COPD is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases.

COPD is becoming the leading cause of mortality in the world, it’s the 4th leading cause of death in the world and it’s a very progressive disorder. The global burden of the disease study reports a prevalence of 251 million cases of COPD globally in 2016. Globally it is estimated that 3.17 million deaths were caused by the disease in 2015. COPD is common in countries with high pollution index. Air pollution in India is a serious health issue. Of the most polluted cities in the world, 22 out of 30 were in India in 2018. As per a study based on 2016 data, at least140 million in India breath air that is 10 times or more over the WHO safe limits. COPD has led to 13 % of deaths in India and 7.5 million cases are at the risk of the disease.COPD is caused because of long term exposure to cigarette smoke, irritant gases such as biomass, dust, chemical fumes etc.

Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is an inflammation of the lining of the bronchial tubes. Patients with chronic bronchitis present with daily cough and mucus (sputum) production. These patients are termed as pink puffers Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. Patients with emphysema have symptoms such as a barrel chest, enlarged lungs, shortness of breath, and weight loss. These patients are termed as blue bloaters.

COPD diagnosis is confirmed by a simple test called spirometer or pulmonary function test. Pulmonary function tests measure the amount of air a person can inhale and exhale, and if the lungs are delivering enough oxygen to the blood. It can also be used to track the progression of the disease and to monitor how well treatment is working. Spirometer often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. A chest X-ray can show emphysema, one of the main causes of COPD. A CT scan of the lungs can help detect emphysema and help to determine if the patient might benefit from surgery for COPD. Arterial blood gas analysis. This blood test measures how well the lungs are bringing oxygen into the blood and removing carbon dioxide out. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAT) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.

When it comes to the treatment of COPD avoidance of risk factors is the first thing to be done. Smoking cessations for smokers is the first step of the treatment, avoidance from irritable gases, dust and fumes must be followed. Medications such as bronchodilators in the oral or inhaled form are prescribed and these are prescribed based on the severity of the disease.  Few may require home oxygen support. Patients with COPD and respiratory failure, whether acute or chronic have a poorer prognosis than patients without respiratory failure.

Non-invasive ventilation (NIV) has been shown to be a useful tool in both the acute hospital and chronic home care setting. NIV has been well established as the gold standard therapy for acute decompensated respiratory failure complicating an acute exacerbation of COPD with reduced mortality and intubation rates compared to standard therapy. The role of non-invasive ventilation in the treatment of COPD has tremendously improved the morbidity and mortality rate in the patients of COPD, it has reduced the number of hospital admissions for patients with COPD.NIV is a small, easily operated machine that helps a person with COPD to breathe. When using an NIV machine, a person takes in pressurized air through a mask to regulate their breathing pattern while they are asleep or when their symptoms flare. In patients with COPD, the lungs become less elastic or filled with mucus which becomes difficult for the air to enter into the lungs and the oxygen diffusion to happen, A NIV machine gives a continues pressurized air into the lung allowing the patient to breathe normally and it makes the adequate oxygen diffusion to happen in the lungs and also removes the carbon dioxide. There are various types of NIV machines available these days of which the basic types are the BiPAP (bi-level positive airway pressure) and CPAP (continuous positive airway pressure). The main difference between BiPAP and CPAP devices is that BiPAP machines have two pressure settings: one pressure for inhalation (IPAP), and a lower pressure for exhalation (EPAP).

The BiPAP machine is designed to increase the pressure when you inhale to keep the airways in the nose and throat from closing while you are sleeping and provide a lower pressure during exhalation that continues to maintain an open airway. While CPAP provides continuous pressure during inhalation and exhalation. The doctor decides a suitable machine for the patient based on the patient’s condition.

So with the advancement in the field of medicine COPD can be treated and controlled and as citizens, we should also be responsible to control the pollution from our end to reduce the incidence of this dreadful disease.

 - Dr. Aishwarya MBBS, MD (Pulmonary Medicine) Consultant Pulmonary Medicine

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