COPD

Chronic Obstructive Pulmonary Disease (COPD)

COPD is an umbrella term for Chronic Bronchitis and Emphysema. Both are the consequence of long-term smoking. They are not two separate diseases, more of a continuum and most people have some of both. 

Over many years, smoking cigarettes damage both the air sacs (alveoli) of the lung and the tubes which connect the windpipe to those sacs (bronchials). Damaged alveoli dissolve over time. As air sacs dissolve there is less surface area to allow oxygen in and carbon dioxide out; this is emphysema. As the bronchials are damaged they produce more mucus; which causes congestion. The bronchials have a muscular layer which can go into spams (wheezing). Bronchial congested with mucus further narrow making it hard to get air out (the obstruction in COPD).; this is chronic bronchitis.

Cigarette smoke also paralyzes the microscopic hairs that line the bronchials. These beat in unison like oars from a crewed boat. This pushes mucus up on out of the lungs. Without this movement mucus stays in the lung causing congestion (the “smoker’s cough”). It only takes about a week for these little hairs to “wake up” after one stops smoking and recently quit smokers will often notice more congestion a week after they stop as these hairs start bringing up old mucus.

COPD causes shortness of breath, coughing, congestion, tightness, wheezing, and labored breathing with activity. As it advances the lungs lose the ability to meet the basic oxygen needs for the body and the patient then needs to wear oxygen. Carbon dioxide builds up to but the kidneys compensate for this.

When symptoms act-up we call this a COPD exacerbation. Infections, fluid back up, changes in weather/environment, allergies, smoking, and other factors can all precipitate an exacerbation.

Treatment involves decreasing inflammation and mucus production and opening (dilating) the bronchials to increase air flow.

Common Medications used:

Bronchodilators – albuterol and ipratropium (Atrovent) transiently open the bronchials to improve air flow.

Steroids – decrease inflammation and mucus production. Can be inhaled (Advair, Dulera, Trelegy, Symbicort, fluticasone, mometasone, etc), pill (prednisone) or IV (methylprednisolone). Come with many side effects both short and long term; high blood sugars (hyperglycemia) is the most common and immediate.

Mucolytics – thin mucus; not truly a cough medication because doesn’t suppress cough. Guaifenesin (Mucinex) and acetylcysteine (Mucomyst)

Cough medicine – help to suppress cough. Dextromethorphan (DM in Robitussin DM) and tessalon perles.

BiPAP – Bilevel Positive Airway Pressure – similar to a CPAP mask for obstructive sleep apnea but with different settings. Tight mask over mouth and nose; forces are in the lungs both on inhale and exhale. On exhale this pressure splints open the bronchials allowing more air flow and better exhale.

Intubation – breathing tube into windpipe and placed on ventilator (this is life support). Last line of treatment. Goal is the treat the patient until they get better and then take them off the ventilator. Not everyone who is intubated will be able to come off the ventilator (extubated). When doctors talk about life support, heroic measures, artificial breathing, etc. this is what we are talking about. NOT wanting to be put onto a ventilator is the DNI (Do Not Intubate) in a durable DNR/DNI. It tells the medical staff that you don’t want to be put on life support.

Asthma – asthma is similar to COPD except it develops spontaneously without coming from cigarette smoking and the spasms of the bronchial muscles are more reversible. Develops earlier in life; while COPD develops much later as it takes decades of smoking to damage the lungs. Asthma treatment is generally the same as COPD treatment.