Introduction
Worldwide it is estimated that 65 million people suffer from a form of Chronic Obstructive Pulmonary Disease (COPD).1 In the Netherlands there are almost 600.000 COPD patients.2,3 The World Health Organization (WHO) predicts that this disease will be the third cause of death worldwide in 2020.
So many people are affected by it, but what is it? It is all in the name. COPD is a chronic lung disease in which air gets trapped (obstructed) in lung tissue during breathing.
Smoking is the number one cause of COPD. Other causes are exposure to chemical fumes, allergic reactions and in poorer countries in can be a result of cooking fuels in poorly ventilated homes. Because it is caused by exposure to this kinds of stressors over an extended period, COPD is found mainly in older people. It can, but is rarely caused by a genetic alpha-1-antitrypsin (AAt) deficiency.1,2,3
The two main types of COPD are: emphysema and bronchitis.2 In case of emphysema alveoli are slowly destroyed. Our lungs are relatively small but have to transport a lot of oxygen. In order to enlarge their surface they developed alveoli. These are small bags which exchange oxygen between the lung and the blood vessel. If the walls of these small pockets are destroyed a large pocket remains. However, in the end the surface that is left is a lot smaller. Less oxygen is exchanged and the patient becomes short of breath. Bronchitis is the COPD type in which bronchi are inflamed. When you breath the air passes first your nose, throat, trachea and then is divided in even smaller branches, bronchi. Inflamation causes bronchi to swell which makes it harder for the air to pass. Furthermore, inflammation causes mucus, the patient has to cough and it makes breathing more difficult.
Symptoms & Complications
Most common symptoms include shortness of breath, coughing, wheezing, fatigue and tightness in the chest. As the disease progresses oxygen levels in the bloodstream are lowering. As a result, fatigue and shortness of breath appear and it may also lead to blue discoloration of lips and fingernails. Daily activity costs a patient more energy than is normal and therefore a lot of patients lose weight.2,4,5
The complications of COPD are divers. Patients are more vulnerable to the common cold, are at risk of severe pneumonia and can develop pulmonary hypertension. Additionally, they are at risk for heart disease, suffer more often of depression and when the patient smoked he is at increased risk of developing lung cancer.2,4,5
Diagnosis
Diagnosing COPD can be done in different ways but the most used and accurate way is a spirometry.5 While the patient breaths via a tube the lung function is monitored. A CT-scan is another possibility to diagnose COPD. It shows large air pockets in advanced emphysema and inflammation of lung tissue in case of bronchitis.
Treatment
COPD is a progressive disease. Therefore, treatment of COPD is aimed at symptom suppression. Most COPD patients use bronchodilators, these expand the airways and make breathing easier. Often this medication is combined with inflammation inhibiting medication. Unfortunately, in time patients will become dependent of oxygen.
