COPD

COPD and asthma are similar in many ways, including similar symptoms including blocked airflow and shortness of breath. However, COPD is a chronic disorder and highly progressive. Asthma is often triggered by allergens. The main cause of COPD is smoking.

Asthmatics don’t automatically develop COPD. COPD patients don’t always have asthma. However, it is possible to simultaneously have both of these respiratory conditions. If you have both, you will need treatment for both.

Smoking is the main cause of COPD. However, all smokers don’t have the disease. You may be at an increased risk of developing the disease if:

• You are over the age of 65.
• You are someone who was assigned female at birth.
• You have worked with chemicals, dust or fumes.
• You have been exposed to air pollution.
• You have had many respiratory infections during childhood.
• You have alpha-1 antitrypsin deficiency (AAT), a genetic risk factor for COPD.

Almost 90% of COPD cases are caused by smoking tobacco. Other causes of the disease include:

• Secondhand smoke.
• Alpha-1 antitrypsin (AAT) deficiency, a genetic disorder.
• Workplace dust and fumes.
• Air pollution.
• Smoking

Tobacco smoke causes airway irritation, inflammation of the airways, causing their narrowing. Smoke also results in damage to the cilia so that they can’t perform their job of removing the mucus and trapped particles from the airways.

AAT deficiency

AAT deficiency is a rare, inherited disorder that can cause emphysema. AAT is an enzyme that helps safeguard the lungs from the damaging effects of inflammation. Having AAT deficiency doesn’t produce an adequate amount of alpha-1 antitrypsin. Your lungs are more susceptible to developing damage from exposure to irritating agents like dust and smoke. It is impossible to distinguish COPD associated with alpha-1 antitrypsin deficiency from normal COPD. Therefore, all people with chronic obstructive pulmonary disease should get screened alpha-1 antitrypsin deficiency with a blood test.

Following are some signs and symptoms of chronic obstructive pulmonary disease:

• Shortness of breath performing regular daily activities.
• Wheezing.
• Difficulty taking a deep breath.
• Shortness of breath with mild exercise (like walking or using the stairs).
• Cough with mucus that persists for long periods of time.

If you have signs and symptoms of COPD, you should not delay seeking care. Consult the best pulmonologists in Indore at Kokilaben Dhirubhai Ambani Hospital, Indore for further assistance. You must not wait for your symptoms to get so severe that you need emergency medical care. If you experience symptoms early, your must seek prompt care for COPD.

Non emergency care

You must talk to your healthcare provider on the phone within twenty hours if you experience these changes in your health:

Shortness of breath that has become worse or occurs more often

Examples include:

• You need more pillows or have to sit up to sleep because of breathing difficulty.
• Unable to walk as far as you usually could.
• You need breathing treatments or inhalers more often than usual.
• You feel more tired because you're working harder to breathe.
• Sputum (mucus) changes
• You wake up short of breath more than once a night.

Presence of mucous

Examples include:

• Changes in colour.
• Odour.
• Changes in thickness or amount. You have more mucus than usual or more than you’re able to cough out.
• Presence of blood.

Other signs and symptoms of COPD that should prompt a call to your healthcare provider regarding COPD include:

• Swelling in your feet, ankles, or legs that is new or has become worse and doesn't go away after a night's sleep with your feet up.
• More coughing or wheezing.
• Frequent morning headaches or dizziness.
• Unexplained weight loss or gain of 1 kg to 2 kg in a week.
• Confusion, restlessness, forgetfulness, slurring of speech or irritability.
• Fever, especially with cold or flu symptoms.
• Extreme, unexplained weakness or fatigue that lasts for more than a day.

To evaluate your lungs and overall health condition, your doctor will take your medical history, perform a complete physical examination and order some investigations, such as breathing tests.

Medical history

To detect diseases like COPD, your provider will ask questions like:

• Have you had long-term exposure to dust or air pollutants?
• Do other members of your family have COPD?
• Do you smoke?
• Do you get short of breath with exercise? When resting?
• Do you cough up phlegm?
• Have you been coughing or wheezing for a long time?

Physical examination

To facilitate with the diagnosis, your healthcare provider will perform a physical exam that includes:

• Checking your blood pressure and pulse.
• Listening to your lungs and heart.
• Checking your feet and ankles for swelling.
• Examining your nose and throat.

Investigations

Healthcare providers employ a simple test known as spirometry to check how well your lungs function. For this test, you blow air into a tube that is linked to a machine. This lung function test is used to measure the amount of air you can breathe out and how fast you can do it.

• Your doctor may also want to run few other tests, including:
• Arterial blood gases (ABGs): These tests are performed to check your oxygen and carbon dioxide levels.
• Pulse oximetry: This test is used for the measurement of the oxygen in your blood.
• Electrocardiogram (ECG or EKG): This test is used to check the function of the heart function and to rule out heart disease as a cause of shortness of breath.
• Chest X-ray or chest CT scan: Imaging tests are used to look for lung changes that are caused by COPD.
• Exercise testing: Your provider uses this to determine if the oxygen level in your blood drops when you exercise.

COPD can worsen gradually. How fast it progresses from mild to severe varies from person to person.

Mild COPD (stage 1 or early stage)

The first sign of COPD is often feeling out of breath with light exercises, like walking up stairs. Many people confuse this symptom for being unfit or getting old. Another sign is a phlegmy cough (a cough with mucus) that’s often particularly troublesome in the morning.

Moderate to severe COPD (stages 2 and 3)

Shortness of breath is seen to be more evident in case of advanced COPD. Symptoms of exacerbations of COPD include increased phlegm, discoloration of phlegm, more shortness of breath and are commonly seen in higher stages of COPD. Your risk of getting lung infections such as bronchitis and pneumonia also increases.

Very severe COPD (stage 4)

When COPD becomes severe, almost everything you do can cause shortness of breath. This limits your mobility. You may need supplemental oxygen from a portable tank.

Treatment for COPD is targeted towards relieving symptoms, like breathing problems and coughing, and avoiding respiratory infections. Your provider may recommend:

• Medications for relaxing the airways. You inhale a mist containing medications that help you breathe easier.
• Anti-inflammatory medications
  You might be prescribed inhaled steroids or oral steroids to prevent lung inflammation.
• Supplemental oxygen
  If the amount of oxygen in your blood is low (hypoxemia), you may need a portable oxygen tank so that your oxygen levels are improved.
• Antibiotics
  COPD makes you more susceptible to developing lung infections, which can cause further damage to your weakened lungs. You may even need to take antibiotics to prevent a bacterial infection.
• Vaccinations
  Respiratory infections prove more dangerous in COPD patients. It’s especially vital to get shots to prevent pneumonia and flu.
• Rehabilitation
  Rehabilitation programs teach effective breathing strategies to lessen shortness of breath and on conditioning.
• Expectorants
  These products thin mucus in the airways so you can cough it out more easily. You should take these medications with about 8 ounces of water.
• Antihistamines
  These are medications that relieve sneezing, stuffy heads, and watery eyes. Even though these relieve symptoms effectively, antihistamines can dry the air passages, making breathing challenging, as well as causing difficulty when coughing up excess mucus. You will be directed to these medications with food to reduce an upset stomach.
• Antivirals
  Your doctor might prescribe some antiviral medications to treat or prevent illnesses caused by viruses, most frequently to treat or prevent influenza. Influenza is especially dangerous for COPD patients.

The best way to avoid developing COPD is by avoiding smoking at all costs. If you are a smoker and you want to quit, you can join a smoking cessation program. Also, avoid any environment that has poor air quality — air that has particles like dust, smoke, gases and fumes.

Symptoms of COPD

COPD patients have difficulty freeing their lungs of dust, dust and other pollutants in the air. This increases their risk for developing lung infections that may cause further lung damage.

Therefore, it is vital to watch for signs of infection and follow these tips to prevent developing infections. You might not be able to avoid infections entirely, but these tips will help you prevent infections as much as possible.

• Increased shortness of breath, difficulty breathing or wheezing.
• Coughing up increased amounts of mucus.
• Yellow- or green-coloured mucus.
• Fever (temperature over 101°F) or chills (may or may not be present).
• Increased fatigue or weakness.
• Scratchy throat, sore throat or pain when swallowing.
• Unusual sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones.

If you have any of these symptoms, consult a pulmonologist for further evaluation.

Following are some ways you can follow to help prevent infections:

Hand washing

You must frequently wash your hands with warm water and soap, especially before eating, preparing food, and taking medications or breathing treatments. You must thoroughly wash your hands after using the bathroom, sneezing or coughing, touching soiled clothes or linens, after you've been to a social gathering, or after you've been around someone with a cold or the flu. It is also a good idea to carry waterless hand sanitizers with you so that you can use those whenever required.

Visitors

If your visitors are suffering from symptoms of a flu, ask them not to visit you until they feel better.

Environment

• Ensure that your house is clean and free from excess dust. Keep your bathroom and sinks clean from mildew or mould.
• Don’t visit or work in any type of construction site. Dust can be detrimental for you. If you have no choice but to go near this type of area, you must wear a mask that your doctor provides you.
• Stay away from air pollution, especially from wood or oil smoke, tobacco smoke, industrial pollution, and car exhaust fumes, which can facilitate the entry of inhaled irritants into your lungs. You must also avoid exposure to pollen.
• You must ensure that your cooking vent is functioning properly so that it can draw cooking fumes out of your house.
• If possible, try avoiding large crowds in the winter and the fall when the flu season is at its peak.

Equipment care

Don’t let others use your medical equipment, including metered-dose inhaler (MDI), your oxygen cannula, nebulizer tubing, MDI spacer, and mouthpiece.

Keep your breathing equipment clean.

Diet

Try consuming a balanced diet. Good nutrition is vital to help the body fight against infections. You must consume foods from all food groups. Some people find eating fewer carbohydrates and more fats helps them breathe better. This is because some amount of carbon dioxide is generated during the metabolism of food. You must talk to a certified dietitian to help you make smart food choices.

Drink plenty of fluids. You must aim to consume at least 6-8 ounce glasses of fluids every day. Water, sport drinks, and juices are the best for you.

Other general health guidelines

• Avoid rubbing your eyes, as this can lead to the spread of germs in your nasal passages via the tear ducts.
• You must quit smoking and avoid inhaling secondhand smoke. This will protect your lungs against infections.
• Get enough sleep and rest.
• Follow your doctor's medication guidelines.
• Manage your stress.
• Talk to your healthcare provider or doctor regarding getting a flu shot every year and get the pneumonia vaccine if you haven’t already taken one.
• Be careful to avoid infection when travelling. In places where the water might be unsafe, consume bottled water or other beverages (order beverages without ice). Swim only in chlorinated pools.

For every person, COPD progresses at a different rate. After it has progressed, the lung damage caused by it can’t be reversed. However, if you follow a healthy lifestyle and seek treatment as early as possible, you can manage your symptoms and feel much better.

Life expectancy for COPD patients varies from person to person. It depends on a number of factors including how early your provider detects the disease, your overall health condition (including associated diseases you might have), and how well you manage your treatment. Some patients live quite a long time post-diagnosis. On the other hand, others, with more severe disease, don’t fare that well.

You must seek an appointment with your healthcare provider if you experience any of the warning signs of an infection. You must also talk to your healthcare provider if you have symptoms that concern you.

Following are some measures you can take to make breathing easier and slow the progression of the disease:

• Take prescribed medications as directed by your provider.
• Quit smoking.
• Maintain a healthy weight.
• Talk to your healthcare provider about a pulmonary rehabilitation program, which teaches you how to be active with less shortness of breath.
• Avoid air polluted by smoke, chemicals, fumes or dust.
• Get an annual flu shot.

The lungs of COPD patients are sensitive to certain substances in the atmosphere, including exhaust fumes, strong perfumes, paint/varnish, cigarette smoke, cleaning products, pollen, dust, pet dander and air pollution. Extreme hot or cold weather conditions can also cause lung irritation.

You can avoid some of these irritants by:

• Sitting in nonsmoking sections of public places.
• Asking those around you not to smoke.
• Avoiding underground parking garages.
• Avoiding high traffic or industrialised areas.
• Using nonaerosol cleaning or painting products in well-ventilated areas and wearing a mask while cleaning.
• Not using perfumes, scented lotions or other highly scented products that may irritate your lungs.
• Keeping pets out of the house, especially if you wheeze.
• Using an exhaust fan when cooking to remove smoke and odours.
• Reducing exposure to dust.
• Staying indoors when the outside air quality is poor.
• During cold weather, cover your face when going outdoors. During extreme humidity, try to stay in air-conditioned areas.
• Following weather reports and avoiding extreme weather.

Chronic obstructive pulmonary disease (COPD) causes irreversible lung damage. Even if the damage can’t be reversed, there are ways you can follow to manage symptoms. If you take the necessary steps to support your lung capacity and fight lung irritation, breathing will be easier for you. Early treatment of COPD is essential to better chances of recovery.

The Department of Pulmonary Medicine at Kokilaben Dhirubhai Ambani Hospital, Indore offers comprehensive diagnostic and therapeutic care for a diverse range of pulmonological diseases. Our services include endoscopic ultrasound, endo bronchial ultrasound, endobronchial brachytherapy, innovative therapeutic techniques, bronchial thermoplasty and surgical interventions like video-assisted thoracoscopic surgery and lung volume reduction. Our staff comprises highly qualified pulmonologists who deliver optimum treatment for lung diseases supported by state-of-the-art technology and modern equipment.

We follow an evidence-based approach during all our services to ensure excellent outcomes matching international standards. Apart from having a fully-equipped Bronchoscopy suite with C-arm facilities, we house a state-of-the-art PFT machine.