Approximately 300 million people have COPD globally, with a prevalence of approximately 12.2% . This disease represents the fifth leading cause of death worldwide and it is estimated that by 2030 it will be the fourth . 80% of COPD deaths occur in low- and middle-income countries
What is Chronic Obstructive Pulmonary Disease (COPD)?
COPD is characterized by persistent airflow limitation that is typically progressive, not fully reversible, and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (e.g., exposure to cigarette smoke). The two most common conditions that contribute to COPD are emphysema (destruction of alveoli) and chronic bronchitis (inflammation of bronchioles). Acute exacerbation of COPD (AECOPD) is characterized by an increase in dyspnea, cough and/or sputum that is beyond normal day-to-day variation.
Causes and phatogenesis Of COPD:
COPD results from a complex interaction between genes and the environment. The genetic risk factor that is best documented is a severe hereditary deficiency of alpha-1 antitrypsin (AATD), a major circulating inhibitor of serine proteases. Cigarette smoking is the leading environmental risk factor for COPD, yet even for heavy smokers, fewer than 50% develop COPD during their lifetime.
Inhalation of cigarette smoke or other noxious particles, such as smoke from biomass fuels, causes lung inflammation. Lung inflammation is a normal response that appears to be modified in patients who develop COPD. This chronic inflammatory response may induce parenchymal tissue destruction (resulting in emphysema), and disruption of normal repair and defense mechanisms (resulting in small airway fibrosis). These pathological changes lead to gas trapping and progressive airflow limitation
Symptoms of COPD:
- Dyspnea (increased effort to breathe, chest heaviness, air hunger, or gasping)
- chronic cough (may be productive or unproductive)
- Sputum production (purulent sputum reflects an increase in inflammatory mediators)
- Wheezing and chest tightness
- Additional features in severe disease (Fatigue, weight loss and anorexia)
- History of exposure to risk factors for the disease
Diagnosis of COPD:
Spirometry is the most reproducible and objective measurement of airflow limitation. Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD in patients with appropriate symptoms and significant exposures to noxious stimuli. Levels of severity in COPD based on symptoms FEV1 are categorized into mild (FEV1 (% predicted 80), moderate (FEV1 (% predicted 50-79), severe (FEV1 (% predicted 30-49), and very severe (FEV1 (% predicted <30).
Prevention For COPD:
- Smoking cessation: Smoking cessation has immediate benefits including: 1) improving symptom control, 2) slowing progression of disease, 3) improving cardiovascular outcomes, and 4) reducing long-term risk of lung cancer.
- Vaccinations ( influenza vaccine, pneumococal vaccine): Individuals with COPD are at higher risk of complications of influenza and pneumococcal infection.