Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a general term that describes a chronic, persistent inflammatory condition in the lungs that restricts airflow to impact breathing resulting in breathlessness. Many conditions contribute to COPD including chronic bronchitis, emphysema and refractory asthma.

Despite the treatment options available COPD is not only considered a progressive illness, in that it worsens with time, but it is also considered incurable with treatment options aimed at delaying it’s progression and minimizing it’s negative symptoms.

Chronic Bronchitis

• Bronchitis, as the name suggests, is an inflammation in the bronchial tubes of the lungs, responsible for the transfer of air to and from the alveoli. If this inflammation is persistent and lasts 3 months or more, for at least two years in a row, it is considered to be chronic. Chronic bronchitis presents as a persistent and productive cough, with constant daily sputum and mucus production.

Emphysema

• Emphysema is characterised by damage to the alveoli, resulting in a decreased carrying capacity and absorption properties of the alveoli due to the disruption of the walls inside the alveoli. This damage is commonly caused by long term exposure to cigarette smoke or other harmful inhalants. On top of breathlessness and fatigue, emphysema causes the lungs to lose their shape, becoming stretched and less responsive during normal breathing. This makes it harder to exhale with air frequently being unable to escape the lungs.

Asthma

• Asthma that is non-reversible, in that it does not respond to typical asthmatic treatments is considered refractory and contributory to COPD. The constriction of the bronchioles in asthma can not be reversed using the usual beta agonist treatments such as albuterol, in COPD.

Symptoms of COPD

COPD manifests in a number of key presenting complaints ranging from mild to severe. Below shows the most common signs that present in COPD;

• Productive daily cough
• Shortness of breath
• Tight chest
• Fatigue
• Edema
• Swelling in the extremities 
• Recurrent respiratory tract infections
• Weight loss

Causes of COPD

It has been known for many years that the most prominent cause of COPD is tobacco use. Other causes such as dangerous levels of air pollution, for example with smog in major cities, also causes a high percentage of COPD, particularly in LEDCs (less economically developed countries). It is estimated that up to nearly one third of chronic smokers may develop COPD.

The best way to prevent the progression of the disease is to minimize exposure to the irritants causing COPD. That means if you are a smoker, get help quitting now. Although incurable, the disease state will slow or halt progressing in non-smokers. If you are exposed to harmful inhalants causing your condition at home or at work take steps to improve your air quality, either by ventilation techniques or wearing suitable masks.

Diagnosing COPD

Proper diagnosis of COPD will require a range of testing and questioning. On top of discussing your environment and behaviours, your doctor will examine your familial history of the disease before performing lung function tests, chest x-rays and/or other lab tests to arrive at an accurate diagnosis.

In the past many smokers have been misdiagnosed with COPD due to poor or inadequate diagnosis measures.

Treatment of COPD

Smoking Cessation is the most essential step in the treatment of COPD. There are several other medications that are used in slowing the progression of the disease or alleviating the symptoms. Below outlines the medications and therapies most commonly used.

Steroids

• Steroids are routinely prescribed for COPD, usually in the form of an inhaler or combination inhaler (see below). Steroids dampen the immune response, reducing inflammation of the airways allowing the patient to breathe much more freely. Inhaled steroids require constant daily use to work. They are also require a minimum of 7 - 14 days for these inhalers to reach their optimal therapeutic value. The most common inhaled steroid are;
   
  • Flovent HFA (Fluticasone)
  • Flovent Diskus (Fluticasone)
  • Pulmicort (budesonide)
  • QVAR (beclomethasone)

Oral steroids are also used in acute exacerbations of COPD, usually for small durations of around 5 days. 
 

Beta Agonists

• Short Acting Beta-agonists (SABA) are used frequently in exacerbations of COPD as a ‘rescue’ inhaler when breathing is difficult. The most common beta-agonists are listed below;
   
  • Proair (Albuterol)
  • Ventolin (Salbutamol)
  • Xopenex (Levalbuterol)
     
• Long Acting Beta-agonists (LABA) are used in the maintenance treatment of COPD. They take longer to work than the SABAs but last much longer.
   
  • Serevent (Seretide)
  • Foradil (Formoterol)
     

Antimuscarinics

• One of the most commonly prescribed medications to help with breathing by action as a bronchodilator, is antimuscarinic inhalers containing tiotropium. Although tiotropium and last up to a full 24 hours it can take 4 - 8 weeks of continually usage to attain full therapeutic effects.
   
  • Spiriva Respimat (Tiotropium)
  • Spiriva Handihaler (Tiotropium)
     

Combination Inhalers

• As COPD sufferers quite often need to be using a number of different types of inhaled medications, it makes sense to use combination inhaler, containing two or more drugs, to improve adherence and compliance. There are many different combination inhalers, some of which are listed below. 
   
  • Advair Diskus (Fluticasone and Salmeterol)
  • Advair HFA (Fluticasone and Salmeterol)
  • Symbicort (Budesonide and Formoterol)
  • Dulera (Mometasone and Formoterol)
  • Trelegy (Fluticasone, Umeclidinium and Vilanterol)
  • Anoro Ellipta (Umeclidinium and Vilanterol)
     

Phosphodiesterase-4 inhibitors

• This drug decreases the symptoms of chronic bronchitis by reducing inflammation in the airways, allowing air to move more freely.
   
  • Daliresp (Roflumilast)
     

Theophylline

• Theophylline is a methylxanthine drug that can improve breathing and prevent worsening of COPD
   
  • Theophylline
     

Antibiotics

• Antibiotics are prescribed frequently in COPD due to continuous respiratory tract infections that patients suffer from. Antibiotics are used when these infections are screened as positive for bacterial infections or when bacterial infection is highly probable.
   

Oxygen

• Oxygen therapy is frequently used in the treatment and maintenance of COPD. It allows for the patient to breathe higher in a higher concentration of oxygen so that they need less air for equivalent oxygen.