Introduction

Emphysema: This results from damage to your lungs’ air sacs (alveoli) that destroys the walls inside them and causes them to merge into one giant air sac. It can’t absorb oxygen as well, so you get less oxygen in your blood. Damaged alveoli can make your lungs stretch out and lose their springiness. Air gets trapped in your lungs and you can’t breathe it out, so you feel short of breath.

Chronic bronchitis: If you have coughing, shortness of breath, and mucus that lingers at least 3 months for 2 years in a row, you have chronic bronchitis. Hair-like fibers called cilia line your bronchial tubes and help move mucus out. When you have chronic bronchitis, you lose your cilia. This makes it harder to get rid of mucus, which makes you cough more, which creates more mucus.Refractory asthma. This type may also be called nonreversible. It doesn’t respond to normal asthma medications.

COPD Causes and Risk Factors

• Long-term exposure to things that irritate your lungs is the most common cause. Cigarette, pipe, or other types of tobacco smoke.
• If you hang around other smokers and breathe in a lot of secondhand smoke, that can play a role, too. Your odds also go up if you smoke and have asthma.
• If you smoke and have COPD, it tends to get worse faster. You might also develop this condition if you’ve been exposed to things like dust, air pollution, or certain chemicals for long periods of time.
• Women can also have COPD due to household air pollution.

Your age can make COPD more likely. It develops slowly over the years, so most people are at least 40 when symptoms begin. It’s rare, but your genes could put you at risk for COPD. If you lack a protein called alpha 1 antitrypsin (AAT), you may be more likely to get it.

What Are the Symptoms?

At first, you might not have any symptoms. But as the disease gets worse, you might notice these common signs of COPD:

• A cough that doesn’t go away
• Coughing up lots of mucus
• Shortness of breath, especially when you’re physically active
• Wheezing or squeaking when you breathe
• Tightness in your chest
• Frequent colds or flu
• Blue fingernails
• Low energy
• Losing weight without trying (in later stages)
• Swollen ankles, feet, or legs

COPD Phenotypes

For COPD, phenotypes is almost synonymous with clinical subgroup.

COPD phenotype is defined as a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death.)

• Emphysema-predominant phenotype: This phenotype is characterized by destruction of the alveolar walls, leading to reduced lung elasticity and gas exchange. Emphysema-predominant COPD patients have severe dyspnea, air trapping, and hyperinflation.
• Chronic bronchitis phenotype: This phenotype is characterized by chronic cough and sputum production for at least three months in two consecutive years. Patients with this phenotype have airway inflammation and mucus hypersecretion, leading to narrowing of the airways.
• Asthma-COPD overlap (ACO) phenotype: This phenotype is characterized by a combination of features of both asthma and COPD. Patients with ACO have symptoms of both diseases, such as wheezing, coughing, dyspnea, and exacerbations.
• Non-exacerbator phenotype: This phenotype is characterized by a low frequency of exacerbations and relatively stable lung function. Patients with non-exacerbator COPD have mild to moderate symptoms, and a lower burden of systemic inflammation.
• Exacerbator phenotype: This phenotype is characterized by a high frequency of exacerbations, leading to a rapid decline in lung function and quality of life. Exacerbator COPD patients have more severe symptoms, higher inflammation, and a higher rate of comorbidities.
• Mixed phenotype: This phenotype is characterized by a combination of emphysema, chronic bronchitis, and asthma. Patients with mixed COPD have a variety of symptoms and responses to treatment, making it more difficult to manage.

Identifying COPD phenotypes can help to guide personalized treatment and management strategies, including targeted pharmacological interventions and lifestyle modifications.

COPD Diagnosis and Tests

Your doctor will ask about your symptoms, your medical history, and whether you smoke or have been exposed to chemicals, dust, or smoke at work. They’ll also do a physical exam and breathing tests. Let them know if you have an ongoing cough.

The most common test is called spirometry. You’ll breathe into a large, flexible tube that’s connected to a machine called a spirometer. It’ll measure how much air your lungs can hold and how fast you can blow air out of them.

Your doctor may order other tests to rule out other lung problems, such as asthma or heart failure. These might include:

More lung function tests

• Chest X-rays that can help rule out emphysema, other lung problems, or heart failure
• CT scan, which uses several X-rays to create a detailed picture of your lungs and can tell the doctor if you need surgery or if you have lung cancer
• Arterial blood gas test, which measures how well your lungs are bringing in oxygen and taking out carbon dioxide
• Laboratory tests to determine the cause of your symptoms or rule out other conditions, like the genetic disorder alpha-1-antitrypsin (AAT) deficiency

6min walk test

• 6-minute walk test is commonly used to assess functional capacity and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary hypertension, and other respiratory disorders.
• The test can provide valuable information about a patient’s ability to perform activities of daily living, predict outcomes, and evaluate the effectiveness of interventions.
• During the test, patients are instructed to walk as far as possible in 6 minutes while maintaining a constant speed. They are allowed to stop and rest as needed, but the clock continues to run.
• The total distance covered in 6 minutes is recorded, along with other measures such as heart rate, oxygen saturation, and perceived exertion.

What Are the Treatments for COPD?

There’s no cure, so the goal of treatment is to ease your symptoms and slow the disease. Your doctor will also want to prevent or treat any complications and improve your overall quality of life.

One of the best things you can do to stop your COPD from getting worse is to stop smoking. Talk to your doctor about different things you can try.

Medical Treatment Pulmonary Rehabilitation

Pulmonary rehabilitation is a comprehensive program designed to help people with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), improve their overall physical condition, quality of life, and ability to function. The program typically includes a combination of exercise training, breathing techniques, education, and psychological support.

• The exercise component of pulmonary rehabilitation involves aerobic exercise and strength training to help improve lung function, increase stamina, and reduce shortness of breath.
• Breathing techniques, such as pursed-lip breathing and diaphragmatic breathing, are taught to help individuals improve their breathing control and efficiency.
• Education is provided on topics such as medication management, energy conservation, and nutrition to help individuals better manage their condition.
• Psychological support may also be included in pulmonary rehabilitation to help individuals cope with the emotional and psychological stress of living with a chronic lung disease. This may involve counseling, stress management techniques, and support groups.
• Pulmonary rehabilitation is often conducted in a group setting, with a team of healthcare professionals, including physicians, nurses, physical therapists, and respiratory therapists.

Overall, pulmonary rehabilitation has been shown to be an effective way to improve quality of life, reduce hospitalizations, and increase survival in people with chronic lung diseases.

Abstinence from smoking

Abstinence from smoking refers to the act of completely stopping the use of tobacco products, including cigarettes, cigars, and smokeless tobacco.

• Smoking is a leading cause of preventable death worldwide, and quitting smoking has numerous health benefits, including reducing the risk of developing lung cancer, heart disease, and other smoking-related illnesses.
• Quitting smoking can be challenging due to the addictive nature of nicotine, but it is possible.
• There are many resources available to help individuals quit smoking, including nicotine replacement therapy, prescription medications, counseling, and support groups.
• It’s important to seek the help of a healthcare professional to develop a personalized plan to quit smoking that works for you.
• In addition to the health benefits, quitting smoking also has financial benefits and can lead to improved relationships with family and friends who may have been negatively impacted by the habit.
• It’s important to remember that quitting smoking is a process and may take several attempts before being successful, but with perseverance and support, it is possible to live a smoke-free life.

Bronchodilators: You inhale these medicines. They help open your airways.

Corticosteroids:  These drugs reduce airway inflammation. You could inhale them or take them as pills.

Combination inhalers: These inhalers pair steroids with a bronchodilator.

Antibiotics: Your doctor might prescribe these to fight bacterial infections.

Roflumilast: This drug stops an enzyme called PDE4. It prevents flare-ups in people whose COPD is linked to chronic bronchitis.

Flu or pneumonia vaccines: These vaccines lower your risk for respiratory illnesses, including COVID-19.

Oxygen therapy: You may need this to reduce shortness of breath, protect your organs, and enhance your quality of life.