COPD


What is COPD

Chronic Obstructive Pulmonary Disease (COPD) which is the fifth leading cause of death in Hong Kong, is a chronic airway disease characterized by airflow limitation; it comprises Chronic Bronchitis and Emphysema. It is caused by noxious particles or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung. COPD is an irreversibledisease that makes sufferers hard to breathe, affect their daily life and may progressively lead to death. 

Tobacco

Symptoms of COPD

The most common symptoms of COPD are

-         Daily cough and phlegm for at least three months a year for a number of years

-         Excessive sputum production and a chronic cough

-         Progressive shortness of breath during daily activities that was not a problem before

-         Dyspnea



Causes of COPD

The causes of COPD are always associated with the inflammation of the small airways or bronchioles, lung and pulmonary vessels. It leads to the repeated injury and repair and causes structural changes of the lung. It is thought that cigarette smoke induces inflammation in the small airway and lung substance. An excessive amount of enzyme (protease) is produced which stimulates mucus secretion, which damages the airway walls and lung tissues and destroys the local immune system. When patients breathe out, the alveoli and small airways collapse. The loss of elasticity of the lung tissue makes it harder for air to get to the periphery or furthest part of the lung during inhalation, and also harder for air to exit the damaged part of the lung during exhalation. The pathological changes of hyperinflation cause the progressive airflow obstruction in the lung. 



Impact of COPD

The damage of Chronic obstructive pulmonary disease to the human body is irreversible, so the impact on patients is a long-term and progressive. Patients' lungs will get worse continuously and lead to other complications, such as pulmonary hypertension, pulmonary heart disease, osteoporosis and diabetes type II.

 


Diagnosis of COPD

The symptoms of COPD are various depending on different people. Doctors will ask about
1.       Symptoms: any cough, sputum, dyspnea, or COPD risk factor exposure? 
2.       Medical history: whether suffered from asthma, allergic diseases, sinusitis or nasal polyps and other respiratory diseases?
3.       Spirometry: utilizes a spirometer to measure the volume of air inspired and expired by the lungs in one second.

The stages of COPD
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses FEV₁measurements to help with this determination:

Severity of COPD (GOLD scale)FEV1 % predicted
Stage1: Mild Greater than or equal to 80% predicted
Stage2: Moderate Less than 80%, greater than 50% predicted
Stage3: Severe Less than 50%, greater than 30% predicted
Stage4: Very Severe Less than 30%, or less than 50% in chronic respiratory failure


COPD Treatment

Medications

  • Bronchodilators
  • Steroids
  • Expectorant
  • Pectoral

Non-medications
Non medications treatment focuses on dealing with the problems after using all kinds of inhalers. It is aimed to improve patients' quality of life and increase daily activities.

  • Oxygen therapy
  • Exercise training
  • Breathing training
  • Surgery: in highly selected patients, the resection of emphysematous lung substance or bullae will improve lung function and daily activities.
     
     

What is Emphysema

Emphysema is a long-term, progressive disease of the lung(s) and occurs when the alveolar walls are destroyed along with the capillary blood vessels that run within them. This lessens the total area within the lung where blood and air can come together, limiting the potential for oxygen and carbon dioxide transfer. In early emphysema, patients will decrease exercise tolerance; in the late stage, patients found it difficult to breath after walking for few meters and have a bed/ house bound and seriously affect patients' quality of life.
Diseasedlung tissuenormal lung tissue
         Diseased lung tissue                                                                              Normal lung tissue
 

Emphysema and COPD

Emphysema has been following the cancer, heart disease, pneumonia and cerebrovascular disease, to become the fifth leading cause of death in Hong Kong.It is a common complication associated with smoking, air pollution, pneumoconiosis and especially chronic obstructive bronchiolitis.

 

Emphysema Treatment

Although emphysemais a progressive and irreversible disease, it can still be alleviated the development of the disease and reduced the risk of complications if taking an effective treatment.The treatment of emphysema includes smoking cessation, medication such as bronchodilators, steroids and expectorant, breathing training and oxygen therapy. For patients whoused all kinds of inhalers but still has many symptoms, may take a surgery and reduce the volume of lung.

 

ELVR for Emphysema

Endobronchial Lung Volume Reduction (ELVR) is a new therapy for Emphysema patients. Doctor places a small and one-way valve to the targeted airways to direct the flow of air out of diseased portions of the lung in order to reducing hyperinflation. It is intended to achieve reduction of volume in the diseased portion of the lung and make the rest function normally. Comparing with the traditional surgery, ELVR is a non-invasive surgery as there is no cutting and needs 30 – 45 minutes only.

Valve image


Ways to prevent COPD

The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. Also, try to avoid lung irritants which include secondhand smoke, chemical fumes and dust. Patients are suggested doing more moderate exercises in order to strengthen the body.

  

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