chronic obstructive pulmonary disease

 Chronic obstructive pulmonary disease (COPD)

 
Symptoms and causes
Diagnosis and treatment
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Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the lungs that obstructs the flow of air from the lungs. Symptoms include shortness of breath, cough, mucus production (sputum) and whistling when breathing. It is caused by long-term exposure to irritating gases or particles, in most cases of cigarette smoke. People with COPD are at increased risk for heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to the development of COPD. Chronic bronchitis is inflammation of the lining of the bronchi, which carry air to and from the air sacs (alveoli) of the lung. It is characterized by daily cough and the production of mucus (sputum).

Emphysema is a condition in which the alveoli at the ends of the smaller airways (bronchioles) of the lungs are destroyed as a result of harmful exposure to cigarette smoke and other irritating gases and particles.

COPD can be treated. With proper treatment, most people with COPD can achieve good control of the symptoms and quality of life, as well as reduce the risk of other related conditions.

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symptom
Symptoms of COPD usually do not appear until after significant damage has already occurred and usually get worse over time, particularly if the patient is still exposed to tobacco smoke. Patients with chronic bronchitis present a daily cough and production of mucus (sputum) as the main symptom for at least three months a year in two consecutive years.

Other signs and symptoms of COPD may include the following:
Difficulty breathing, especially during physical activity
Whistle when breathing
Pressure in the chest
Having to clear the throat early in the morning, due to excess mucus in the lungs
A chronic cough that can produce mucus (sputum), which can be transparent, white, yellow or greenish
Blue color on the lips or nail beds (cyanosis)
Frequent respiratory infections
Lack of energy
Unintentional weight loss (in more advanced stages)
Swelling in the ankles, feet or legs
It is also likely that people with COPD have episodes called exacerbations, during which the symptoms worsen more than the usual daily variation and last for at least several days.

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Causes
The main cause of chronic obstructive pulmonary disease (COPD) in developed countries is smoking. In developing countries, COPD often occurs in people who are exposed to combustible gases used for cooking or heating in poorly ventilated homes.

Only about 20 to 30 percent of chronic smokers can have clinically apparent COPD, although many smokers with a long-standing history of smoking may have reduced lung function. In some smokers less frequent pulmonary conditions are manifested. They can be misdiagnosed as COPD until a more thorough evaluation is done.

How the lungs are affected
The air moves through the trachea and enters the lungs through two long tubes (bronchi). Inside the lungs, these tubes are divided many times, like the branches of a tree, into smaller tubes (bronchioles) that have at their ends tiny air sacs (alveoli).

The air sacs have very thin walls filled with blood vessels (capillaries). The oxygen present in the air you inhale passes through these blood vessels and enters the bloodstream. At the same time, carbon dioxide is exhaled (a gas that is a waste product of metabolism).

The lungs depend on the natural elasticity of the bronchi and air sacs for air to leave the body. Because of COPD, they lose their elasticity and stretch excessively, so that air remains trapped in them when exhaling.

Normal lung tissue and lung tissue damaged by emphysema
Emphysema
Illustration of bronchitis
Bronchitis
Causes of airway obstruction

The causes of airway obstruction include the following:
Emphysema. This disease of the lungs destroys the fragile walls and the elastic fibers of the alveoli. The small airways collapse when you exhale, which prevents the flow of air outward from the lungs.
Chronic bronchitis. If you have this disease, the bronchial tubes become inflamed and narrow, and the lungs produce more mucus, which can block even narrower bronchi. The patient may have a chronic cough for trying to clean the airways.

Cigarette smoke and other irritants
In the vast majority of cases, the lung damage that causes COPD is due to smoking for a long time. However, there are probably other factors that play a role in the onset of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers could have COPD.

Other irritants can cause COPD, including cigarette smoke, secondhand smoke, pipe smoke, environmental pollution, and workplace exposure to dust, smoke, or vapors.

Alpha-1 antitrypsin deficiency
Approximately, in 1 percent of people with COPD, the disease occurs because of a genetic disorder that causes low levels of a protein called alpha-1 antitrypsin. Alpha-1 antitrypsin is produced in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1 antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lungs can occur in infants and children, not just in adults with a history of long-term smokers.

For adults with COPD related to alpha-1 antitrypsin deficiency, the treatment options are the same as for people who have more frequent types of COPD. In addition, treatment for some people may involve replacing the missing alpha-1 antitrypsin protein, which can prevent further damage to the lungs.

Risk factor'sRisk factors for COPD include the following:

Exposure to tobacco smoke. The most significant risk factor for COPD is smoking for a long term. The more years and more cigarettes you smoke, the greater the risk. Pipe, cigar and marijuana smokers can also be at risk, as can people exposed to plentiful amounts of secondhand smoke.
People with asthma who smoke. The combination of asthma, a chronic inflammatory disease of the respiratory tract and smoking further increases the risk of COPD.
Occupational exposure to dust and chemical substances. Long-term exposure to gases, vapor, and dust from chemicals in the workplace can irritate and inflame the lungs.
Exposure to combustion gases. In the developing world, people exposed to combustion gases for cooking and heating in homes with poor ventilation have a higher risk of COPD.
Age. COPD occurs slowly over a period of years, so most people are at least 40 years old when symptoms start.
Genetics. The rare genetic disorder called alpha-1 antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors probably make some smokers more prone to the disease.


Complications
COPD can cause many complications, including the following:
Respiratory infections. People with COPD are more likely to suffer from colds, flu or pneumonia. Any respiratory infection can make breathing very difficult and cause more damage to the lung tissue. Annual flu vaccination and regular vaccinations against pneumococcal pneumonia can prevent some infections.
Heart problems. For reasons that are not fully understood, COPD can increase the risk of heart disease, including heart attack. Stopping smoking can reduce this risk.
Lung cancer. People with COPD have a higher risk of lung cancer. Stopping smoking can reduce this risk.
High blood pressure in the pulmonary arteries. COPD can cause high blood pressure in the arteries that circulate blood to the lungs (pulmonary hypertension).
Depression. Breathing difficulty can prevent you from doing activities that you enjoy. In addition, living with this serious illness can contribute to the patient's depression. Talk to your doctor if you feel sad or helpless, or if you think you may have depression.

Prevention
Unlike other diseases, COPD has a clear cause and a clear mode of prevention. Most cases are directly related to smoking, and the best way to prevent COPD is to not smoke or stop smoking right now.

If you have been a smoker for a long time, maybe these simple statements do not seem so simple, especially if you have tried to quit once, twice or many times. However, you should keep trying to quit. It is very important to find a program to quit smoking that can help you quit forever. It is your best chance to prevent damage to your lungs.

The exposure generated by certain works to vapors and dust of chemical substances is another risk factor for COPD.
If you work with this type of lung irritant, talk to your supervisor about the best ways to protect yourself,for example, wear respiratory protection equipment.