COPD: symptoms, diagnosis, treatment, rehabilitation

Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease of the airways. Suppose COPD is not detected and treated in time. In that case, it develops, worsening the quality of life – breathing will become difficult, and shortness of breath will interfere with daily activities and work. A constant lack of oxygen leads to serious consequences, primarily heart failure, arrhythmia, and a heart attack. Emphysema and bronchiectasis, fibrosis of the lung tissue, bullae in the lungs, and pneumothoraxes that form in COPD are complications of this disease and can lead to hospitalization.

Many patients with COPD were treated for bronchial asthma, not providing proper care and allowing the disease to progress. Some patients were diagnosed in vain, bought expensive drugs, and experienced stress from this diagnosis.

Basic concepts for COPD:

• An obstruction is an obstruction to the free passage of air. The inflammation processes inside the bronchi lead to their narrowing and difficulty in the passage of air through the bronchi. Therefore, COPD is a broncho-obstructive disease.
• Emphysema – (in Greek, “inflate”) – is a pathological expansion of the lung sacs (alveoli) and adjacent parts of the respiratory tract (distal bronchioles), as a result of which the lungs become excessively “bloated.”
• Bronchitis – prolonged inflammation of the walls of the bronchi leads to their thickening and deformation. The bronchial mucosa loses its ability to self-purify. This leads to mucus retention and coughing.

Symptoms of COPD

The main clinical manifestations of the disease are:

• Shortness of breath – when damage to the bronchi and bronchioles becomes pronounced, there is a problem of gas exchange in the body: it becomes increasingly difficult to get enough oxygen and eliminate excess carbon dioxide. These changes lead to shortness of breath and heart palpitations.
• A prolonged cough with difficulty separating viscous sputum becomes a person’s constant companion. The sputum changes its color from gray to green. It depends on the attached bacterial infection.
• Wheezing breath. Shortness of breath and cough is accompanied by wheezing and whistling in the chest. The narrowing of the lumen of the bronchus causes whistling sounds during breathing. Phlegm inside the bronchi enhances or changes these sounds.
• Decreased exercise tolerance – if earlier a person could easily climb up to the 3rd floor or run after a bus, then with COPD, this isn’t easy. You need to catch your breath and restore your breath.

Diagnosis of COPD

To answer the question of COPD or not, it is necessary to conduct two mandatory studies:

1. Spirometry (RF) – after receiving the test results, the doctor evaluates the degree of obstruction according to the recommendations of the GOLD (Global initiative for Obstructive Lung Disease) and receives an answer whether the patient has COPD. Depending on the degree of narrowing of the bronchi, the pulmonologist prescribes medications – inhalers.
2. CT of the chest organs – this study will show changes in the lung tissue – bronchial deformities, emphysema, and bullae in the lungs. A doctor can visually assess the severity of changes in a patient with COPD.

Additional research methods are body plethysmography and diffusion test. These are special studies necessary to control the course of the disease and prevent its progression.

Disease stages:

• Mild severity – GOLD 1, FEV1 more than 80% of the expected value (FEV1 expiratory rate in one second, the indicator is obtained during the FVD)
• Moderate severity GOLD 2, more than 50% FEV1 less than 80%
• Severe GOLD 3, more than 30% FEV1 less than 50%
• Extreme severity GOLD 4, FEV1 less than 30%

To assess the risks of COPD progression, an important indicator is the number of COPD exacerbations per year. It has been proven that the more the airflow through the bronchi is limited due to their narrowing (low FEV1), the more frequent exacerbations and the risk of death.

COPD treatment

Treatment of COPD is a long and gradual process that should be carried out under the supervision of a pulmonologist. The main groups of drugs used:

• Bronchodilators. Their task is to expand the bronchi as much as possible and keep them in an expanded state for as long as possible. This gives relief in breathing. Modern drugs have a 24-hour effect. Combined with short-acting bronchodilators, they can reduce shortness of breath, shortness of breath, wheezing and wheezing.
• Expectorants or mucolytics – dilute sputum and do not allow it to linger in the bronchi. If a plug of sputum forms in the narrowed bronchus, the person will not be able to breathe normally. He will choke and cough constantly. Modern expectorants reduce the viscosity of sputum; some prevent pulmonary fibrosis. Drugs are administered through a nebulizer, tablets, or intravenously.
• Antibiotics are needed to treat an exacerbation of COPD. They must act quickly and reliably. Patients often have antibiotic-resistant microflora in their bronchi. Then the pulmonologist should prescribe the right antibiotic or a combination of them.
• Hormonal drugs are effective in patients with combined asthma (loop syndrome). They are sometimes used as an intravenous or tablet for severe COPD flare-ups.

These remedies restore breathing, reduce cough and sputum production, reduce shortness of breath, restore strength for work and life, and prevent complications.

FAQ

Can asthma develop into COPD?

No. Quite a common misconception. These are two completely different diseases. They are united by one syndrome – broncho-obstructive. In both cases, the pulmonologist is faced with narrowing the bronchi-bronchial obstruction. In the case of COPD, it is not reversible; in the case of asthma, it is reversible. Outcomes of diseases are also different. Treatment of diseases has common features but is still completely different. Very many therapists and pulmonologists immediately prescribe to a patient with COPD and drugs used for asthma and COPD. But this doesn’t seem right.

Why does one patient need one inhaler and another three?

Prescribing therapy for COPD is a very delicate matter. It all depends on the stage of the course of the disease, its form (phenotype), and the frequency of exacerbations. This is clarified during the examination and consultation with a pulmonologist. In addition, COPD is a disease in which there are concomitant diseases. For example, diseases of the heart or blood vessels, diabetes.

They all aggravate the disease, and drugs prescribed for treating COPD can worsen the course of concomitant diseases. And this must be taken into account. Pulmonologists should only treat COPD. Do not self-medicate and contact only specialists. Beware of ignoramuses and charlatans!

Do you need to breathe oxygen in COPD?

Prescribing oxygen therapy is no less difficult than prescribing drug treatment for the disease. Not every COPD patient needs oxygen. The correct appointment of inhalation therapy, expectorant drugs, and antibiotics to increase oxygen in the blood without using oxygen.

Incorrectly prescribed oxygen therapy may worsen the prognosis of the disease or not get the desired effect. Many doctors, seeing reduced oxygen levels in a COPD patient, are in a hurry to prescribe oxygen therapy without finding out whether it is necessary. Is it safe?!

To determine whether an oxygen concentrator is needed, pulse oximetry is used for the long term (night, daily). The study is carried out either at night or during the day. The test allows you to continuously measure oxygen concentration in the blood and the heart rate for many hours. Based on the pulse oximetry results, the pulmonologist will select the mode of oxygen supply – the diversity and speed of its supply and duration.

Is there surgery for COPD?

Yes, surgical treatment of some forms of the disease is carried out. First of all, it is bullous emphysema. This is a variant of the flow of emphysema, in which cysts and bullae (cavities in the form of large blisters) form in the lungs. Surgery is performed using modern endoscopic techniques.

Also, according to indications, with extremely severe COPD, a lung transplant is possible – transplantation.

In both cases, lung surgery is a dangerous and complex procedure that requires high skill from thoracic surgeons.

Is COPD bronchitis or emphysema?

Chronic obstructive pulmonary disease is often used along with bronchitis and/or emphysema because they are the most common clinical forms of this disease (COPD). In other words, emphysema or chronic obstructive bronchitis is COPD.

In addition, the treatment of COPD, chronic obstructive bronchitis, and emphysema are similar. But the outcomes of simple chronic bronchitis and COPD are different. That is why it is so important to make the correct diagnosis.