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Chronic Obstructive Pulmonary Disease and tobacco smoking, good friends? – COPD

Chronic Obstructive Pulmonary Disease is amid the five top reasons for death in the United States, and smoking tobacco is mostly the cause.

It is to worry that several people at a high risk of developing the disease are unaware of its existence. Summed up, many of them that actually have the condition in the early phases ignore their symptoms and remain without a diagnosis; therefore, the disease progresses till it is too late.

Maybe due to the high-level of unawareness, this disease impacts so toughly on the population. So do not be caught off-guard. Please, read through this article to get the up-to-date information about this horrible condition, obtaining key insights from a doctor.

What are the lungs?

The lungs are two sponge-like structures that allow humans to breathe, which is the process where the body acquires oxygen and eliminates carbon dioxide (CO2). Its particular composition and how it functions will enable us to understand what is happening in whatever lung disease. Let me show you the basic structures and, in a simple way, how we breathe.

The air loaded with the essential oxygen would flow either through the nose, or the mouth, it would pass the pharynx, and the epiglottis for entering in the trachea (windpipe.) Utilize the image to guide you. To this point, this is the upper respiratory tract, and its function is to conduct air to the lower respiratory tract that is where the oxygen gets inside the body.

The windpipe then divides into two, the bronchial tubes. They continue, each one within one lung and branch into multiple, and as it progresses, minimal structures. Their function is also to conduct the air, but this time, inside the lung reaching the final and most significant component of the lung, the alveoli. If there is any obstruction of the bronchial tubes, the air will not get to the alveoli.

The alveoli, as you could see in the image, is a space composed of sacs, surrounded by very elastic tissue and blood vessels. The elastic tissue allows them to expand and constrain with every chest movement for the air to flow through. Without this particular tissue and no expansion, the air would stagnate, and no new oxygen would be there to breathe. On the other hand, the blood vessels are there to catch the oxygen that is going in, and toss out the toxic carbon dioxide, that thanks to the respiratory movements, there will rapidly be new air to breathe.

De Salud, Medicina, Anatomía, Pulmón, Etiquetado
Lung anatomy

What is Chronic Obstructive Pulmonary Disease?

Chronic Obstructive Pulmonary Disease or COPD is a condition itself. However, the base of its explanation is through three others that overlap. A minimum of two diseases is always present, such as chronic bronchitis and emphysema, to a higher or lesser extent. The third one is asthma, which could be present, albeit, it is not that consistent as the former two.

Chronic bronchitis definition relies on symptoms and timing. It involves a cough with plenty of mucus production that lasts three months each year for at least two consecutive years.

On the other hand, emphysema is an abnormal enlargement of many of the air spaces within the lung, in charge of the breathing process, as I just told you. The sacs lose their elastic capability, so they expand and cannot constrain again, core for renewing the air each time.

Asthma is a disease where exists a chronic inflammation and constriction of bronchial tubes due to many triggers that impossibilities the air to reach the alveoli. And its characteristics symptoms are out of the sudden shortness of breath, coughing, and wheezing.

This lung disease is a triad of these three, but each one of them has its particular features. So as we will see further causes, symptoms, complications, treatment, and nearly all would be based on which of them is predominating and if it was an environmental/lifestyle or genetic disease.

The estimation is that EPOC affects ten percent of the people worldwide, and it causes death to 3 million of them each year. Also, It is one of the diseases that have not given any sign of slowing the pace because people keep smoking. The expectation is that the cases will keep rising, as the worldwide population will do.

What causes COPD?

COPD is a pulmonary disease; therefore, the leading cause would be in relationship to what the people are breathing. Tobacco smoke would be the cause of acquiring COPD in nine of every ten patients. Approximately, one smoker of every seven would develop COPD and its symptoms, in the long run. Not only that, but secondhand smoke also increases the risk by causing lung disease, triggering asthma symptoms, and diminishing the pulmonary function.

Despite this, COPD can also occur in non-smoker patients due to environmental and genetic factors. COPD diagnosis in patients that never smoked is a possibility, and the belief is that it is in relationship with air pollution or lung irritants, although never to the same extent as cigarette smoking.

The genetic expression of this disease is by the deficiency of a protein, Alpha1-antitrypsin. It is a protein produced in the liver that plays a vital role within the lung. This protein regulates a process of a cell that discharges molecules breaking the elastic function within the lung. Therefore, if it is missing, then the molecules would start causing lung damage. This pulmonary disease affects a younger population, if smokers, even more, although only account for less than 1% of the cases in the United States.

Other possible but rarer causes are intravenous drug use, VIH positive patients, and collagen-related autoimmune disorders.

Overall, it is normal to have inflammatory responses in patients that are in constant inhalation of harmful gases. However, in patients with COPD, there is also an increase in the likelihood that the inflammatory response modifies lung structures to cause either chronic bronchitis or emphysema. The studies show lung inflammation in COPD patients even without symptoms, and that it increases stepwise with mild to severe symptoms manifestation.

What causes difficulty breathing?

The way chronic bronchitis and emphysema affect the lung is astonishing. I am going to tell you some of the gross changes in the essential structures in charge of the breathing process, as the bronchial tube and the lung. Chronic bronchitis causes shortness of breath due to a narrowing in the lower respiratory airway, while in emphysema is because of a loss of the constriction capacity within the lung. For knowing how the third pulmonary disease produces a lack of air, please refer to the asthma article by clicking here.

The constant irritation of the airways causes chronic inflammation. Chronic bronchitis has abnormally large mucous glands within the bronchi plus an increase in the mucus discharge, and thickening of its walls. All of them contribute to the airway narrowing that significantly reduces the space for the air, ending in an airflow limitation. Basically, the alveoli, that picks up the oxygen for the body is not directly damaged; However, there is no airflow getting to them.

On the contrary, emphysema does not have an airway obstruction; it directly affects the lung tissue. This pulmonary disease destroys the alveoli and its surroundings, affecting in multiple ways how we usually breathe. For example, by eliminating the constriction capacity, there is stagnation of the airflow. Besides, by losing the lung tissue, there is subsequent narrowing that also impossibilities the air to get where it needs to be.

What are the risk factors for this lung disease?

The typical patient has a minimum of forty years. Then, cigarette smoking would be the most critical risk factor for this pulmonary disease, and all the details matter. For example, the initiation age of smoking, how many packs of cigarettes have smoked daily throughout its life, and what is the current smoking status. What does this mean? It means that even though quitting smoking can aid in overcoming this pulmonary disease if the habit was strong enough, it can still chase you in the long run. If any of those factors is positive, and if positive, while higher values, then bigger are the chances of getting this condition.

The studies support that people with a history of 40 pack-years of tobacco smoking was the best predictor of airflow obstruction. The pack-years is a tool the doctors use to quantify how much a person is smoking. For example, if you smoke one pack of cigarettes per day for ten years, it would be a score of 10 pack-years. And, if you smoke two packs of cigarettes per day for the same time, it would be a score of 20 pack-years, as you see, it is a worse scenario.

What are the symptoms of COPD?

COPD symptoms start slowly and progress over the years. Typically, patients cope with their symptoms by changing their lifestyles or ignoring them. The main COPD symptoms include chronic cough with mucus production, shortness of breath, progressive intolerance to exercise, wheezing, or even alteration of mental status. These symptoms are a complex interaction of the three pulmonary conditions composing EPOC. Furthermore, COPD affects not only the lungs. The manifestation of this pulmonary disease is also throughout the body. There is a loss of weight, muscle weakness, anemia, depression, lung disease, and cardiovascular disease.

From all the symptoms, the cough with vast quantities of mucus is the most common. It tends to affect more in the morning, producing colorless mucus. However, the breathlessness or shortness of breath is the most significant symptom for which very often patients consult to doctors. It usually appears by the sixties, albeit it can occur to younger people, and yes, the lung function is already affected.

Even though this is a chronic disease, there could be an exacerbation or crisis that causes particular and severe symptoms. Usually, wheezing occurs in COPD patients that are having a “crisis.” This symptom talks about an acute airway obstruction, which is indeed the most exasperating symptom. As the pulmonary disease progresses, the exacerbations could become more frequent and severe, so a close follow-up is a must.

Regarding the differences between chronic bronchitis and emphysema when causing EPOC, they are tangible. The classic findings in COPD patient with a chronic bronchitis predominance is a chronic cough with mucus production and progressive shortness of breath, recurrent lung infection, weight gain, and heart and lung failure. On the contrary, emphysema has a dry cough, weight loss, severe shortness of breath, and respiratory failure.

What are the complications of COPD?

The patient with COPD has two critical complications, like respiratory infection and lung cancer. Tobacco smoke has a relationship with this situation, but it is not all. The background of people, having a family history of cancer, being exposed to multiple respiratory infections throughout life, and more, influence these possible developments.

There is a bacteria population that contributes to individual health in all the human respiratory systems; however, for COPD patients, they are not the same. Previous studies support that patients with COPD have different bacteria than healthy people do and are keener to develop both acute and chronic respiratory infections. This situation is something to worry about because the infections are the number one triggers of COPD exacerbations and the worsening of symptoms. Indeed, it can lead to death.

Lung cancer is another story. The problem is that COPD is a huge friend of tobacco smoke, and so it is lung cancer. And the opposite is also true. Allow me to explain myself better, it is a common situation to find lung cancer in a patient that was initially studied because of COPD, and nearly half of the patients with lung cancer as a primary diagnosis when studied, are found to have COPD. And again, this situation is not pleasant; the coexistence of these conditions shadow the possibility of successful therapy. Lung cancer needs to be removed by surgery, although patients with COPD have a decrease in lung function, so taking away the lung could cause even more harm.

Despite all this information, current studies show the importance of assessing everyone. The risk of lung cancer for patients with COPD that have never smoked is actually higher than smoker patients with COPD and the same as tobacco smoker people without COPD.

How is COPD diagnosed?

The history and body examination in an acute or severe phase of the condition can tell a lot about the pulmonary disease to your doctor. However, patients at the beginning of it may not have symptoms that obvious.

The cornerstone for assessing this pulmonary disease is the spirometry exam, either for diagnosis or evaluating disease progression. It consists of an assessment of the airway obstruction severity with and without a bronchodilator. In fact, the definition of this disease is based on the so typical results it has with it. The patient is sited and is asked to blow through a spirometry nozzle as hard as it can. Then, a computer measures the airflow and compares it to healthy people with similar characteristics.

For being positive in this exam, while exhaling abruptly, your ratio of the forced expiratory volume in one second over forced vital capacity must be below 70%. In other words, the air cannot get out of your lungs because there is airway obstruction. As we will see further, this exam serves to classify the patient’s disease into mild, moderate, severe, and very severe stages.

Furthermore, for COPD patients with exacerbations a necessary although painful exam is an arterial blood gas levels. Chest radiography in patients with moderate to severe symptoms can show typical patterns of the disease. However, chest tomography is the best exam for COPD. It accurately discerns between chronic bronchitis or emphysema and is also helpful for determining the disease spread level in the lung.

What are the 4 stages of COPD?

The spirometry aid in defining how good or bad is the lung function. First, the patient will inhale a bronchodilator, which is a drug that opens the bronchial tubes widely. Then, the procedure will be precisely the same as described in the diagnosis section.

There are four stages, one or mild, two or moderate, three or severe, and four or very severe. While the lower the airflow, the worse the lung condition. This classification talks about lung wellness but not about how likely it is that a person dies from pulmonary disease as a fact. For that, there is another assessment tool that takes into account other variables as the weight, for example.

What is COPD treatment?

To the present, there is no cure or possibility of regression of this pulmonary disease. The treatment for COPD will only reduce the symptoms, increase the quality of life, and decrease complications or crisis.

The treatment relies on inhaled bronchodilators, which could be of short or long action, respiratory rehabilitation therapy, inhaled steroids, long term supplemental oxygen, or even surgery. The use of each one of them would depend on the severeness of the pulmonary disease. And before all of those fancy options, smoke cessation is fundamental for this treatment.

Patients with the mild disease would benefit solely from a short-acting bronchodilator. Then, as the severeness progresses, the doctor would add more and more treatment options from the list. Till the very severe pulmonary disease, that is the one that profits from nearly all of them, including oxygen therapy and surgery.

As I said earlier in this article, a pulmonary infection can lead to exacerbations. Therefore, prevention is also vital for these patients. Vaccinations represent a considerable opportunity for preventing the most common pathogens, bacteria, and viruses. The influenza vaccine should be annually for these patients. While the pneumococcal vaccine in patients older than 65 years or with severely compromised lung function.

What is the treatment for COPD exacerbation?

A pulmonary specialist would handle a COPD exacerbation with bronchodilators, steroids, antibiotics, oxygen, and medically assisted ventilation, depending on the severity. Basically, the same treatment as before, but now the antibiotics play a leading role because the most probable cause of the exacerbation is an infection. However, it is core to remember that viruses could cause it also. So a careful assessment of the situation is a must because viral infections do not benefit from antibiotics.

There may be the need to hospitalize the patient. In all these cases, severe shortness of breath, the rise of complications, and not having adequate tools to manage the condition at home. However, in some cases, after a course of treatment, the patient could be ready to go home.

What surgery is available to treat it?

A lung doctor would recommend two types of surgery in the worst disease scenarios and if the patient fulfills specific requisites. The patients with COPD and predominance of emphysema, the studies show an improvement in selected patients with lung volume reduction surgery. It consists of removing the upper sections of the lung, and it is no extent of complications. So it is reserved for genuinely terrible stages of the disease.

Then, there is lung transplantation, which usually is receiving a portion (a pulmonary lobe) of a living donor. The criteria for undergoing this expensive and complicated procedure is rigorous. The majority of the centers do not accept patients over 65 years for this surgery. Also, life expectancy after this major surgery is five years. It is only thought to help in decreasing symptoms and improve the quality of life.

Can COPD be prevented or avoided?

It would depend, it is not possible to one hundred percent avoid it if you are genetically predisposed, for example. However, for the vast majority of the cases, it is possible through smoking cessation.

Smoking cessation requires a plan, patience, and treatment, with and without drugs. It mostly fails because nicotine is really addictive. However, in the long term, patients would benefit from these tools if they acknowledge what the smoking habit can cause to them.

What should I do if I have symptoms of it?

Well, this tool is a chronic obstructive pulmonary disease symptoms checker. It is going to help you in determining how likely it is that your symptoms are indeed by this condition. This symptoms checker is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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