Overview of Chronic Obstructive Pulmonary Disease (COPD)

COPD stands for Chronic Obstructive Pulmonary Disease. It is a chronic and progressive inflammatory lung disease that causes obstructed airflow from the lungs, resulting in breathing difficulties. Unlike asthma, this condition is irreversible and usually worsens over time.

COPD was the 10^th leading cause of death in Singaporeans in 2022, and is now estimated to be the fifth leading cause of death across the world.

The single biggest cause of COPD is cigarette smoking. Other causes include prolonged exposure to environmental pollutants such as chemical irritants, smoke and industrial pollution, and a rare genetic condition known as alpha-1 antitrypsin deficiency, where there is a lack of an enzyme important for the repair of lung tissue. In some cases, the cause can be unknown.

Most people with COPD have a mix of both emphysema and bronchitis. Bronchitis develops when prolonged exposure to cigarette smoke results in narrowing of your airways. Due to changes in the airway, copious amounts of phlegm are then produced. Loss of lung tissue due to breakdown of the alveoli walls (air sacs in the lungs) can also occur, known as emphysema. COPD is not contagious.

There are many signs and symptoms of COPD. These include:

• Cough – Usually a ‘wet’ or chesty (productive) cough with phlegm (sputum), commonly referred to as ‘smoker’s cough’
• Excessive sputum – Damaged airways produce more mucus than healthy airways
• Wheezing – Caused by narrowing of the airways
• Shortness of breath – Can occur even while resting
• Frequent respiratory infections – Due to chronic lung damage
• Unintended weight loss and fatigue – Usually happens in later stages

COPD is diagnosed through:

1. Pulmonary/Lung Function Tests – COPD can be confirmed and graded by performing a test called spirometry. In this test, an individual is asked to blow hard into a machine, which analyses the amount of air expired and the time required to do so. It is a simple and painless test.
2. Chest X-ray – This can rule out other conditions that resemble chronic lung disease.

COPD is a chronic disease that is progressive in nature. Structural lung damage cannot be restored once it has happened. Various treatments are available and effective if given during the early course of the illness. These treatments can help to improve your condition and slow down damage to diseased lungs.

Lifestyle

• The most important thing to do is to stop smoking, regardless of how long you have been a smoker or the amount you have smoked – Studies have shown that stopping smoking at any stage of COPD will slow down the deterioration in lung function
• Consider getting influenza and pneumococcal vaccination – This will assist in protecting you from frequent respiratory infections which can result in acute exacerbation episodes
• Nutrition – A well-balanced diet is important to help fight the symptoms

Medications

• Bronchodilators – Agents which open up the airways
• Steroids – Used only on a short-term basis to control a ‘flare up’ (exacerbation) of symptoms
• Mucolytics – Used to reduce thick sputum during an attack
• Antibiotics – Can be given in acute exacerbation episodes

Pulmonary Rehabilitation

• This is involves supervised exercise training and education by a physiotherapist

Long Term Oxygen Therapy

• Patients with severe COPD may require home oxygen use to improve symptoms and prolong survival

Surgery

• Certain COPD patients may be offered surgery as a treatment option (lung volume reduction surgery)

COPD can cause many long-term complications, including:

• Recurrent respiratory infections – People with COPD are at higher risk of catching common colds, influenza and pneumonia, which can worsen symptoms and cause further damage to your lungs.
• Pulmonary Hypertension – Causes changes in arterial pressure of blood vessels which circulate blood to the lungs, leading to increased strain on the heart and lung systems
• Heart diseases – Increases the risk of heart diseases such as heart failure and heart rhythm irregularities (cardiac arrhythmias).
• Mood disorders such as depression – Symptoms of COPD can be disabling and affect your mental health.
• Lung cancer – COPD has been shown to increase the risk of developing lung cancer.

• Quit smoking – It has been proven that there is a direct link between smoking and the development of COPD, which is why the best prevention is to stop smoking.
• Avoid prolonged exposure to lung irritants – Prolonged exposure to environmental agents such as chemical fumes and irritants is another risk factor for COPD. If you cannot avoid these types of lung irritants, ensure you use respiratory protective equipment to minimise exposure.