COPD or Chronic Obstructive Pulmonary Disease is defined as a group of diseases of lungs which are responsible for difficult breathing.
Two commonest diseases of lungs which are responsible for this breathing difficulty and which form chronic obstructive pulmonary disease are Bronchitis and Emphysema.
These diseases produce defect in the structures of airways of lungs (bronchial tubes, alveoli) and block the airflow. This blocking of airflow lead to difficulty breathing and when this derangement of lung airway structures persists for long time then it is termed as chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease occurs in different stages i.e. mild, moderate, severe and very severe. The two main diseases involved in formation of COPD enphysema and bronchitis and destruction done by these diseases in lungs are as follows
• Emphysema involves the destruction of alveoli of lungs.
• Bronchitis involves the destruction of bronchial tubes of lungs.
Path physiology of COPD depends on the pathology of emphysema and bronchitis. When both these diseases stay in an individual for a long time then chronic obstructive pulmonary disease is formed.
In chronic bronchitis the bronchial tubes catch an infection and get inflamed.
Due to inflammation of bronchial tubes the body reaction (defense) against the infection is in the form of making mucus in airways. This mucus leads to narrowing the air passage in lungs leading to difficulty in breathing.
In case of emphysema, this disease affects the alveoli of lungs.
The alveoli are like balloons when a person inspires these alveoli to stretch like a balloon and on expiration come to original shape. In emphysema infection of alveoli occur leads to damage to elastic property of alveoli. Due to this breath in the air do not properly diffused in blood and lead to oxygen deficiency of blood leading to impaired breathing.
When both these conditions of lungs continue for a long time i.e. for over years then it leads to the formation of COPD.
COPD occurrence is more in women than men.
People of higher age groups especially old people are more affected by COPD.
Individuals who belong to the genetic history of lung diseases show the high occurrence of COPD in later ages.
The chronic obstructive pulmonary disease occurs worldwide in all races but prevalence is more in developed countries as east south central U.S.
• The long history of smoking tobacco is the leading cause of COPD.
• Exposure to environmental pollutants.
• People living near smoke releasing industries are at more risk of getting infected due to COPD because they are continually affected by inhaling polluted air.
• Individuals working in chemistry labs.
• In villages, females who are on regular exposure to cooking fire smoke are also prone to get infected by COPD.
• People living in metropolitan cities are in continuous exposure to pollutants of smoke by vehicles and who have a genetically weak immune system.
• Exposure to smoking directing or indirectly for the long term. A person who is an active smoker is surely at higher risk but the passive smoker who is not directly smoking but is under continuous exposure to tobacco smoke is equally at higher risk of suffering from COPD.
• People who work in smoke producing industries are under the continuous exposure of pollutants. These pollutants can inflame and irritate the lungs tissue leading to their destruction and derangement of air pathway of lungs producing COPD.
• Genetic factors also become a risk factor especially deficiency of alpha -1 trypsin protein.
• People who are already suffering from lung diseases like asthma and who smoke along with this is more prone to develop COPD.
• Age factor also plays a risk factor, individuals above the age of 35 years develop COPD as it develops slowly over years.
• Tightness feeling in the chest.
• Too much formation of mucus in the chest at night and expelled in the morning.
• During exertion of the body there is difficulty in breathing, lead to shortness of breath.
• The patient suffers from recurrent attacks of infection of lungs.
• Weight loss in later stages of infection.
• Cyanosis occurs in a patient suffering at a severe level of COPD, appeared in the form of the blueness of lips and fingernails beds.
• A long-lasting cough is present.
COPD shows different stages of disease which are as follows
Stage 1 (mild symptom stage)
• History of a chronic cough with much mucus.
• Pulmonary function test shows more than 80% value indicates lungs are normal at this stage.
Stage 2 (moderate symptom stage)
• Breath is short during physical exertion.
• A chronic complaint of coughing with associated mucus.
• Pulmonary function test results show between 50-80%. Lungs are functioning at not normal levels.
Stage 3 (severe symptom stage)
• Shortness of breath is increased.
• Due to a decrease in intake of oxygen by blood through lungs leading to fatigue of body and reduce in physical work capacity.
• Repeated and recurrent attacks of breathless and lot of cough and mucus.
• Pulmonary functions test decreased to further low levels i.e. 30-50%.
Stage 4 (very severe stage)
• At this stage, there is the severity of shortness of breath.
• The patient is not comfortable in performing regular routine works.
• Weight loss is increased.
• There is the occurrence of edema in extremities especially legs and arms.
• Emergency flaring up of symptoms occur at this stage and patient needs hospitalization.
• Pulmonary function test is very low levels showing the result of respiratory failure i.e. less than 30%.
• History of symptoms of the patient helps a lot in making disease picture.
• Amount of mucus coming daily help to know the severity of the disease.
• Sputum examination in cases of infection.
• X-ray chest.
• CT scan of chest helps to detect the severity of stage of the disease.
• Pulmonary function tests are the final help to analyze the functioning of lungs.
• Arterial blood gas analysis also helps a lot.
• Lung cancer.
• Respiratory failure leading to death.
• Heart diseases risk increased.
• Depression is also a leading complication of COPD.
• Hypertension can occur in chronic cases.
• Cor pulmonale.
• Severe weight loss in chronic cases, malnutrition.
Prognosis is bad if the cause is not removed at right time as like smoking, fumes, occupational change.
Chronic cases need a proper care and management.
If COPD is due to occupation hazards then a change of job helps in treatment a lot. Severe cases are very difficult to treat they are only managed.
• Stoppage of the habit of smoking is very important to stop the progress of the disease.
• If the disease occurs due to occupational area pollutant then a change of job is necessary.
• Medication when disease is at severe stage or when complication is present, medication is following
Oral steroids (show a lot of side effects)
Antibiotics are very helpful to curb the infection.
• There are different type of therapies
Pulmonary rehabilitation program
Lung volume reduction surgery.
• Well indicated medicine for asthma, breathing difficulties.
• There is a large accumulation of purulent discharges and feeble expectoration, which is increased in cold weather.
• Mucus is tough and hard.
• There is coarse rattling in the chest of old people.
• The patient is unable to lie down on bed and fear of suffocation.
• Air passages of the patient are constricted.
• Complaints of asthma aggravate at night.
• There is excessive cattarh and the patient feels suffocative.
• A cough is increased after midnight.and is worse when lying on back.
• Respiration in chest produces wheezing sound.
• Expectoration is frothy and very scanty.
• There is an increase in the mucus in lungs which fill up the bronchial tubes.
• There is tickling in the larynx.
• There is pressure feeling in the bronchi, with constriction and due to which respiration is difficult.
• A cough is dry and hard.
• There is congestion seen in the upper lobe of left lung.
• Well indicated medicine for pneumonia, hepatization stage is present when the resolution is failed.
• There is a bursting pain in back on coughing.
• End of a cough occurs in a sneeze.
• There is a great amount of bronchial cattarh, with soreness in the chest walls, with profuse mucus.
• The sensation of weight on the chest.
• There is present asthenic bronchitis in old people with chronic emphysema.
• There is exudation in pleura well indicated on this condition.
• There is too much pressure on chest and patient feels as if lungs are pushed back on spine.
• The patient suffers from difficult respiration and wants windows of the room to be opened.
• Well indicated for bronchitis where a cough is loose, cough is aggravated on talking, in the morning time.
• Mucus expectorated is greenish in color, purulent, sweetish in taste.
• During pneumonia, there is much rattling of mucus in the chest.
• Sensation as if the load is put on the chest.
• Dyspnea is present in patient especially in the middle of night and relieved by sitting up.
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