COPD: It takes your breath away

August is National Lung Month. It highlights the importance of lung diseases, such as Chronic Obstructive Pulmonary Disease or COPD, as a major cause of death and disability in the Philippines.  COPD is not curable, but it is preventable and treatable.  Lifestyle changes and medications can help patients cope with chronic lung disease and live longer and fuller lives.

The average person takes more than 20,000 breaths a day.  With each breath, air travels down the windpipe, or trachea, then through smaller tubes called bronchi (see figure). The linings of the bronchi are studded with mucous glands that add moisture to the air and their walls contain muscle that can make the tubes wider or narrower.  The air’s final destination is the lung’s 300 million tiny air sacs called alveoli.  Here, oxygen enters the blood to nourish the body’s tissues, and carbon dioxide makes its way out of the bloodstream.

The work of breathing is powered mainly by the diaphragm, the strong muscle that separates the chest from the abdomen.  As you inhale, your chest expands and your bronchi widen; when you exhale, the reverse occurs.  The narrower your bronchi, the longer it takes to expel air from your lungs.

What is COPD?

COPD is a complex disorder.  There are two major forms: chronic bronchitis and emphysema.  In both, narrowed bronchi make it hard to exhale.  Narrowed bronchi also cause asthma — but in asthma, the narrowing is temporary and reversible, while in COPD, it’s permanent.  In chronic bronchitis, an enlargement of the mucous glands and excessive mucous production cause the narrowing.  In emphysema, the narrowing comes from damage to the bronchi themselves and is more severe.  Most patients with COPD have a mixture of chronic bronchitis and emphysema.

Narrowed bronchial tubes are the hallmark of COPD, but the damage doesn’t stop there.  It takes more force to exhale through narrow airways, thus in emphysema, the air sacs become hyperinflated, filled with too much air.  But pressure is not the main culprit in emphysema. It’s the inflammation triggered by inhaled irritants. White blood cells respond to the irritation, but instead of controlling the problem, they release chemicals that damage and eventually destroy lung tissue.

Signs and symptoms

Smoking is responsible for about 85 percent of cases; heavy smokers are at highest risk. Airborne toxins account for COPD in many nonsmokers. Secondhand smoke is another likely contributor. In others, an inherited deficiency of a protein (alpha-1 antitrypsin) that keeps the lung healthy is to blame.  In some cases, no cause is apparent.

COPD starts gradually and progresses slowly.  At first, there are no symptoms — but little by little, problems appear, usually in middle age.  A morning “smoker’s cough” is often the first complaint. The cough gradually gets worse and occurs throughout the day.  Next, shortness of breath develops. In the beginning, patients only notice shortness of breath during exercise, but as the disease progresses, breathing becomes a chore, even at rest.  Wheezing is another common symptom.  Most patients also become tired and weak.  And in addition to daily symptoms, most have two or three exacerbations each year.  These are abrupt flares that are often triggered by lung infections.  Subsequently, symptoms get much worse and aggressive treatment is needed.

TREATMENT: Lifestyle

• Avoid tobacco. It’s the first rule in prevention, and the most important.  And it applies to secondhand smoke, too.  No exceptions.

• Good nutrition is also important.  A high intake of fruits, vegetables, whole grains, and fish appears to protect the lungs and reduce the risk of COPD, while refined grains, red meat, and cured meats all increase a smoker’s risk of lung cancer.  Patients with chronic bronchitis and heart strain must avoid sodium (salt).  Patients with severe emphysema are often emaciated and may benefit from high-calorie nutritional supplements.  Good hydration is important to keep phlegm loose and easy to cough out.

• Exercise makes patients huff and puff, but a gradual program of low-to-moderate-intensity exercise helps muscles get the most bang out of the oxygen that damaged lungs can deliver.  Walking is best, starting with five minutes three to four times a day, then building up to as much as 45 minutes a day.  Patients with severe COPD or heart disease may need supervision. Structured pulmonary rehabilitation programs also offer breathing exercises designed to strengthen chest muscles.

• Preventing infection is essential.  Be sure your flu and pneumococcal pneumonia immunizations are up- to-date. Keep your distance from folks with respiratory infections, particularly the flu.  Wash your hands carefully, using an alcohol-based hand rub.

Treatment: Medications

Prescription medications can do a lot for patients with COPD.  Your doctor will decide what’s best for you and will explain the likely benefits and possible side effects. Here is a summary of the major groups of medications:

• Bronchodilators relax the muscles in the walls of the bronchi, widening the tubes and easing the passage of air. The most popular short-acting bronchodilators is albuterol, which is inhaled through a metered-dose inhaler (MDI) up to four times a day for quick relief of wheezing, coughing, or shortness of breath.

Patients with mild COPD may need only a short-acting bronchodilator, but patients with more advanced disease also benefit from long-acting bronchodilator. Although these medications have been controversial in asthma, they appear safe and effective in COPD when used carefully and properly.  Salmeterol, formoterol, and aformoterol can be inhaled twice daily from an MDI, from a dry powder inhaler (DPI), or from a nebulizer. Long-acting bronchodilators are used to prevent symptoms, not provide rapid relief.  Patients taking these medications should continue taking their short-acting bronchodilators from rapid relief.

• Corticosteriods (steroids) reduce inflammation in the tubes.  Inhaled steroids can help many, but not all, patients with moderate to severe COPD.  They are not effective for patients who are also taking long-acting bronchodilators.  Steroids are also available in oral and injectable forms.  These preparations have powerful anti-inflammatory effects but can also produce serious side effects.  Whereas inhaled steroids are desirable for long-term maintenance of patients with COPD, steroid tablets and injections are used only for short-term treatment of severe flares or exacerbations.

• Anticholinergics are drugs that widen the bronchial tubes and also reduce the volume of secretions without making sputum thick and hard to raise.  They are inhaled for long-term control; the relatively newer drug tiotropium can be used just once a day, while ipratropium must be administered twice a day.  Tiotropium has been widely used for COPD with good results and may even slow the progression of early COPD. Because the anticholinergics and bronchodilators work in different ways, patients can benefit from using both types of drugs.

• Antibiotics are not helpful for maintenance therapy but can be critically important for exacerbations or flares. Notify your doctor promptly if your breathing becomes worse, if you develop fever, or if your phlegm becomes thicker, discolored, or more abundant.

Treatment:  Oxygen and Surgery

COPD patients who have low blood oxygen levels can benefit greatly from long-term, round-the-clock oxygen therapy.  For home use, oxygen can be stored in cylinders or generated by machines called oxygen concentrators. Portable tanks can provide several hours of oxygen away from home. Safe oxygen therapy requires the responsible cooperation of patients and household members.

Select patients with severe emphysema may benefit from special types of lung operations.  Expert evaluation by experienced physicians is mandatory.  A few COPD patients may be eligible for lung transplantation.

Living with COPD

During the course of a lifetime, the average person will take some 600 million breaths.  Most people can keep their lungs healthy simply by avoiding tobacco smoke and noxious fumes.  A good diet should also help.  And even when COPD causes damage, early diagnosis and treatment can slow the process, ward off complications, and improve quality of life.  New therapies are on the way, but simple prevention is the best treatment of all.

Don’t take COPD for granted.  It can literally take your breath away!

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Source:  www.health.harvard.edu