Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)encompasses a group of lung disorders that include chronic bronchitis, emphysema, chronic obstructive airways disease and chronic asthma. COPD affects millions of people worldwide and this disease is mostly attributed to smoking. Air pollution, working in an environment with harmful effluents and passive smoking are also likely causes for Chronic Obstructive Pulmonary Disease. Sometimes a patient may suffer an inherited form of emphysema due to a deficiency of alpha-1-antitrypsin. With chronic bronchitis, the air passages and mucus glands are enlarged thereby leading to severe cough. Over time, the enlargement can lead to reduced oxygen supply to the lungs. Elevated blood pressure is noticed. This condition is more predominant in those who smoke or have a history of respiratory illness. While some patients develop wheezing and shortness of breath, others notice mucus while coughing. Chronic bronchitis is noticed with symptoms such as continuous cough, rapid breathing and cyanosis (bluish tint to the lips and nails). Morning headaches may be noticed on account of inability to remove carbon dioxide from the blood. Patients with severe case of COPD may face hemoptysis (alternatively haemoptysis) (blood while coughing). Emphysema occurs when the tiny alveoli in the lungs are destroyed thereby hampering efficiency of the lungs. It leads to labored breathing and the patient often feels out of breath. Other symptoms are loss of weight, disturbed sleep and tight constriction in the chest.

Diagnostic tests for COPD include blood tests and pulmonary function test. The pulmonary function test is an indicator of the extent of blockage of the lungs. Chest x-rays help in identifying damaged areas of the lungs and areas of fluid collection as well as any masses in the lungs. Sputum culture can identify any respiratory infection. A spirometry test measures the amount of air a person can blow in a second. Arterial blood gas analysis indicates how efficiently the lungs bring oxygen into the blood and remove carbon dioxide.

Antibiotics can help in tackling the bacterial infections in the lungs. Bronchodilators open up the air passages in the lungs thereby alleviating some of the symptoms of Chronic Obstructive Pulmonary Disease. Inhaled corticosteroids will reduce airway inflammation. In severe cases, oxygen is administered. In addition, some lifestyle changes must be followed:

• Avoid smoking
  
• Avoid exposure to secondhand tobacco smoke
  
• Adopt physical fitness regime to maintain good lung health
  
• As far as possible, avoid environmental irritants, hazardous inhaled substances such as paints, chemicals and cleaning agents
  
• Balanced diet
  
• Plenty of water and fluids
  
• Steam inhalation
  

Bronchodilators

Bronchodilators are respiratory medicines that help in clearing of the airway in the lung muscles. Often the cause of congestion in the lungs is either an inflammation or an infection associated with it. Most of the bronchodilator mechanism of action is on the smooth muscle. Bronchodilators are classified based on their duration of action when administered - long acting and short acting.

Beta 2 agonists

These are administered through inhalers for temporary relief in case of shortness of breath. Their pharmacokinetics is predominantly associated with the movement of cilia inside the lungs to clear the presence of mucus. They are very useful in treating conditions such as asthma. Since their effect is short lived, they are not used in chronic obstructive pulmonary disease.

Anticholinergics

These drugs are similar to beta 2 agonists as they also help in removing the mucous from the channels in the lung tissue. However, the action of this respective drug is longer and hence it becomes an option to treat COPD. In order to administer this drug, a nebulizer is necessary. In the emergency medicine protocol, the drug is used in the form of a mist in the mask following which the patient is asked to inhale the drug.

Theophyllines

These are durable action oriented class of bronchodilators and they are used a lot for COPD. The mode of action of this drug is to limit inflammation by relaxing the lung muscles and air pathways. Increased use of these drugs can trigger side effects such as nausea and light-headedness. These drugs are administered as syrups and they are only recommended in case the patient does not show prophylaxis in case of COPD.

Side effects

Bronchodilators can cause many side effects and their extensive usage can also lead to damage to many organs. Bronchodilators are not recommended in case of medical conditions such as Cardiomyopathy, diabetes and hyperthyroidism as they interfere with metabolic activities of the body sometimes leading to organ failure. This is because bronchodilators also have a tendency to interfere with beta-blockers and cause hindrance in the prophylaxis of tachycardia or hypertension. They also hinder the action of antidepressants in case of conditions such as Alzheimer's disease.

Pneumonectomy

Pneumonectomy is a surgical removal of the lung. This is done on patients suffering from lung cancer, COPD and emphysema. When a person is suffering from lung cancer, it has to be ascertained if the cancer has not spread. CT scan and bone scan can help. When the patient has a tumor near the lung center, Pneumonectomy is done when there is no other option. In a simple Pneumonectomy surgery, only the affected lung is removed. In extra pleural Pneumonectomy, a part of the pericardium and parietal pleura is also removed.