Understanding chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a group of inflammatory lung diseases that cause inflammation in the lungs, resulting in airflow blockage and breathing problems. COPD may broadly be categorised into emphysema and chronic bronchitis. Emphysema can damage the lung compartment containing air (air sacs or alveoli), over time, making it hard to breathe. Chronic bronchitis, most common among smokers, affects the air tubes (bronchi) that branch into the lungs from the voice box, causing them to become inflamed. People with chronic bronchitis are more susceptible than others to various lung infections.

Chronic obstructive asthma is also considered a subtype of COPD. There is no pattern to its occurrence and is accompanied by tightness in the chest, coughing, and breathing difficulty. People with COPD are at increased risk of developing heart problems, lung cancer, respiratory system failure, and various other conditions.

COPD by the numbers

In India, COPD claims nearly a million lives every year. The country accounted for nearly 32% of all COPD cases, worldwide (2019). Half of all smokers will develop COPD, and the majority of cases (60–80%) in developed countries are attributable to smoking. By contrast, in India, the main culprits behind more than half the COPD cases are indoor and outdoor air pollution. Coal, kerosene, wood, animal dung, straw, grass and shrubs are widely used for cooking and heating, and prolonged exposure to their toxic fumes is an important risk factor for COPD. Various types of dust (flour, silica, coal), fumes (welding), chemicals (isocyanate) and potential toxins (asbestos) occur in many work settings and breathing in such fine particles could also lead to COPD, directly or indirectly.

Prevention

Quitting smoking and avoiding exposure to second-hand smoke is a good way to reduce the risk of COPD. Smoke cessation labs, like the one at PD Hinduja Hospital & Medical Research Centre, Khar, have trained experts who can help smokers kick the habit.

If a work site is one where toxic fumes, dust, gases, and smoke are impossible to get away from, then it is highly advisable to wear protective gear, such as dust-filtration masks, for instance, to filter off lung irritants. If not, it would be prudent to avoid such an environment and look for alternative vocations, if possible. People with COPD are more susceptible to respiratory infections, so getting vaccine shots for pneumonia, influenza, and the coronavirus will help fight these infections faster.

Many patients skip meals and experience loss of muscle tissue in the body as a consequence, which increases the chance of infection. Changing dietary habits to include muscle-building proteins (eggs, pulses, nuts), and omega-3 fatty acids (nuts, seeds, fish) with anti-inflammatory properties will help maintain the body’s muscle mass. Whole grains (ragi, whole wheat, whole grain brown rice) are more desirable since these are rich in immune-supporting fibres. Moreover, they don’t produce as much carbon dioxide (which patients struggle to expel) as their refined or “white” versions. For the same reason, sugars, soft drinks, and baked goods are also best avoided.

People with COPD should consider sticking to an exercise routine prescribed by a doctor, to boost muscle strength and beat fatigue.

Signs and symptoms

COPDs are non-communicable diseases but that does not make them any less risky. There is no cure, as such, for COPD, at any stage of the disease. But these illnesses are preventable and can be controlled with proper medication.

A whole-body approach, that includes prescribed medication, lifestyle changes, and regular exercise is key to treating COPD. The condition takes many years to develop, so symptoms are easy to miss, especially in the early stages. In many instances, people with COPD become aware of the condition only in their late 40s or 50s. Hence, it’s important to watch out for early symptoms without letting the condition worsen and get in the way of daily activities.

Earliest signs of COPD include persistent coughing along with discharge of sticky and slimy secretion (mucus) from the nose and lungs. The colour of the mucus could be white, yellow, or green, depending on the type and extent of the infection. Shortness of breath, general tiredness, chest infections, and trouble sleeping are early warning signs. Another common symptom one shouldn’t ignore is a high-pitched, coarse, and persistent whistling sound when breathing. Initially, this tends to show up during exercise or other physical exertion.

Diagnosis and Treatment

At P.D. Hinduja Hospital & Medical Research Centre, Khar, our experts make use of highly sophisticated, patient-friendly breathing tests to measure a person’s lung function and diagnose COPD and other conditions.

Pulmonary function tests (PFT)

PFT is an umbrella term covering multiple tests including the widely used “spirometry.” Here, the patient blows into a mouthpiece of a flexible tube that attaches to a spirometer. Based on up to 10 measures, including the volume of air inhaled and exhaled as well as the volume of air exhaled per minute, the physician determines how well the lungs are functioning. Spirometry is non-invasive and generally safe, though patients might feel a bit tired for a while after the test. The lung function laboratory at PD Hinduja Hospital & Medical Research Centre tests at least 30 patients daily.

Bronchoscopy

In this procedure, a thin, flexible, and lighted tube, with a camera, is maneuvered through the nostril, past the mouth, throat and windpipe and into the two large tubes that convey air to the lungs (bronchi). Through the scope one can examine the bronchi for any obstruction, foreign body, or infection. Secretions and tissue samples can be collected if required. The probe connects to a monitor, delivering high-res images of the air passage for doctors to analyse. Because the patient is under “conscious sedation,” they stay awake, aware, and relaxed without discomfort. The procedure takes 30–45 minutes and the patient returns home the same day.

Endobronchial ultrasound bronchoscopy (EBUS)

Like a Bronchoscopy, there is an ultrasound attached to a scope and using sound waves, images of the lungs and state of the lymph nodes are generated. The latter contain white blood cells responsible for fighting off respiratory infections. The screen grabs produced by the EBUS procedure serve as the basis for diagnosis and further treatment. Although EBUS is extremely safe, general anaesthesia is often administered to put the patient into a deep sleep to ease any pain.

In addition, people with respiratory issues can avail of the bi-level positive airway pressure (BIPAP) machine at P.D. Hinduja Hospital & Medical Research Centre, Khar, for non-invasive ventilatory support. Our pulmonary specialists provide diagnostic and whole-body therapeutic services that go beyond COPD to cover a broad spectrum of respiratory disorders. Our experts in pulmonology, chest medicine, respiratory ailments, pleural disorders, sleep health, and rehab improve patients’ quality of life by ensuring their lungs work better.