The name “chronic obstructive pulmonary disease or COPD refers to a set of breathing problems severe and irreversible. The main ones are chronic bronchitis and emphysema. Symptoms rarely begin before middle age.
People with COPD cough a lot and are easily out of breath. As the disease progresses, daily activities become more difficult. These must be reorganized according to the energy and the breadth available.
Long-term smoking is responsible for 80% to 90% of COPD cases. About 1 in 5 smokers develop COPD. Exposure to second-hand smoke and air pollutants can also contribute. Sometimes the cause is unexplained.
Types of Chronic Bronchitis and Emphysema
Often, one finds characteristics of both chronic bronchitis and emphysema in the same person (see diagram):
- Chronic bronchitis. It accounts for 85% of COPD cases. Bronchitis is said to be chronic when the cough has been present for at least 3 months per year, for 2 consecutive years, and there is no other pulmonary problem (cystic fibrosis, tuberculosis, etc.).The wall of the bronchi produces mucus in abundance. In addition, the bronchi are constantly undergoing inflammatory reactions because they become “colonized” by bacteria. This colonization is not considered an infection, as it is usually understood. On the other hand, normally, the bronchi are sterile, that is to say, that no bacterium and no virus or other microorganism is there.
- Emphysema. The alveoli of the lungs lose their elasticity, deform little by little or break. When the cells are destroyed or damaged, the exchanges of oxygen and carbon dioxide become less efficient. In addition, the walls of the bronchi close at the expiration due to lack of support from the surrounding tissues. This closing of the bronchi at expiration does not only hinder the passage of air. It also causes the sequestration of an abnormal amount of air in the lungs.
|Better understand COPDNormally, inspiration is an active phenomenon and the expiration a passive phenomenon. When there is a bronchial obstruction, as is the case in COPD, the effort to breathe greatly increases as the exhalation is forced to become active. The feeling is similar to that felt during a significant physical effort. The obstruction we are talking about therefore occurs at expiration and not at inspiration.
In the case of chronic bronchitis, the size of the bronchi is decreased by inflammation, secretions, and sometimes spasms of the muscles located in the bronchial wall. In the case of emphysema, the bronchi collapse and lose their elasticity. The cells become abnormally dilated; they are then less effective for gas exchange.
The lungs of a person with chronic bronchitis or emphysema come to contain much more air than normal. However, this air is not quality: it is of little use to the body because it contains little oxygen and is stagnant. The role of the lungs is to perform gas exchange. With each breath, the lungs absorb oxygen and remove carbon dioxide (CO 2 ). In a person with COPD, there is “prisoner” air in the lungs, which does not participate in these gas exchanges.
More and more frequent
In Canada, COPD is the 4th cause of death after cancer, heart disease, and stroke. Experts predict that by 2013, they will appear at the 3rd leading cause of death. COPD gradually leads to heart failure by overloading the heart, which must propel the blood through the diseased lungs. In smokers, COPD increases the risk of lung cancer.
About 6% of Canadians aged 55 to 64 suffer, and 7% of those aged 65 to 74.
Currently, chronic bronchitis and emphysema affect both men and women.
Even before the first symptoms appear (cough, usually), lung damage is already well established and irreversible. At this point, stopping exposing one to irritants, such as tobacco smoke, is still very profitable. The progression of the disease is slowed down.
With time, the cough becomes more frequent, as well as colds and acute bronchitis. Sputum is more abundant. The breathing becomes increasingly difficult when significant efforts. The person tends to become more sedentary. At a certain stage, the disease causes shortness of breath at the least physical effort, and then even at rest. Symptoms are exacerbated during periods of smog, normally normal infections or exposure to irritating substances to the respiratory tract. Hospitalization is sometimes necessary.
It is important to treat symptoms of exacerbation of symptoms that may increase the destruction of fragile lung tissue.
Burnout, psychological suffering, and isolation are common challenges for people with this debilitating disease. A weight loss may occur in an advanced stage of the disease because the work of breathing is such that it compares to practice an important and constant physical effort.
Currently, physicians are concerned that COPD is often diagnosed too late, limiting the effectiveness of treatment.
- A heavy cough accentuated at sunrise and at bedtime, commonly known as “smoker’s cough”. Changing position moves secretions, which stimulates coughing;
- Sputum of whitish mucus ;
- Sometimes vomiting or dizziness, caused by coughing;
- Frequent respiratory infections At this point, the mucus becomes yellowish or greenish;
- At an advanced stage of the disease, shortness of breath, swelling of the legs and blueness of the skin and lips.
- A short breath and a feeling of shortness of breath that worsens gradually;
- A wheezing ;
- A feeling of tightness in the chest;
- A significant weight loss.
People at risk
- People who have had multiple lung infections (eg, pneumonia and tuberculosis) as children;
- People who, for genetic reasons, have alpha 1-antitrypsin deficiency are prone to emphysema at a very young age. Alpha 1-antitrypsin is a protein produced by the liver that neutralizes substances normally present in the lungs, found in greater amounts during infections. These substances can destroy lung tissue. This deficiency leads to emphysema at an early age;
- People with heartburn frequently (gastroesophageal reflux). The acid from the stomach that goes up into the esophagus can be sucked into the lungs in minimal amounts and cause pneumonia. In addition, the bronchi of people with reflux have aperture diameters that are usually smaller than normal (due to excessive stimulation of the vagus nerve ), which also contributes to respiratory problems ;
- People whose close relative has suffered from chronic bronchitis or emphysema.
|Does being asthmatic increase the risk?
The subject has long been debated. Today, most experts believe that asthma is not related to COPD. However, an individual can be afflicted with both asthma and COPD.
- Smoking for many years: this is the most important risk factor;
- Exposure to secondhand smoke ;
- Exposure to an environment where the air is laden with dust or toxic gases (mines, foundries, textile factories, cement plants, etc.).
|Basic preventive measures|
|Early detection measure|
|It is possible to detect early COPD even before it causes symptoms, through spirometry tests. It is a set of measurements of lung capacity (for example, the volumes and airflows that flow into the lungs at inspiration and expiration), performed with the help of a spirometer. For the patient, simply blow into a small electronic device with a tip. Spirometry has been used for many years in the diagnosis of asthma and COPD. Its use in screening has been discovered more recently. This examination is done by order of the doctor, in a clinic or a hospital. Doctors recommend it to smokers aged 40 and over, to detect lung disease as early as possible and limit it’s worsening.|
There is no cure for chronic bronchitis or emphysema. All the same, it is possible to improve the well-being of the sick person and slow down the progression of his illness.
With smoking cessation and good medical follow-up, if the disease is not too advanced, it may be possible to resume activities previously neglected due to shortness of breath.
Quitting smoking is the most important and also the most neglected measure. This is the first intervention to be undertaken as soon as possible to improve the quality of life. In smokers, the deterioration of the respiratory capacities is on average 3 to 4 times faster than that observed with the normal aging of the lungs. A person who quits smoking returns to a normal rate of decline.
Adaptation and follow-up
Many hospitals have specialized COPD clinics or COPD teaching centers (see Sites of Interest). Services may include nutritional counseling, physiotherapy, and occupational therapy, quiet support, etc. It teaches you how to become familiar with medication and respiratory rehabilitation exercises. The effectiveness of treatments relies heavily on the involvement of the person with the disease. The medical care is also very important. When the symptoms are exacerbated, it is advisable to see your doctor again.
Bronchodilators. In order to treat shortness of breath, the doctor usually prescribes bronchodilators in the form of inhalers (pumps ). There are several types, such as beta2-agonists and anticholinergics. Among the beta2-agonists are salbutamol (Ventolin) and terbutaline (Bricanyl), short-acting (4-6 hours), and formoterol (Oxeze) and salmeterol (Serevent), long-acting (12 hours). Anticholinergics include ipratropium bromide (Atrovent), with a short-lived effect, and tiotropium (Spiriva), which is taken only once a day. Some inhalers have a quick effect and act in minutes; others take a little longer before acting.
Other bronchodilators are used as tablets, such as xanthines. They are less used than inhalers but are sometimes used in combination with them.
These medications can cause side effects. For example, Beta-2 agonists sometimes cause tremors and increased heart rate.
Inhibitor of phosphodiesterase type 4 (IPDE-4). A new drug, roflumilast (Daxas), was approved by Health Canada in December 2010 to treat COPD in addition to bronchodilators. It can slightly reduce the number of exacerbations of symptoms. It would act by countering the inflammation present in the bronchi.
Corticosteroids. The corticosteroids are mainly used when the disease is moderate or advanced stage to prevent or treat the periods of exacerbation of symptoms (caused, for example by air pollution or respiratory infection). They facilitate breathing by reducing inflammation in the airways. They are usually taken in small doses as inhalers on a regular basis (eg Flovent and Pulmicort). Some preparations are combined with a bronchodilator (eg Advair and Symbicort). Inhaled corticosteroids may have side effects, such as a hoarse voice and superinfection throat by mushrooms.
Corticosteroids in the form of tablets may be administered punctually. Prolonged use of oral corticosteroids is not recommended because of their even greater adverse effects (weakening of the bones, increased risk of hypertension and cataracts, etc.).
Antibiotics. The least respiratory tract infection (influenza, acute bronchitis, pneumonia) will be promptly treated, usually with the help of antibiotics and cortisone tablets, to prevent an exacerbation that could lead to a life-threatening emergency. Example of respiratory distress.
Note. Use of long-acting bronchodilators and inhaled corticosteroids have been shown to reduce the frequency of exacerbation attacks in chronic bronchitis.
|We generally advise patients to receive a vaccine against the flu every year, and a vaccine against pneumococcal disease. These infections can be responsible for serious pneumonia.|
Respiratory rehabilitation and physical exercise
The respiratory discomfort can lead the sick person to lead a sedentary life, which weakens the entire musculature and increasing breathlessness. A gradual relearning of the physical effort can significantly improve the quality of life. Exercises that work the chest muscles are particularly beneficial. Get advice from a health professional.
In the case of acute respiratory distress, oxygen will be used. In addition, long-term oxygen therapy is indicated when the respiratory functions are so deteriorated that the oxygen level in the blood is constantly too low. It is administered daily at home by means of mobile equipment, has the effect of reducing the consequences of respiratory insufficiency on the heart and to bring better comfort. To be effective, oxygen therapy must be used 16 hours a day.
It is possible to correct some of the deleterious effects of emphysema – induced lung distention by surgically reducing the volume of this organ. Doctors use this practice in an exceptional way.
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