COPD (exacerbated): see pathophysiology, symptoms, treatment

Chronic Obstructive Pulmonary Disease, also known as COPD, was the 5th leading cause of death in Brazil in 2017, affecting approximately 9.9 million Brazilians. It is a set of diseases that affect the lung, causing dysfunction.

The main risk factor for its development is smoking and exposure to toxic gases , which makes it a preventable disease.

Despite the high number of people suffering from the disease, only 12% are diagnosed. Of these, only 28% are treated.

The World Health Organization (WHO) estimates that, in 2020, COPD will be the 3rd leading cause of death in the world. Understand more about COPD below!

What is COPD?

The Chronic Obstructive Pulmonary Disease (COPD) is a set of diseases that lead to lung dysfunction, characterized by difficulty breathing. Its main cause is the cigarette, followed by inhalation of pollution and chemical substances.

COPD is usually made up of chronic bronchitis and pulmonary emphysema .

During its development, there is a progressive loss of lung function and, many times, the patient does not even realize that he is sick.

That’s because it confuses the symptoms with normal reactions of aging, since the disease requires several years of smoking and exposure to substances to develop completely.

When the disease is not treated or even diagnosed, the patient starts to have shortness of breath when performing simple daily tasks, such as walking, climbing stairs, bathing standing up, among others.

In extreme cases, shortness of breath happens even when you are at rest.

It is a progressive disease that affects mainly people over 35 years old, smokers, ex-smokers, coal workers, potteries, pizzerias, among others.

Rarely, the disease has a genetic cause and affects younger people.

It can be found in the International Classification of Diseases, the ICD-10 , through the code J44.1 .

Pathophysiology

To understand the disease, it is necessary to understand how the lung works. When you breathe, the air descends through a structure called the trachea, which connects to the bronchi (breathing tubes that take the air to the lungs).

The air passes through these tubes and is taken, through the bronchioles, to the alveoli, small “bags” of air where the gas exchange takes place that guarantees the oxygen levels in the blood.

Inside the lungs, there are structures called “cilia”, responsible for scanning and cleaning the accumulated mucus.

When an irritating substance (such as a cigarette) enters the lungs, these cilia are damaged, causing the airways to swell, which results in mucus production and the development of bronchitis.

If bronchitis becomes persistent, it can turn into chronic bronchitis, which may have the effect of temporary bouts of acute bronchitis.

One of the main manifestations of COPD is low breath. Common and peaceful activities, such as climbing a ladder, can make the patient already become breathless.

This is because the lungs are producing more mucus and the bronchioles, because they are inflamed, become narrower, making it difficult for air to pass.

Adding these two factors, less oxygen reaches the capillaries and participates in gas exchanges, which can have consequences on the circulatory system, since the lack of oxygenation of the blood can make it more acidic.

The acidity of the blood, in addition to worsening the symptoms of shortness of breath and causing complications in the circulatory system, in more severe cases, causes the suppression of breathing and disorientation, which can lead the patient to a coma.

Diseases that make up COPD. Understand the types

COPD is mainly composed of chronic bronchitis and pulmonary emphysema . Many experts still consider refractory asthma to be part of the group.

Understand each one of them:

Chronic bronchitis

Bronchitis is an inflammation of the bronchi (breathing tubes that take air to the lungs) characterized by frequent coughing with phlegm, in addition to excessive mucus production.

The disease can be divided into acute (lasts a few days or weeks) and chronic (extends for at least 3 months). Only the latter is part of COPD.

Usually, chronic bronchitis occurs due to excessive tobacco consumption or strong exposure to pollution, two substances that limit the functioning of the bronchi and the respiratory tract, an anatomy that goes from the nose to the pulmonary alveoli.

Pulmonary emphysema

Emphysema is characterized by inflammation and destruction of the alveoli (small air sacs in the lungs), leaving the lungs full of holes that retain air.

Thus, the exchange of gases is impaired, which contributes to the decrease in the concentration of oxygen in the blood, whereas the carbon dioxide remains unchanged.

The disease can arise from a complication of chronic bronchitis.

Refractory asthma

Also called chronic non-reversible asthma , it is characterized by inflammation of the airways, causing symptoms such as shortness of breath, exacerbated mucus production, wheezing (noise in breathing), cough with worsening at night and feeling of tightness in the chest.

This type of disease is considered non-reversible because it does not respond to drugs commonly used in treatment. In this case, the medicine is not able to bring relief and free up space for air inside the lungs.

Causes

The lung depends on the elasticity of the bronchi to expel air from the body.

The loss of this elasticity causes the air to be trapped in the lungs, instead of being eliminated naturally. This loss can occur due to the following conditions:

Cigarette, smoke and chemicals

About 85% of COPD cases are caused by smoking, that is, cigarette smoking. However, the number of smokers developing COPD is only about 20%.

Alpha-1-antitrypsin deficiency

COPD can be caused by genetic factors that provide deficiency in the alpha-1-antitrypsin enzyme, which helps protect the lung.

Thus, this deficiency makes the person more susceptible to lung damage and, consequently, to the development of COPD.

For this reason, the disease can also affect younger people, non-smokers and who have not been exposed to the substances that cause the disease for a long time.

Exposure to irritating substances

Even those who have never smoked may be subject to COPD. Exposing yourself to cigarette smoke as a second-hand smoker or exposing yourself to gases, dust, smoke and other irritating substances can cause problems.

It is estimated that these factors are responsible for 15% of COPD diagnoses.

Risk factors

 

It is possible to state that the main risk factor for COPD is smoking. However, in addition to it, some other risk factors related to the disease are:

  • Passive exposure to cigarette smoke;
  • Tuberculosis history;
  • Chronic asthma;
  • Exposure to smoke from cars, chimneys, etc .;
  • Frequent use of firewood for cooking without adequate ventilation;
  • Recurrence of lower airway infections as a child.

COPD symptoms

COPD symptoms start suddenly, usually from the age of 40, with coughing and shortness of breath after physical exertion.

These symptoms are confused with the effects of age and are thus ignored.

Because of this, the patient can only realize the problem when it is too late.

About 50% of the respiratory function is already lost at the time of most diagnoses.

Therefore, it is important to be aware of the symptoms and their intensities, since they tend to become more intense as time passes.

Symptoms of COPD include:

  • Shortness of breath when performing simple daily tasks, such as walking or doing household chores;
  • Chronic cough, which lasts for a long time or comes and goes frequently;
  • Increased production of mucus (phlegm), which is expelled by coughing. In some cases, the cough may be accompanied by blood;
  • Fatigue;
  • Ease of contraction of respiratory infections;
  • Pieira (wheezing) in cold temperatures.

The intensity of the symptoms depends on the size of the damage to the lung.

If the patient continues to smoke or expose himself to harmful substances, the damage increases and the symptoms become more intense.

This happens in most cases, and the symptoms that come and go end up coming back stronger than the last time they were present.

Exacerbated COPD

One of the characteristics of COPD is exacerbations or exacerbations .

These periods can be defined as a time when there is a sudden worsening of symptoms, causing the patient to suddenly suffer from an increase in cough, an increase in the amount of sputum and shortness of breath even worse than usual.

During these crises, it is important to seek medical help, as they can contribute to the faster development of the disease.

What is the difference between COPD and asthma?

Some asthma symptoms are very similar to those of COPD, so many people may end up confusing illnesses.

At an anatomical level, the two diseases are similar, but they have an extremely important differentiating factor: reversibility.

In COPD, the airways are permanently narrowed and bronchodilator drugs only help to a certain extent, as the damage is not reversible.

Meanwhile, asthma is characterized by the temporary narrowing of the airways, which usually happens when the patient is exposed to irritating agents, such as dust, pollen and smoke.

In the case of asthma, the drugs help to open the airways completely, so that the patient can breathe normally. In addition, there is no destruction of alveoli in asthma.

It is important to remember, however, that some types of asthma, chronic and irreversible, may be within the spectrum of COPD.

How is COPD diagnosed?

 

Usually, the diagnosis of COPD is made through the patient’s history and physical exams.

The doctor, usually a general practitioner, may ask if the patient smokes, works or has worked in places where there is a lot of smoke and harmful substances that may have been inhaled for a long time.

The history of respiratory tract infections and family health history may also be asked.

In order to diagnose COPD, a general practitioner can refer the patient to a pulmonologist , a specialty that takes care of diseases of the respiratory tract.

Differential diagnosis

Some diseases can be confused with COPD, even after several tests have been performed and, for this reason, subsequent tests are often necessary to be sure of the condition.

This process is called differential diagnosis.

Some diseases that can be confused with COPD are:

  • Asthma;
  • Congestive heart failure;
  • Bronchiectasis;
  • Tuberculosis.

Exams

The tests that can help in the diagnosis of the disease are:

Spirometry

It is one of the main tests that help in the diagnosis. Its function is to measure lung volume, flow and capacity. The exam consists of taking a deep breath and exhaling, with your mouth, as strong as possible, in a tube connected to a device called a spirometer.

When spirometry is performed , it is calculated:

  • Forced Vital Capacity (FVC);
  • Forced Expiratory Volume in the first second (FEV1).

The results are expressed as a percentage, according to the normal values ​​referring to the patient’s gender, age and height. Thus, spirometry helps to classify the degree of COPD into:

  • Grade 0 (At risk) – Normal lung function, despite chronic cough and sputum;
  • Grade I (mild COPD) – Demonstrates mild airflow limitation (with FEV1 / FVC less than 70%, but with FEV1 greater than 80% of predicted). He usually has a chronic cough and sputum. At this stage, the patient may be unaware that his lung function is impaired;
  • Grade II (moderate COPD) – Airflow limitation worsens (with FEV1 greater than 50% and less than 80% of predicted), causing progression of symptoms, such as shortness of breath. Exacerbations are usually noticed from this stage;
  • Grade III (severe COPD) – When there is severe airflow limitation (with FEV1 less than 30% of predicted), or from the presence of respiratory failure, in addition to clinical symptoms of right ventricular failure. Thus, quality of life is severely impaired, and exacerbations can be life threatening.

Chest imaging exams

The doctor should order conventional radiographs or CT scans of the chest area. These tests can show signs of COPD or other conditions that may be causing the symptoms, and it is important to make sure that it is not another disease.

Blood gas analysis

Blood gas tests, such as oximetry, which measure the rate of oxygen gas in the blood, can be performed. Such tests can show gas rates and show an increase in carbon dioxide, a sign that contributes to the diagnosis.

Laboratory tests

In general, laboratory tests are not used to diagnose COPD. However, in some cases, tests may be ordered to make sure it is not another condition.

In the case of patients with a family history of alpha-1-antitrypsin deficiency, laboratory tests are responsible for the correct diagnosis of the disease.

Does COPD have a cure?

Unfortunately, COPD is a disease that causes irreversible damage to the lung and, therefore, has no cure . The treatment seeks to increase the survival of patients, in addition to ensuring quality of life even with the obstacles provided by the disease. Know more:

What is the treatment?

As the disease has no cure, the treatment of COPD seeks to improve the patient’s quality of life and help him overcome the obstacles caused by the disease. Understand:

Quit smoking

The first step for smokers is to stop smoking.

There are several programs, public and private, that seek to help overcome addiction. In the market there are also products that help to stop: chewing gum, lozenges, adhesives, among others.

Medical follow-up at this stage is very important, and, depending on the case, some doctors may recommend the use of antidepressants to assist in the process.

Use of bronchodilators

Bronchodilators are drugs that aim to relax the muscles around the airways, which, in turn, helps to relieve coughing and shortness of breath, making breathing easier.

These are more emergency measures, that is, they serve when the patient is going through a crisis and cannot breathe, as it has an immediate relief effect.

Oxygen therapy

When necessary, the patient can receive oxygen therapy, which consists of the medical application of oxygen. This therapy prevents carbon dioxide poisoning due to its high levels in the bloodstream.

Respiratory rehabilitation physiotherapy

Because they have lost much of their lung function, patients may need physical therapy for respiratory rehabilitation.

Because of irreversible damage, the patient will not fully recover his respiratory function, but physical therapy can help him to get the most out of his breathing capacity.

Mechanical ventilatory support

Machines like CPAP and BiPAP are alternatives for people with severe respiratory failure.

These devices “push” the air into the lungs, so that breathing is facilitated and the exchange of gases, for the removal of carbon dioxide from the system.

Vaccines

COPD patients are more likely to contract respiratory infections and, therefore, it is extremely important that they are vaccinated against influenza and pneumonia frequently, that is, annually.

The contraction of such conditions could generate serious complications for the patient.

Volume-reducing surgery

In some people, volume reduction surgery may be performed. Such procedure consists of removing the most affected areas of the lung, which helps in the function of the healthiest parts.

Lung transplant

For a very small number of people, lung transplantation may be an alternative. When the patient does not improve with any of the treatments and a compatible lung is available, this is an option to be considered.

COPD Medicines

Drug treatment of COPD depends on the severity of the disease and consists of bronchodilators, corticosteroids (for a limited time) and antibiotics during acute attacks (exacerbations).

Medicines can be oral, in the form of tablets or capsules, or inhaled, as a dry powder.

Controlled and emergency medications

For the treatment of COPD, there are two types of medication: controlled and emergency.

The prescription drugs must be taken every day and do not promote immediate relief and is responsible for maintaining the long-term respiratory function.

Already the emergency drugs are used to crises (exacerbations) , and unlock the airways in about a minute.

Controlled medications should not be given up to take emergency medications only when necessary, as this can result in even more damage to the respiratory system.

Bronchodilators

Bronchodilators can be administered through inhalers, nebulizers, nebulizers (sprays or “bombs”), turbohaler (type of bomb in which a dry powder is inhaled) or rotadisks (disk-shaped).

Check out the main ones:

  • Formoterol ;
  • Ipratropium bromide ;
  • Tiotropium bromide ;
  • Salbutamol ;
  • Terbutaline Sulfate ;
  • Fenoterol ;
  • Salmeterol;
  • Indacaterol maleate .

Corticosteroids

Corticosteroids are used to prevent worsening of COPD. However, they can have serious side effects, such as weight gain, diabetes , osteoporosis , cataracts and increased risk of infection.

The main one used in COPD cases is:

  • Budesonide ;
  • Prednisolone .

Bronchodilators + Corticosteroids

Certain medications have both actions in the body, as is the case of Formoterol Fumarate + Budesonide .

Phosphodiesterase 4 inhibitors

These drugs are an anti-inflammatory type used to fight inflammation of the lungs and bronchi, reducing the number of attacks. Its use should be complementary to bronchodilators and should never be used in isolation.

Examples include:

  • Roflumilast ;
  • Cilomilast.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living with COPD

 

Living with COPD may seem impossible, since the disease causes numerous limitations due to shortness of breath.

However, there are some measures that can be taken to prevent the disease from developing more quickly and to reduce the discomfort caused by the symptoms. Know more:

Stay active

It is important not to be inactive, as this can further impair your respiratory function, in addition to easily triggering emotional disorders such as depression .

Some tips are:

  • Ask the physical therapist how much you can walk each day;
  • Increase the walking time little by little from time to time, according to your breathing capacity;
  • When you feel short of breath during the walks, do not talk, as the act of talking uses more air;
  • Exhale the air slowly through your mouth when walking, so that your lungs are empty when you inhale again;
  • Do not do exercises that need a large lung capacity to perform;
  • Do simple and light exercises, as developing muscle strength helps with breathing capacity. If necessary, consult your physical therapist to set up an exercise routine.

Adaptations in the routine

In order to improve the quality of life, some adaptations in the routine, at home, at work and wherever else is necessary may be necessary. Check out:

  • Ask for help when you need it, don’t waste the air unnecessarily;
  • Avoid too hot or too cold weather;
  • Avoid living with smokers;
  • Avoid barbecues and other festivities with a high concentration of smoke;
  • Reduce air pollution at home by getting rid of irritating agents;
  • Rearrange your home so that essential environments and objects are easily accessible;
  • Plan your days better to make sure you have plenty of time to rest and get air when needed.

Breathe clean air

Having reduced breathing capacity, it is not only the amount of air that counts, but also the quality of the breathed air. That is why:

  • If you smoke, seek professional help to quit smoking;
  • Ask others not to smoke near you;
  • Avoid air pollution from cars;
  • Always prefer to take walks in parks or places with clean air, never on busy streets where many cars pass;
  • If you live in a busy place, close the windows and use air purifiers and humidifiers to ensure indoor air quality;
  • Avoid leaving the house when it is too hot or too cold.

Eat well

Adequate nutrition is essential to fight any disease, but it can bring several benefits to patients with COPD.

This is because it is the food that provides the energy that moves the lungs, and factors such as obesity make breathing more difficult.

Some tips for eating well while having COPD include:

  • Eat small meals and snacks that guarantee energy, but do not cause a “stuffy” feeling, as large meals impair your breathing for a while;
  • Drink plenty of water during the day, as the intake of fluids helps in the dissolution and elimination of mucus (phlegm);
  • Prefer healthy proteins, such as milk, cheese, eggs, meat, fish and grains;
  • Also have a preference for healthy fats, such as olive oil, canola, among others;
  • Limit the amount of sweets, avoid cakes, cookies and soft drinks;
  • If necessary, avoid foods that help in the production of gases, such as beans, cabbage and carbonated drinks;
  • If you are overweight, plan, together with a physiotherapist and nutritionist, a routine that will help you lose weight.

Sleep well

Sleeping well is also essential for maintaining health.

However, COPD can present several obstacles at this time, as it causes shortness of breath (apnea), and some medications can cause difficulty sleeping or even require night doses.

Some safe tips for better sleep are:

  • Tell the doctor in charge that you have trouble sleeping. He can adapt the treatment so that you can have better quality sleep;
  • Before going to sleep, practice some relaxing activity, such as taking a warm bath or reading a book;
  • Lie down to sleep at the same time every day;
  • Do not use prescription-free medications that help you sleep, as they can cause adverse reactions, interact with other medications and even worsen your breathing.

Take care of your mental health

Limiting diseases often have an impact on mental health , too . So it is important that you:

  • Don’t feel guilty about the disease;
  • Talk about your feelings;
  • If necessary, do psychotherapy;
  • Join a support group for people with COPD.

Know when to contact the doctor

It is extremely important that you know when to go to the doctor urgently. This includes when you:

  • He cannot take a deep breath;
  • You need to lean forward to breathe more easily;
  • You need to use the strength of your muscles and ribs to breathe;
  • You experience headaches more often;
  • Feels very drowsy and confused;
  • Have a fever;
  • Releases dark or larger mucus with cough;
  • It presents bluish color in the fingertips, lips and skin around the nails;
  • He feels breathing more difficult and shallow, needing to breathe faster.

What are the complications?

Even when treated, COPD can cause several complications that can put the patient’s life at risk. Are they:

Cor pulmonale

Due to lung disease, heart failure may occur in which the chambers on the right side of the heart, the side responsible for receiving venous blood and pumping it into the lungs, are impaired.

Pneumonia

Because of the damage caused by COPD, the body is more susceptible to infections such as pneumonia, which can cause inflammation in the air sacs of one or both lungs, in addition to leaving them full of fluid.

Pneumothorax

Also because of the damage caused by COPD in the lungs, there may be an accumulation of air in the pleura, the membrane that covers the lung, which decreases the expansion capacity of this organ.

Lung cancer

Since COPD is related to smoking, people who suffer from this disease are also more likely to develop lung cancer , especially if the patient has not stopped smoking.

Weight loss and malnutrition

When the disease progresses, many patients may find it difficult to eat, which can result in weight loss and malnutrition.

Osteoporosis

When the patient has to make continuous use of corticosteroids to control the inflammatory and immunological processes, it can result in the development of osteoporosis.

Debilitation

Weakness can be characterized by physical weakness and dejection. It usually happens because of shortness of breath.

Depression

The impairment caused by COPD can make the patient deprived of performing activities that previously gave him pleasure, which increases the chances of the patient developing depression.

Therefore, it is important that treatment is done in conjunction with a mental health professional, psychologist or psychiatrist, to prevent depression from being a possible complication.

How to prevent?

The best way to prevent chronic obstructive pulmonary disease is to not smoke , or to stop smoking as soon as possible.

In addition, people working in places where there is a lot of air pollution must be aware of the amount of pollution inhaled and, if necessary, change professions to maintain physical integrity.

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