Chronic obstructive pulmonary disease is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by individual factors such as abnormal lung development.

According to the WHO, it is third leading cause of death worldwide, causing over 3 million deaths, a majority of which are in low- and middle-income countries (LMIC) like the Philippines. 

The body’s natural inflammatory response is permanently modified after chronic exposure of the respiratory tract to irritants such as cigarette smoking and noxious gases. Most common cause is cigarette smoking. However, COPD may also develop in patients who have never smoked.

This chronic inflammation causes narrowing of airways into the lungs. Air becomes trapped in the lung, and subsequent changes in the architecture of the lung occur. These processes altogether cause the signs and symptoms of COPD.

Risk Factors include

• Genetic factors, Congenital/Developmental abnormalities
• Constant exposure to Tobacco smoke (either as user or secondhand)
• Constant inhalation of smoke from home cooking and heating fuels
• Occupational dusts, vapors, gases, fumes, and other chemicals
• Family history of COPD

The most common symptoms of COPD include:

• Shortness of breath/Difficulty of breathing/Dyspnea
  • That is progressive over time
  • Worse with exercise
  • Persistent
• Chronic cough
  • May be intermittent
  • May be unproductive
  • May include a wheezing sound
• Chronic sputum/phlegm production
  • Not always present
  • But if present, may indicate COPD

Diagnosis is then made via Spirometry, where a patient’s lung capacity will be tested using a device called a Spirometer.

Pharmacologic/medical management does NOT treat COPD. It can help manage symptoms and help increase long-term smoking abstinence rates. However, smoking cessation remains key in management.

Pharmacotherapies for smoking cessation:

• Nicotine replacement products (nicotine gum, inhaler, nasal spray, patch, etc)
  • Cannot be used by patients with recent heart attack or stroke
• E-cigarettes may contain nicotine and other chemicals whose long-term health effects are largely unknown

Pharmacotherapies for symptom control

• Bronchodilators and Inhaled corticosteroids (Inhalers)
• Antimuscarinic drugs
• Anti-inflammatory agents
• Oral glucocorticoids
• Mucolytics

Prevention is best attained by smoking cessation and avoidance of irritants. For exposure to cooking fumes, cooking in open areas with good ventilation may reduce exposure to noxious gases and fumes. For patients struggling to stop smoking, consult your primary physician for counseling.

Reference:

Venkatesan, Priya. “GOLD report: 2022 update.” The Lancet Respiratory Medicine 10.2 (2022): e20.