Chronic obstructive pulmonary disease (COPD)

Diagnosis

A significant number of individuals with COPD may not receive a proper diagnosis until their condition has reached an advanced stage.

To diagnose COPD, healthcare providers will assess the patient’s signs and symptoms, inquire about their medical history and family history, and gather information regarding exposure to lung irritants, notably cigarette smoke. Additionally, the healthcare provider may request a series of tests to aid in the diagnosis.

• Lung function tests: These examinations check the patient’s ability to breathe in and out as well as their ability to provide the blood with enough oxygen. In order to determine how much air the lungs can contain and how quickly they can expel it, the most frequent test, called spirometry, requires the patient to blow into a big tube that is attached to a small machine. Additional tests comprise the assessment of lung volumes and diffusing capacity, the six-minute walk test, as well as pulse oximetry.
• Chest X-ray: Emphysema, one of the main causes of COPD, can be seen on a chest X-ray. Additionally, an X-ray can rule out heart failure or any lung issues.
• CT scan: Emphysema can be found on a lung CT scan, which can also help doctors decide whether or not you need COPD surgery. Lung cancer screening can also be done with CT scans.
• Arterial blood gas analysis: This blood test evaluates how well the lungs remove carbon dioxide from the blood and deliver oxygen to it.
• Laboratory tests: Although lab tests aren’t utilized to diagnose COPD, they can be used to identify the symptom’s underlying cause or rule out other diseases. The genetic condition alpha-1-antitrypsin deficiency, which in some cases may be the cause of COPD, can be detected via laboratory tests, for instance, to see if the patient has it. If COPD runs in the family or if the person develops the disease at a young age, this test might be conducted.

Stages

COPD may progressively worsen. It varies from person to person how quickly it goes from mild to severe.

• Stage 1 (Mild or early stage): When doing simple workouts like walking up stairs, the first indicator of COPD is frequently feeling out of breath. Many people don’t know they have COPD because it’s simple to attribute this symptom to becoming older or being out of shape.
• Stage 2-3 (Moderate to severe): The more severe the COPD, the more obvious shortness of breath is. Even during routine activities, a patient may experience shortness of breath. Higher stages of COPD are also more likely to encounter exacerbations, which are episodes in which a person experiences more phlegm, phlegm that is discolored, and more shortness of breath. Infections of the lungs, such as pneumonia and bronchitis, also become more likely in the patient.
• Stage 4 (Severe): Almost anything the patient do can make them feel out of breath if their COPD is severe. The movement is so limited. A portable tank of oxygen can be required for the patient.

Treatment

Effective treatments for COPD can effectively manage symptoms, minimize the progression of the disease, reduce the likelihood of complications and exacerbations, and improve the overall quality of life, even in advanced stages of the condition. It is worth noting that while quitting smoking is a crucial step in managing COPD, many patients with milder forms of the disease may not require additional treatment.

• Quit smoking: Stopping up all smoking is the most important step in any COPD treatment plan. Ceasing smoking can prevent COPD from worsening and help in preserving your lung function, thereby reducing the decline in your ability to breathe. It’s not easy to stop smoking.

Consult your healthcare physician regarding medications and nicotine replacement therapies, and seek their advice on relapse prevention strategies. They may also recommend joining a support group specifically designed for individuals who want to quit smoking. Furthermore, it is important to minimize exposure to secondhand smoke and avoid environments with poor air quality, characterized by dust, smoke, gases, and unpleasant odors. Taking these measures can greatly contribute to managing COPD effectively.

• Medications: The signs, symptoms, and problems of COPD are managed with a variety of medications. Some medications may be taken routinely by the patient and others only when necessary.
  • Bronchodilators: The medications known as bronchodilators, which typically come in inhalers, relax the muscles surrounding the airways. This can facilitate easier breathing by reducing coughing and shortness of breath. The patient may require a short-acting bronchodilator before activities, a long-acting bronchodilator that may be used every day, or both, depending on the severity of the condition.
    • Short-acting bronchodilators include levalbuterol, ipratropium, and albuterol.
    • Long-acting bronchodilators includes Aclidinium, Arformoterol, Formoterol, Indacaterol, Tiotropium, Salmeterol, and Umeclidinium.
  • Inhaled steroid: Corticosteroids that are inhaled can lessen airway irritation and assist in preventing exacerbations. Hoarseness, oral infections, and bruising are possible side effects. For those whose COPD frequently worsens, these drugs can be helpful. Examples of inhaled steroid include Fluticasone, and Budesonide.
  • Combination inhalers: Inhaled steroids and bronchodilators are both components of several medicines. Formoterol and budesonide (Symbicort), fluticasone and vilanterol (Breo Ellipta), fluticasone, umeclidinium and vilanterol (Trelegy Ellipta), and salmeterol and fluticasone (Advair HFA, AirDuo Digihaler, among others) are some examples of these combination inhalers.

There are also combination inhalers that include many types of bronchodilators. Formoterol and glycopyrrolate (Bevespi Aerosphere), glycopyrrolate and indacaterol (Utibron), olodaterol and tiotropium (Stiolto Respimat), and umeclidinium and vilanterol (Anoro Ellipta) are a few examples of these.

• • Oral steroids: Short courses (for instance, five days) of oral corticosteroids may help persons with moderate or severe acute exacerbations of COPD avoid further deterioration of their condition. On the other hand, prolonged use of these drugs may cause major adverse effects include weight gain, diabetes, osteoporosis, cataracts, and an elevated risk of infection.
  • Phosphodiesterase-4 inhibitors: Roflumilast, a phosphodiesterase-4 inhibitor, is a medication authorized for adults with severe COPD and symptoms of chronic bronchitis. This medication relaxes airway and reduces airway inflammation.
  • Theophylline: Theophylline, a less expensive medicine, may assist improve breathing and prevent episodes of worsening COPD when other treatments have proven ineffective.
  • Antibiotics: Infections of the respiratory system, such as influenza, pneumonia, and acute bronchitis, can make COPD symptoms worse. Although they are often not advised for prevention, antibiotics assist in the treatment of episodes of COPD that are getting worse. Azithromycin (Zithromax), according to some studies, prevents episodes of COPD worsening, however its usage may be constrained by side effects and antibiotic resistance.
• Lung therapies: For patients with moderate to severe COPD, healthcare provider frequently employ these additional treatments.
  • Oxygen therapy: They could require supplemental oxygen if the blood doesn’t contain enough oxygen. They can take light, portable units with them to carry around as well as other equipment to supply oxygen to the lungs.

Certain individuals with COPD utilize oxygen solely during specific activities or while sleeping. Others regularly utilize oxygen. Only oxygen therapy has been shown to extend life and can enhance quality of life in COPD patients.

• • Rehabilitation program (pulmonary): These programs typically include counseling, education, fitness instruction, and nutrition recommendations. They will collaborate with a range of experts, and they can modify the rehabilitation program to suit the needs.

After episodes of COPD worsening, pulmonary rehabilitation may lower the need for readmission to the hospital, boost one’s capacity for daily tasks, and enhance one’s quality of life.

• • In-home noninvasive ventilation therapy: Bilevel positive airway pressure (BiPAP), for example, is supported by evidence when used in hospitals, but some new study suggests that using it at home can also be beneficial. Improved breathing is made possible with a noninvasive ventilation therapy system with a mask, which also reduces carbon dioxide retention (hypercapnia), which can cause acute respiratory failure and hospitalization.
  • Managing exacerbations: The patient may occasionally encounter episodes where symptoms worsen for days or weeks even while receiving continuing treatment. This is known as an acute exacerbation and could cause lung failure if they don’t get immediate medical attention.

A respiratory infection, air pollution, or other inflammatory stimuli may be the cause of exacerbations. Regardless of the cause, it’s critical to seek immediate medical attention if they experience a continuous increase in coughing, a change in their mucus, or difficulty breathing.

Exacerbations may require the patient to take additional medications (such as antibiotics, steroids, or both), supplemental oxygen, or hospital treatment. Once the patient’s symptoms have improved, the healthcare provider can discuss ways to prevent relapses, such as stopping smoking, using long-acting bronchodilators, inhaled steroids, or other drugs; obtaining an annual flu shot; and avoiding air pollution wherever feasible.

• Surgery: When medication alone is insufficient to treat some forms of severe emphysema, surgery may be an alternative. the following surgical options:
  • Lung volume reduction surgery: Small wedges of damaged upper lung tissue are cut out during this procedure by the surgeon. As a result, the chest cavity is given greater room, allowing the diaphragm to function more effectively and the remaining, healthier lung tissue to expand. This operation may increase quality of life and lengthen survival in some patients.

The U.S. Food and Drug Administration recently approved the minimally invasive method endoscopic lung volume reduction to treat COPD. In order to give the healthy portion of the lung more room to grow and function, a tiny one-way endobronchial valve is implanted into the lung, allowing the more damaged lobe to shrink.

• • Bullectomy: When the alveolar walls are damaged, large air pockets (called bullae) develop in the lungs. Breathing issues may result from these bullae as they grow in size. For the purpose of enhancing airflow, surgeons perform bullectomy on the lungs.
  • Lung transplant: A lung transplant may be an option for some patients who meet certain requirements. Breathing abilities can be enhanced by transplantation. However, patients will need to take lifetime immune-suppressing drugs, and the operation carries a number of risks, such as organ rejection.