COPD-Assessment of Disease progression & response to treatment
Dr. Agam Bohra
COPD is common preventable & treatable disease characterized by persistent airflow limitation i.e. usually progressive & associated with chronic inflammation in airways kills more than 3 million people every year, making it the 4th largest cause of death in the world. It has been estimated that by the year 2030, COPD will become the third biggest cause of death. Cigarette smoke, occupational dust & chemicals, indoor & outdoor pollution, ageing population, genetics, infection & socioeconomic status are important risk factors for COPD. These causes lead to small airway inflammation & lung cells destruction. The important symptoms of COPD are chronic cough, sputum production, shortness of breath and wheeze. Spirometry test is commonly used to diagnose and confirm COPD. Though, some of the symptoms of asthma and COPD are common, but can be differentiated with age, smoking history and poor reversibility to bronchodilator. In management of COPD, first consideration should be given to encourage patients to quit smoking and/or nicotine replacement therapy. Nicotine chewing gums and drugs like bupropion & varenicline can be used. In drug treatments, bronchodilators and anti-inflammatory agents used either alone or in combination by inhalation (MDI, DPI and nebulizers). In severe COPD cases long term oxygen treatment (15hrs/day) is recommended. Life style modification such as avoiding risk factors, vaccination & physical activity (Breathing exercises) helps in better COPD management. Medical Nutrition Treatment can be used as add on with diet or as a complete diet for malnourished COPD patients. Surgical procedures like Bronchoscopic lung volume reduction surgery in severe COPD is found useful Moreover, Acute Exacerbation of COPD is very common and can be early diagnosed with the help of Blood gas analysis & pulse oxymetry. Oxygen, bronchodilators, corticosteroids, antibiotics, fluid & nutrition balance therapies are considered based on severity of the disease. Critical Care in ICU for these patients also includes Oxygen therapy, IV corticosteroids & ventilator support. Exacerbations can be prevented or reduced by bronchodilator maintenance treatment. Preventive measures such as avoidance of Exposure to biomass fuel, selection of cocking fuel, passive smoking. Various guidelines recommend use of vaccination has important role in prevention of COPD exacerbations. Strict monitoring of industrial pollution & vehicular pollution as well as patient education by NGO’s & Government agencies is also important
In addition, Comorbidities like Heart Diseases (IHD, Heart Failure, atrial fibrillation & hypertension), Bone disease (osteoporosis), Psychiatric disorders (anxiety & depression) and lung cancer are frequently associated with COPD & cause of death. Comorbidity with tuberculosis and diabetes is also common. However, COPD patients can live normal life if diagnosed and managed appropriately .Patient education contents should include cause, symptoms, smoking cessation and management.
COPD if diagnosed early and appropriately patient can live normal life.
Asst. Hon. & In Charge – Dept Of Chest & TB,
Dr. R. N. Cooper Muni. Gen. Hospital, Mumbai.
Prof. & Dept Of Chest & TB, K J Somaiya Medical College, Mumbai
Asst Editor – Journal Of Association Physician Of India.
Gen Sec – Environmental medical association. Mumbai302, Soni Shopping Centre, L. T. Road, Borivali west.
Mumbai 400 092. Maharashtra. India
Phone no: + 91 22 28954811 / 91 99208 70050