Chronic Obstructive Pulmonary Disease (COPD)

Brief Description

COPD is the acronym of Chronic Obstructive Pulmonary Disease.

  • Chronic: its development is progressive and not completely reversible
  • Obstructive: it entails an obstruction of the air flow
  • Pulmonary: it affects bronchial tubes and lungs

It is an highly invalidating disease that leads to a progressive deterioration of the respiratory function, obstructing the airways and leads to breathing difficulties.

It causes:

  • Narrowing of the airways diameter
  • Thickening of the bronchial tubes walls
  • Phlegm production that causes cough and hinders the airflow during expiration
  • Swelling of the alveoli. Lungs can be compared to a tree where the trunk, the trachea, forms branches in charge of the air transportation, the bronchial tubes. The thinner twigs, the bronchioles, terminate in small appendixes similar to leaves, the alveoli, where the air exchange takes place. COPD causes the alveoli to be swollen with trapped air: respiratory muscles become less efficient due to the strain to expel air, and breathing becomes difficult.

COPD includes both Chronic Bronchitis and Emphysema:

  • Chronic Bronchitis: continuous inflammation of the respiratory tract that leads to an increased production of secretions and bronchial tubes narrowing
  • Emphysema: pathological and irreversible dilatation of the lung due to the alveoli dilatation that, full of air, cannot work properly. The main symptom is dyspnoea, “shortness of breath”.

During its development COPD may lead more or less rapidly to respiratory failure and therefore requires constant monitoring. The worsening of chronic symptoms is usually gradual, but sometimes it happens rapidly and unexpectedly: in this case it is described as an exacerbation.


Symptoms

  • Continuous cough
  • Sputum: phlegm production, especially in the morning due to the stagnation of secretions in the airway
  • Dyspnoea: breathlessness, initially only during physical activities and then also when resting
  • Chest pain, with a feeling of tightness
  • Tiredness or fatigue

The severity of COPD (mild, moderate, severe, very severe) is determined according to the level of lung function impairment, respiratory symptoms and the presence of other lung diseases.


Causes

COPD is a multifactorial disease caused by the inhalation of harmful substances that determine chronic inflammation in susceptible individuals.

Risk factors:

  • Smoking cigarettes, pipes, cigars, and other types of tobacco
  • Passive Smoking
  • Powders and chemicals (vapours, irritants, and fumes)
  • Environmental Pollution

Within this context all respiratory tract infections, including the common cold, are dangerous because:

  • they are a common cause of pneumonia and exacerbations, i.e. an acute worsening of the usual symptoms that goes beyond the normal daily variability
  • they raise the risk of Respiratory Distress Syndrome (ARDS)

Cures and Therapy

  1. Assessment and monitoring of the disease
  2. Reduction of risk factors – it is essential to quit smoking, lead an healthy lifestyle and take control over other risk factors such as air pollution
  3. Treatment of stable COPD through pharmacological and non-pharmacological means. Non-pharmacological treatments include: programs of pulmonary rehabilitation, oxygen therapy and, in limited situations, surgery.
  4. Treatment of exacerbations and management of Respiratory Distress Syndrome with non-invasive ventilation (NIV) or in extreme cases with invasive ventilation. An efficient secretion removal is essential in this phase.