BREATH TAKING?COPD causes progressive and irreversible lung degeneration.
A disease that will take your breath away
Doctor's insight
Dr Ronan Clancy
In my recent article on cigarette cessation, I listed the many diseases caused by cigarettes ranging from numerous types of cancer to heart disease and stroke. Today, I’m focusing in on chronic obstructive pulmonary disease (COPD), which is predominantly caused by cigarette smoking.
Statistics
COPD is the fourth-leading cause of death worldwide and is expected to be the third-leading cause by 2020. It is very widespread and often under diagnosed. Pan European studies show variations between countries, but an overall prevalence figure of 10 percent, affecting 20 percent of men and 15 percent in women aged over 70 year around Europe. The Organisation for Economic Co-operation and Development (OECD) places Ireland highest in Europe for hospitalisation rates for severe COPD.
What is COPD?
COPD is disease causing progressive and irreversible lung degeneration. This leads to poor oxygen uptake and carbon dioxide release, trapping of mucus, recurrent infections and ultimately failure of the lungs and death from heart and lung failure if not treated. It was formerly referred to as emphysema or chronic bronchitis.
Overwhelmingly, COPD is a smokers’ (or passive smokers’!) disease, but it can occur due to exposure to toxic pollutants and gases at work or in the environment, and very rarely due to other medical causes.
Disease process
There are a number of disease (pathological) changes that occur in the lungs in COPD.
Noxious chemicals inhaled in cigarette smoke or the environment over decades cause the lungs to lose elasticity, so that they are unable to efficiently inflate and deflate normally.
Mucus is over produced in the linings of the airways, and the system that wafts mucus upwards breaks down leading to trapping and difficulty clearing mucus and susceptibility to infections.
In advanced disease, the small blood vessels the lungs constrict and narrow due to low oxygen levels. This forces the heart to pump harder to supply the lungs. This can over-strain the heart and cause the heart to fail in a condition called Cor Pulmonale.
Symptoms
Initially, chronic daily cough develops with increased sputum (mucus) production. Shortness of breath occurs with exertion. This happen slowly over time, and often people don’t notice the very early changes. As decline continues, all of these symptoms slowly worsen with chest infections occurring more frequently and severe episodes of exacerbation requiring hospitalisation.
Diagnosis
Your doctor will perform investigations including blood tests, a chest x-ray and lung function tests. Investigations of the heart may also be necessary.
If you think you may have COPD a simple test online test can be undertaken at www.catestonline.org. You can print your results and bring them to discuss with your GP.
Treatment
The aims of treatment are to reduce the COPD symptoms and improve a patient’s quality of life, reduce the frequency of severe exacerbations and extend life by slowing the rate of decline within the lungs.
There are four approaches. Smoking cessation has the greatest capacity to reduce progression of COPD. Exercise and Pulmonary (lung) Rehab programmes nationally are shown to improve quality of life and symptoms of COPD, reduce hospitalisation and improve long-term survival.
Education is also important: A patient who knows and understands their illness is more likely to take medications correctly yielding better benefits and also knowing what to do early on when symptoms disimprove.
The fourth approach involves medications. Inhaled medications can be used to open up the airways to allow for better oxygen uptake and carbon dioxide release. Other drugs reduce inflammation, damage and progression of COPD.
Medications are tailored to the patient’s individual needs and their technical ability to properly take them. In advanced cases, home oxygen or assisted ventilation may be required.
COPD sufferers should receive an annual influenza vaccine from their doctor. It is important to point out that medications are extremely important in COPD management. They can reduce the symptoms, frequency of serious exacerbations and the need for hospitalisation, as well as improving quality of life. However, it is important to point out that as yet, they have not been proven to extend survival in COPD. Longer-term survival occurs as a result of good combination of all four treatment approaches mentioned above.
The most critical of all is stopping smoking.
For more information, visit www.livingwithcopd.ie.
Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.
