Diagnosis and treatment of COPD

Diagnosis 

Diagnosis of COPD is based on evaluation of symptoms, patient’s history, physical examination and respiratory function tests. Plain X-ray graphs and blood gas analyses are also among other helpful tests.

Evaluation of symptoms: Long-term cough, phlegm discharge, shortness of breathing, and/or history of exposure to risk factors would suggest COPD. 

History: Each patient suspected COPD should undergo a detailed medical history taking which includes smoking, occupational exposure, pollution, family history, hospitalizations and medications.

Physical examination: Physical examination is not enough for COPD diagnosis. Physical examination reveals no sign or symptoms until the airflow limitation leads to impairment in respiratory functions.

Respiratory function tests: Each patient suspected COPD should undergo respiratory function tests. Respiratory function tests are easy, repeatable and valid way to demonstrate airflow limitation.^1,2

References:
1. http://www.toraks.org.tr/uploadFiles/book/file/232201117745-tani.pdf
2. http://www.goldcopd.org/uploads/users/files/GOLD_Pocket_May2512.pdf

Treatment

COPD is preventable and partly treatable disease. Four important approaches in COPD are;

• Education of patient and relatives, 
• Reduction of COPD risk factors, 
• Medical treatment and 
• Reduction of exacerbations. 

The main goals of treatment are to prevent progression of the disease, to reduce symptoms, to increase exercise capacity and to improve quality of life. 

• Although prevention of COPD is fundamental, patient education and compliance together with encouragement for an active life style are crucial.
  

• One of the most effective step of treatment is quit smoking which is the leading cause of COPD. Besides smoking, occupational exposure may play role in development of COPD, therefore, avoiding exposure may retard loss of respiratory functions.
  

• Besides stable drug therapy in COPD, there are alternative options including long-term oxygen treatment, exercise education, and psychological support.
  

The difference between COPD and ASTHMA

COPD and asthma may be comorbid conditions in the same person, they have similar symptoms and are long-term, obstructive airway diseases. Both present with airway inflammation, but characteristics of this inflammation are very different in two conditions, eventually their treatment responses are very different. Airflow limitation in asthma may fully relieve spontaneously or on medication, whereas airflow limitation in COPD is not fully reversible and it is progressive when the exposure is continuing.

COPD FAQs (Frequently Asked Questions)

• How does smoking affect COPD?
  

Of the daily smokers, 82% started smoking under 18 years of age and 53% started to smoke on daily basis before that age. Smoking is the leading risk factor for development of COPD. It also compromise the response to treatment. Smokers, with or without COPD, have inflammation and thickening of small airways. This increases exacerbations and progression of the disease.

• What is the proper time to consult a physician?
  

If long-term smokers or workers of mine, metallurgy, cement sector have cough and phlegm discharge (without an obvious reason) for at least 3 months and 2 years in a row, they should consult a physician, 

If they have progressive shortness of breathing, they should consult a physician.

• What are the body and breathing exercises for COPD?
  

Exercise is necessary for proper lung function. Unfortunately, many lung patients afraid of exercise. This is due to the feeling of difficult breathing or fear of getting harm from difficult breathing. But this is not true, feeling of difficult breathing does not hurt lungs. Immobility leads to muscle weakness and reduced lung capacity. Mobile and active life-style improves lung capacity.

Mainly 4 types of exercises are recommended for COPD patients. The intensity of each type of exercise depends on your COPD exercise program structured by your physician.

Stretching exercises: this type of exercises lengthens your muscles and increase elasticity of your body. In addition, these exercises prepare your body to other works and reduce the possibility of muscle injury.

Aerobic exercises: your heart and lungs work during aerobic exercise and their endurance capacity are increased. This, in turn, increases productivity of oxygen consumption and improves your breathing. If you have COPD walking or cycling ergometer are good choices for aerobic exercise.

Strengthening exercises: comprise of muscle work until exhaustion. This type of exercises for upper body may strengthen your respiration muscles.

Breathing exercises for COPD: work outs which enable deeper breathing with a smaller effort. If you have COPD, you may start breathing exercises 3 or 4 times a day, 5 to 10 minutes puffing and diaphragmatic breathing exercises.

References:

1. Erdinç M, et al. KOAH ile yaşam. Ankara. Galenos Yayıncılık San.Tic.Ltd.Şti. 2011.20pp.
2. http://www.webmd.com/lung/copd/copd-and-exercise-breathing-and-exercise-programs-for-copd

• What are the precautions during using home nebulizer?
  

Nebulizer is used to administer drugs into airways when the obstruction or difficult breathing is severe. If a nebulizer is recommended:

-Carefully read the instructions of your nebulizer.

-You can use it by a mouth piece or a mask. Prefer mask in case of emergency.

-After you turn on the nebulizer, you should breathe calmly.

-Wash your face after nebulization.

-You should clean your nebulizer up in accordance to instructions. Otherwise, it may be a source of microbes. Before cleaning, be sure that it is not plugged.

-Nebulizer set should be changed in every 15 days or month according to frequency of use.

-Store your nebulizer in a dry room away from direct sunlight. Do not leave your device on downy places (carpet, blanket).

-Nebulization lasts 10 to 15 minutes. If it lasts longer than 20 minutes, call technical service.

-Nebulizer should be preferred only during attacks and should not be used in state of inhaler.

• What are nutritional factors during the course of disease?
  

-Body weight should be kept close to ideal.

-If excess weight is present; sugar, floury and fatty food should be avoided.

-If the body weight is lower than normal; Protein and fat-rich diet including meat, chicken, fish, egg, cheese, milk should ne preferred.

-If carbon dioxide in blood is high, fatty food rather than carbohydrates should be preferred.

-Meals should be 6 times a day rather than 3 times.

-Adequate amount of fluid should be taken.

• How to avoid COPD?

-The biggest factor in development of COPD is “smoking”. Even if the patient is not a smoker, exposure to cigarette smoke negatively affects disease. The first line precaution is COPD is to quit smoking and stay away from smoking areas.

-Subjects who work in areas of occupational dust and smoke should not smoke, as it increases the risk of COPD. Staying away from smoking is very important in these subjects. Using mask and other protectors are important in such workplaces.

-In rural areas, animal waste and vegetable products should not be used for heating and cooking. Other sources should be chosen.

-Each year, during September to October, influenza vaccination is important to reduce common cold and flu. Pneumonia vaccination is also recommended every 6 years in required individuals.

• Do I have COPD? 

- Are you a smoker?

- Do you have cough?

- Do you discharge phlegm?

- Do you experience trouble in catching your peers? 

- Do you have shortness of breathing?  

If you say YES to these questions, you may have COPD.