoking is the single most important thing you can do to reduce your risk of developing this disease and also slowing it down. Your doctor will recommend treatments that help relieve your symptoms and help you breathe easier. Inhaled medicines that are given to widen your breathing tubes (bronchodilators) are the main form of treatment for relieving symptoms.
In other countries, medications are often combined with programmes of pulmonary rehabilitation. These rehab programmes educate the patients about their condition and help them to stay active despite the breathlessness. They also teach various techniques of physiotherapy to ease breathing through narrowed tubes. Other options include oxygen treatment at home, and in severe cases, surgery to remove parts of the damaged lungs.
The treatment for COPD is different for each person. Your family doctor might undertake to treat or may recommend that you see a lung specialist. Treatment is based on whether your symptoms are mild, moderate or severe.
Living with COPD
If you have been diagnosed with COPD here are some suggestions that may help. It is important to keep the air in your home clean. Even a simple chest cold can cause problems if you have COPD. These exacerbations could even be life threatening.
Here are some things that may help you in your home:
- Encourage others not to smoke and avoid smokers!
- Keep smoke, fumes and strong smells out of your home.
- If your home is painted or sprayed for insects, have it done when you can stay away from home.
- Cook near an open door or window.
- If you cook with wood or kerosene, keep a door or window open.
- Keep your windows closed and stay at home when there is a lot of pollution or dust outside.
If your doctor has told you that you have severe COPD, there are some things that you can do to get the most out of each breath.
Make your life as easy as possible by:
- Doing things slowly.
- Doing things sitting down.
- Putting things you need in one place that is easy to reach.
- Finding very simple ways to cook, clean and do other chores. Some people use a small table or cart with wheels to move things around. Using a pole or tongs with long handles can help you reach things.
- Keeping your clothes loose.
- Wearing clothes and shoes that are easy to put on and take off. You will find it difficult to bend down and tie shoe laces.
- Asking for help when moving things around in your house so that you will not need to climb stairs as often.
- Picking a place to sit that you can enjoy and visit with others.
- Developing a positive attitude
If you are having an exacerbation of COPD you should get emergency help. You will know that you are heading for trouble if:
- You find that it is becoming increasingly hard to talk or walk.
- Your heart is beating very fast or irregularly.
- Your lips or fingernails are grey or blue.
- Your breathing is fast and hard even when you are using your medicines
- You find your reliever medicines do not seem to work
- You are coughing up more sputum than normal
- If your sputum is turning greenish