Chronic Obstructive Pulmonary Disease: All You Need To Know About The Causes Of COPD

Chronic obstructive pulmonary disease (COPD), or the deposition of black tar in the lungs, is different from asthma. Asthma is predominantly an allergic disease caused by a combination of genetic and environmental factors and is characterised by variable and recurrent symptoms of wheeze, cough, chest tightness, shortness of breath while the patient may be asymptomatic during allergy-free periods in the early part of the disease. It is predominantly associated with nasal symptoms as well, which characterises its allergic nature.

COPD, on the other hand, is characterised by a narrowing of airways along with the destruction of lung tissue. Patients usually complain of gradually progressive shortness of breath and cough with sputum production. Other symptoms that may be present are chest tightness and wheezing. In the advanced stage of the disease, the patient may have leg swelling, which is due to increased pressure on the right heart (increased obstruction with increased lung size compresses blood vessels coming from the right heart) preventing systemic drainage of blood to the heart and increasing swelling, especially in the legs.

Tobacco smoke is the most common cause of COPD worldwide. In India, among tobacco use, smoking is one of the major cause of deaths and diseases like COPD, lung cancers and others and accounts for millions of such cases. Other causes of COPD are occupational exposure and air pollution. Among all patients with COPD, about 85-90% of patients come with a history of smoking or are smokers. Passive smoking or second-hand smoke is also the cause of COPD, especially among non-smokers.

At workplace increased exposure to dust, chemicals, and fumes increase the risk of COPD. The industries commonly connected to this are mining, cotton textile, and welding. Air pollution, especially indoor air pollution, is increasingly becoming the biggest cause of COPD in developing countries. Coal or biomass fuels are also other major causes as they lead to increased smoke production, which is detrimental to health wherever there are inefficient exhaust systems or poorly ventilated areas. Genetic factors may be involved in the development of COPD. This is suggested by the increased prevalence of COPD among relatives of patients with COPD. Also, deficiency of an important enzyme alpha 1 antitrypsin results in an increased risk of development of COPD in later stages of life.

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The diagnosis of COPD can be made on the basis of history and symptoms, which are in itself very typical and self-explanatory. Lung function test is then used to confirm the diagnosis. Lung function test, especially spirometry shows the presence of an obstruction in the airways and that is irreversible after giving bronchodialator drugs. Chest X-ray also helps in diagnosis and ruling out other causes. It shows an increase in the size of the lungs, which is a characteristic of patients with COPD.

There is no remedy for COPD, hence anticipation frames a significant perspective, which should be considered in each person with risk factors for COPD. This incorporates smoking cessation, improving work environment conditions and indoor air quality. Smoking cessation includes social help, individual effort, end projects, individual and group directing and utilising approved prescriptions.

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Failure in the first attempt is common and usually, more than one attempt is required prior to long-term success in quitting smoking. Therefore, one should not be disheartened and continue with their efforts.

The significant objectives of the management are to reduce risk factors, oversee stable COPD, forestall and treat intense intensifications, and oversee related ailments. Smoking cessation and supplemental oxygen are beneficial as well as lessens mortality among patients with COPD. Vaccination with flu consistently and pneumococcal immunization each year or lifelong is another significant part of treatment.

Pulmonary rehabilitation (PR) forms another significant component of treatment in patients with COPD. The point is to decrease the side effects, increase muscle quality and exercise resistance, and decrease emergency clinic length of remain. This involves respiratory muscle training and counselling (psychological and nutritional), energy-conserving techniques, breathing strategies and education about the disease and how to manage it. And this improves the overall quality of life, ability to exercise and reduces mortality. The kinds of activity incorporate oxygen-consuming, strengthening or resistance and stretching and flexibility exercises. Lung transplant is an alternative in the later phases of the infection.

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Globally millions of people are affected with COPD. The increase in the developing world is associated with an increased incidence of the disease. It is the fourth leading cause of death in the whole world.

(Dr Sandeep Nayar, Sr. Director & HOD, BLK Centre for Chest & Respiratory Diseases, BLK Super Speciality Hospital)

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