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COPD

What is COPD?

 

COPD is the acronym for Chronic Obstructive Pulmonary Disease.

It is defined as a preventable and treatable disease characterized by chronic and poorly reversible airflow limitation. This airflow limitation, usually progressive and often manifesting as dyspnea (suffocation), is associated with an abnormal inflammatory reaction of the lungs to noxious particles or gases, primarily tobacco smoke. It is usually accompanied by chronic cough with or without expectoration. Its severity will depend on the presence of exacerbations and comorbidities (Definition of the Spanish COPD Guide, GesEPOC, derived from those carried out by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR))

 

COPD frequency

The GBD (Global Burden of Disease Study) 2010 update, published by the WHO, estimates the number of people affected by COPD worldwide at 328.615.000 (160 million women and 168 million men). This represents a significant increase since 1990 data indicated that there were 210 million people with COPD worldwide.

Since 2010, COPD is the third leading cause of death worldwide, preceded by ischemic heart disease and cardiovascular accident.

In Spain there are 2.185.764 people between the ages of 40 and 80 who have COPD (1.571.568 men and 628.102 women), which represents 10.21% of the Spanish population of that age. Since 73% of people are not diagnosed, it can be said that 1.595.000 Spaniards still do not know that they have this pathology, so they are not receiving any type of treatment. (Data from the 2010 EPI-SCAN study)

 

Presentation types

According to recent studies, 4 different phenotypes are identified within COPD:

  • Non-aggravating phenotype
  • Mixed COPD-asthma phenotype
  • exacerbator phenotype
  • With emphysema (The walls of the alveoli become less elastic and therefore it is more difficult to empty air from the lungs).
  • With chronic bronchitis (The airways are inflamed and narrowed, which prevents the lungs from emptying normally during exhalation)
COPD severity

To assess the severity of COPD, the BODE index is used, which assesses the body mass index, the FEV value1 obtained in spirometry, the degree of dyspnea according to the modified MRC scale and the distance covered in the 6-minute walk test. Or, failing that, the BODEx, in which the 6-minute walk test is replaced by the number of severe exacerbations.

According to the result of these indices, GesEPOC classifies COPD into five stages of severity:

  1. Marginal
  2. Moderate
  3. Grave
  4. Very serious
  5. End of life
Etiology
  • Tobacco consumption: The risk of COPD among smokers is between 25 and 30%. In addition, this risk is proportional to the accumulated consumption of tobacco, the greater the consumption, the greater the probability of developing it.
  • Passive smoking
  • Biomass fuel burning (wood, charcoal, manure…). Being exposed for long periods of time to the smoke produced by the combustion of these substances is the cause of the production of this pathology.
  • Air pollution: ozone, carbon dioxide, suspended particles... More than a direct cause of COPD, it is a triggering factor for exacerbations.
  • Occupational exposure: Exposure to polluting gases... are risk factors for suffering from this pathology. Patients already diagnosed and who are exposed to these substances present a more serious state than those who are not exposed.
  • Pulmonary tuberculosis: Having suffered from tuberculosis is associated with a 2-4 times greater risk of suffering from COPD.
Factors riesgo
  • Genetic factors: Genetic deficiency of alpha 1 antitrypsin predisposes to an accelerated decline in lung function. It is estimated that it is the cause of 1% of COPD cases and 2-4% of emphysema.
  • Other factors: Most of these COPD-causing factors cannot be changed
  • Age
  • Sex: More frequent in men
  • lung aging
  • Repeated lung diseases in children or adults at an early age
  • Socioeconomic factors
Comorbidities
  • ischemic heart disease
  • Heart failure
  • Arrhythmias
  • Pulmonary hypertension
  • Lung cancer
  • Osteoporosis
  • Myopathy
  • Cachexia
  • Glaucoma/Cataracts
  • Psychological disorders (anxiety and depression)
  • Cognitive impairment
  • Hypertension
  • Diabetes mellitus
  • Metabolic syndrome
  • Anemia
  • sleep apnea syndrome
  • Thromboembolic disease
How is it diagnosed?
Spirometry

Forced spirometry is used to diagnose COPD, because it defines airflow limitation.

Spirometry is a non-invasive, simple, cheap, standardized, reproducible and objective test that measures airflow limitation. It must be performed by a trained professional both for the use of the instruments and for the technique, thus ensuring that the test has a good quality and therefore results with clinical value.

The diagnosis of COPD focuses on the decrease in expiratory flow (FEV value1) and in its quotient with the Forced Vital Capacity (FEV1/FVC). In the initial evaluation of the patient with spirometry, the suspected diagnosis can be confirmed and the severity of the airflow obstruction can be evaluated.

Spirometry can be repeated after the standardized administration of a bronchodilator, thereby assessing the reversibility of the obstruction (bonchodilator test).

 

Simple chest x-ray

In most cases it is normal, but it may also show signs of lung hyperinflation, vascular attenuation, and radiolucency, indicating the presence of emphysema; bullae, radiolucent areas, or signs of pulmonary arterial hypertension.

It should be used in the initial assessment or to rule out complications in cases of unexplained dyspnea of ​​sudden origin (pneumothorax), change in cough pattern, hemoptoic sputum (neoplasia) or suspected pneumonia.

 

chest CT scan

It is used to evaluate the pathological changes in the lung structure associated with COPD and to separate its various phenotypes based on airway involvement.

Blood Tests

The blood count will be affected when complications appear

pulse oximetry

It is a non-invasive measurement with which oxygen saturation can be measured. It helps us to assess hypoxemia in case of suspicion, either in seriously ill patients or during exacerbations. It is not a substitute for arterial blood gases in which the amount of hemoglobin present in arterial blood is measured.

6 minute walk test

It assesses the distance covered by the patient during 6 minutes following a standardized protocol on level ground. It is part of the BODE index. With it, the ability to tolerate submaximal efforts is assessed and it is a good predictor of survival and the rate of hospital readmissions due to exacerbation.

Quality of Life Questionnaire

It includes a series of questions about how the patient feels and how they cope with different activities.

Prevention

COPD prevention should include:

  • Quitting tobacco use
  • Avoid passive smoking
  • Reduce exposure to indoor environments contaminated by biomass fuels

Treatment

The general goals of COPD treatment are:

  • Reduce the chronic symptoms of the disease.
  • Reduce the frequency and severity of exacerbations.
  • Improve the prognosis.

Both short-term benefits (disease control) and medium- and long-term goals (risk reduction) must be achieved.

In the treatment of all patients with COPD, general measures should be taken into account, such as:

  • Quitting tobacco: In a few days the benefits are noticeable. The programs must include pharmacological and psychological-behavioral treatment.
  • Proper nutrition: Rich in fruits and vegetables. It is advisable to have 5 meals instead of 3. Both being overweight and being underweight are detrimental to the evolution of the disease.
  • Regular physical activity: The feeling of dyspnea is not a cause for abandoning this practice. With training this sensation will subside and improve.
  • The evaluation and treatment of comorbidities.
  • Pharmacotherapy.
  • Vaccination: Reduces the risk of exacerbations related to infections that can lead to complications and is intended to reduce morbidity and health costs associated with COPD.
  • Use of oxygen therapy if necessary.

Rehabilitation is part of the comprehensive treatment of the patient with COPD.

What makes the symptoms worse?

  • continue smoking
  • Not taking the recommended treatment.
  • Using the inhaler incorrectly
  • Do not treat other simultaneous pathologies
  • Not going to appointments set by the doctor
  • Limit social relationships
  • Not doing at least 30 minutes of daily exercise

exacerbations

The exacerbation or exacerbation is defined as an acute episode of clinical instability that occurs in the natural course of the disease and is characterized by a sustained worsening of respiratory symptoms that goes beyond their daily variations. The main symptoms reported are worsening dyspnea, cough, increased volume and/or changes in sputum color.

They are usually due to viruses, bacteria, atypical organisms and/or environmental pollution.

What to do before an exacerbation?

Increased dyspnea:

  • Verify the self-management program and follow its advice
  • Keep calm
  • Apply rescue inhalers according to medical guidelines
  • Begin emergency treatment if prescribed
  • In the case of using oxygen therapy, use it throughout the day, even if the normal pattern is lower, without increasing the dose.
  • Perform relaxation and breathing exercises

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Phlegm:

  • Assess if they change color
  • quantity increase
  • thickness increase
  • Greater difficulty for expulsion

Legs and feet swell:

  • Keep your feet up: To do this, you have to lie on the bed and place cushions under your legs in a wedge shape. The feet have to be higher than the heart to facilitate drainage.

When to go to the doctor?

  • Coughing up bloody sputum
  • Greater than normal shortness of breath
  • Increased amount of phlegm and change in their coloration
  • Swollen legs and feet maintained over time, more than 3 days without remission and following action guidelines.
  • Side pain when breathing
  • Sleepiness
  • Sudden mood swings

General practical advice

  • Trips: They can be made following the instructions of the specialist. Special attention must be paid in the case of using oxygen therapy.
  • Clothing: Appropriate to the time of year and loose.
  • Sleep: It is advisable to establish routines and excessive rest during the day should be avoided as it will make it difficult to fall asleep at night
  • Household chores: Chemicals that can irritate the airways and worsen symptoms should be avoided.
  • Annual vaccination against pneumonia and flu.
  • Leisure: It is very important to maintain social relationships
  • Sex: It is not dangerous to have sexual intercourse if you follow the doctor's instructions
  • Heating and air conditioning: The air conditioning has to be adequate both in winter and in summer, care must be taken with sudden changes in temperature.

 

addresses of interest

European Lung Foundation (ELF): www.european-lung-foundation.org

SEPARATE. The Spanish Society of Pneumology. “Controlling COPD”: www.separ.es

The European Federation of Allergy and Airways Diseases (EFA): www.efanet.org

National Heart, Lung and Blood Institute, Living with COPD: www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_LivingWith.html

NHS Choices, COPD (COPD): www.nhs.uk/Pathways/COPD/Pages/Living.aspx

Associations and Foundations

AMALEPOC – Malaga Epoc Association
Góngora, 28 Bass.
Málaga 29002
Telephone: 657 57 52 24
Contact: epocmalaga@gmail.com

ASOCPEPOC – Spanish Association of Relatives and Patients with COPD
C/ Francesc layret 119,6 º 2ª
Badalona 08911 (Barcelona)
Phone: 00 34 671 632 556
Contact: epoc@epoc.org.es
Web: asocepoc.blogspot.com
Alpha-1 Association of Spain
Xosé Chao Rego, 8-10 bass
15705-Santiago de Compostela
Telephone: 981515016.
Contact: info@alfa1.org.es
Website: www.alfa1.org.es

Association A Tot Lung- Asthma and COPD
Hotel d'Entitats La Pau
C/Pere Vergès, 1, 9th p. dptx. 16
08020 Barcelona
Telephone: 93 305 45 97
Contact: atotpulmo@gmail.com
Website: www.atotpulmo.cat

APEAS- Association of COPD and Sleep Apnea Patients
Phone: 695 867 652
Contact: infoapeas@gmail.com
Website: www.apeas.es/