Chronic Obstructive Pulmonary Disease (COPD) includes respiratory diseases such as emphysema, chronic bronchitis, certain types of bronchiectasis and chronic asthma. It is a condition that often goes undiagnosed, and it is estimated that in New Zealand around 200,000 adults may be affected. COPD is the fourth leading cause of death in New Zealand after ischaemic heart disease, stroke and lung cancer. With COPD, some of the airways are permanently blocked off and the lung tissue is damaged, making it hard to breathe. With emphysema the air sacs in the lungs are destroyed over time and people struggle to get enough oxygen. With chronic bronchitis, the airways get narrow with increased mucus production and inflammation. Most cases of COPD are caused by smoking and diagnosed in people over the age of 40.
Patients with COPD suffer from chronic cough, phlegm production, and breathlessness or wheezing. The symptoms of COPD are similar to asthma, however with asthma, the narrowing of the airways is usually reversible. In COPD the narrowing of the airways is not reversible. COPD patients may feel fatigued and tired, lose weight and suffer frequent chest infections. When severe there may be swelling in the ankles, feet and legs. People may find it harder to do normal activities without getting short of breath.
The main cause of COPD in 9 out of 10 cases is smoking. Long-term exposure to other lung irritants such as fumes, dust, second-hand smoke, air pollution and chemicals can also cause COPD. Some people have a genetic tendency to develop COPD due to being deficient in an enzyme that protects the lungs.
COPD is diagnosed through a combination of blood tests, x-rays (to rule out other illnesses) and lung function tests (spirometry). Spirometry measures how much you can breathe in and out of the lungs and how quickly you can breathe out. Your doctor can measure how COPD is progressing by using spirometry and help decide on the most suitable treatment.
The best treatment for this disease is to stop smoking. While this cannot reverse any damage that has already been done, it can prevent more damage. Medicines, mostly in the form of inhalers, are used to relieve symptoms, prevent flare-ups and decrease the inflammation in the airways that causes swelling and mucus production. The medicine in inhalers can get directly where it is needed, right into the lungs. Medicines called relievers (salbutamol, terbutaline, ipratropium) work within minutes to relax the muscles in the airways and open the airways. Long-acting medicines (tiotropium, salmeterol) need to be used every day, not just when a patient is breathless. These medicines also relax the airways but take longer to work and are longer-acting. Some inhalers contain steroids such as fluticasone and budesonide which reduce swelling and inflammation in the airways.
There are complications associated with this disease. People with COPD are more likely to catch colds, flu and pneumonia. Infections make it much more difficult to breathe and cause even further lung damage. Heart problems, and high blood pressure in the lung arteries are common, as is depression as COPD can prevent people from doing things they enjoy as well as causing stress due to living with a serious illness. People with COPD can experience exacerbations (flare-ups) when their symptoms suddenly get worse and persist over several days. During a flare-up a patient may need to increase their dose of reliever medication as well as use a spacer to aid the delivery of inhaler medicines into the lungs. Doctors often prescribe a short course of oral steroids and antibiotics if an infection has caused the flare-up.
Prevention for COPD is to never smoke, or quit if you currently smoke. Decrease your occupational exposure to lung irritants, using protective respiratory equipment at work or around the home. Get an annual flu vaccination and a regular vaccination against pneumococcal pneumonia to decrease your chance of a respiratory infection.
COPD progresses over time, and while it cannot be cured, it can be controlled and further damage can be prevented. People with COPD can expect a good quality of life with proper management and control of their symptoms.
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