Chronic Obstructive Pulmonary Disease

Bryan, aged 79 years has been smoking for about 33 years and has used all forms of tobacco products along the way. He was diagnosed with chronic obstructive pulmonary disease (COPD) in 1998. He has been wrestling his way out since then with pulmonary rehabilitation and medications. His family has been financially affected due to the high cost of treatment. Today, he resents having smoked.

COPD includes an umbrella of lung diseases that obstruct airflow in the lungs. It simply implies that it causes breathing difficulty in a person, the person has air hunger and he needs to strain more to get air into his lungs. This is difficult for any person to go through. The more familiar terms 'Chronic Bronchitis' and 'Emphysema' are no longer used but are included within the diagnosis of COPD.

Like Bryan, millions of people worldwide are affected by COPD. The World Health Organization (WHO) predicts that COPD will become the third leading cause of death worldwide by 2030.

What are the primary risk factors for developing COPD?

• Tobacco use: Tobacco smoking is found to be the primary cause of COPD (including second -hand or passive exposure).
• Indoor (biomass fuel used for cooking and heating) and outdoor air pollution 
• Occupational dusts and chemicals (vapours, irritants and fumes)

What are the symptoms of COPD?

• Chronic cough is the most common symptom or presenting complaint
• Excessive sputum production
• Difficulty in breathing or labored breathing
• History of exposure to risk factors

COPD develops slowly over the years and therefore is diagnosed more commonly in people aged over 49 years and with several years of smoking history.

How can one be diagnosed with COPD?
Spirometry is a simple test performed to confirm COPD. The test measures how deeply a person can breathe and how fast air movement occurs within and out of the lungs. A low peak flow measure on spirometry is consistent with COPD.

How to go about being treated or managing COPD?
Over the years, several self-help groups and health management systems have come up with pulmonary rehabilitation as an important management tool for COPD.

The goals of effective COPD management are:

• To prevent disease progression
• Relieve symptoms
• Improve exercise tolerance
• Prevent and treat complications and exacerbations
• Reduce mortality

People who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation.

Reduce further exposure to risk factors, such as tobacco smoke, to prevent progression of the disease. Smoking cessation is the single most cost-effective way to reduce the risk of developing COPD.

Pharmacotherapy for tobacco dependence is now available worldwide. This should be offered to every patient who is tobacco dependent.

Medication used to manage stable COPD:

• Bronchodilator medications such as beta-2 agonists, anticholinergics, theophylline and a combination of these drugs are used to treat symptomatically. Long-term treatment with steroids should be avoided in view of unfavorable risk-benefit ratio.
• Exercise training programs, pulmonary rehabilitation and breathing exercises have proven to be more beneficial to patients in term of improvement in exercise tolerance and symptomatic relief.
• Daily oxygen supplementation has been shown to improve survival in COPD patients.

The Food and Drug Administration (FDA) has recently approved Olodaterol, a long acting beta agonist for the long-term maintenance treatment of COPD.