Chronic Obstructive Pulmonary Disease (COPD)
Overview
COPD is long standing and wide condition, in which the lung capacity is decreased and there is limitation of airflow.
It is group of diseases categorized into; i) Emphysema ii) Chronic bronchitis
i) Emphysema: Damage to the alveolar wall due to chronic smoking and continuous exposure to toxic fumes. Due to this damage the alveoli are not capable enough to contract and thus the air gets trapped inside the lungs, which leads to collapse of lungs. It is irreversible condition.
ii) Chronic bronchitis: Bronchial tube lining are inflamed and continuous mucus production and coughing is observed.
Causes
Continuous exposure to toxic gases is main reason of developing COPD.
Tobacco smoking
Tobacco smoking is the main factor of developing COPD. Smoking cigar and pipe smoke plays equal role.
Pollution
With increase in amount of air pollutants; many people suffer from allergic condition.
Genetic
Deficiency in amount of alpha-1 antitrypsin or AAT deficiency. It is protein present in the lungs which protects from damage.
Asthma
Underlying condition like asthma; over the period of time causes COPD.
Age
With advancing in age; lung function also decreases.
Occupation
Working in environment like in presence of fumes, chemicals, dust or vapor has severe effect on lungs.
Infection
Several respiratory infections can damage lungs.
Pathophysiology
In COPD; airways, lung parenchyma and pulmonary vasculature are involved. There is oxidative stress and protease- antiprotease inhibitors imbalance.
Due to high amount of protease and oxidants; air sacks gets damaged. Neutrophils and macrophages releases inflammatory mediators and destruction of elastin causes of airways to collapse during exhalation.
Forced expiratory volume (FEV1) decreases due to inflammation and obstruction of airways and there is impaired gases exchange.
There is CO2 retention in lungs due to lack of gaseous exchange. Pulmonary hypertension may be seen in these type of patient.
Signs and symptoms
Mild symptoms are felt by patient earlier. As the disease advances it becomes difficult to breath. Wheezing and tightness of the chest may be felt.
3 most common symptoms are:
- Shortness of breath
- Constant coughing
- Sputum production in excessive amount
Early symptoms
At early stage you may not feel any symptoms, as they might be absent or in mild form. So you may overlook those signs.
- Shortness of breath after exercise
- Recurrent cough which is mild
- In morning, need of clearing throat
- You may not be able to do regular activities with same strength as earlier; like exercise, gardening or carrying grocerriers.
Advance condition
If the condition at early stage not treated or taken care properly; slowly pathology advances and you may feel symptoms getting worse.
- Shortness of breath even after walking few steps.
- During expiration a typical high pitched breath is audible; wheezing
- Chest tightness
- Chronic cough with or without expectoration
- Recurrent respiratory infection
- Lethargy
- Constant need of clearing throatg
Last stage
- Great weakness is observed in patient
- Feet, ankles or legs gets swollen
- Weight loss without any activities or diet control
Physical findings
If you are having COPD, then some typical physical signs are likely to be appear
- Muscle wasting
- Respiratory distress
- Use of accessory respiratory muscles
- Wheezing
- Pursed-lip breathing
- Barrel shaped chest due to decrease in anterior-posterior wall diameter
- Skin appears blue (central cyanosis); as oxygen level decreases
- Digital clubbing, lower extremity edema due to right heart failure
Staging
GOLD staging is one of the grading systems to determine COPD severity and plan of treatment. This system is based on spirometry test result. As the Force Expiratory Volume (FEV1) decreases, severity increases.
Grade 1 | Mild | FEV1 ≥ 80 |
Grade 2 | Moderate | 50% ≤ FEV1 < 80% predicted |
Grade 3 | Severe | 30 ≤ FEV1 < 50% predicted |
Grade 4 | Very severe | FEV1 ≤ 30% |
Diagnosis
Based on your physical examination your doctor will guide you for further diagnostic tests.
On auscultation: Wheezing sound present.
Spirometry test
It is non invasive method, in which you will be told to take a deep breath and forcefully has to blow in the tube attached to it.
Chest X-ray
For more detailed analysis; x-ray gives an overview of lungs; including heart and blood vessels.
Chest CT scan (HRCT)
CT scan is for more advance study compared to the x-ray. It gives a accurate diagnosis.
ABG (Arterial blood gas)
To figure out the level of oxygen and carbon dioxide in the blood. It helps to determine pH of the blood.
AAT test (alpha-1 antitrypsin)
If you are deficient to AAT, then it is suggestive of genetic disorder.
Differential diagnosis
- Asthma
- Interstitial lung disease
- Heart failure
- Tuberculosis
- Cystic fibrosis
- Bronchiectasis
- Cancer
Homeopathic treatment for COPD
No matter what treatment you are on, you should always keep one thing in mind, "Quite Smoking". As the exposure to toxic gases decreases; the chances of advancement of disease reduces.
Homeopathic treatment helps to improve the symptoms of COPD, not only that it also reduce the dependency from bronchodilators and steroid medication. On top of it no significant adverse reactions have been found.
1. Ammonium Carb
- Indicated in old age people with bronchitis.
- There is bronchial dilatation, difficult expectoration. Secretion is copious.
- Person may feel no necessity to clear chest even though there is numerous coarse rattles.
- Cough in morning and night, cough disturbs the sleep, spasmodic oppression aggravates after eating, talking, in open air and on lying down.
- Low vitality and atony of bronchial tube favoring emphysema.
- Catarrh of old people at beginning of winter. Aggravation at 3 to 4 AM.
2. Ammonium Tart
- Bronchitis of infant and old people.
- Profuse mucus secretion with feeble expulsive power; rattling of phlegm in chest.
- Great irritability of cough, sudden and alarming symptoms of suffocation with oppression and orthopnea.
- Person has to sit up; fits of suffocation in morning and in evening, during bed time.
- Person is drowsy amelioration on lying on right side or sitting up.
3. Calc Carb
- Indicated in chronic bronchitis with emphysema.
- Fetid sputa, yellow, lumpy and sweetish.
- Cough: ticklish worse on lying down. Dry cough violent and spasmodic.
- Hands and feet are chilly and clammy.
- Poor stamina. Breathlessness while climbing up slops and stairs.
4. Causticum
- Violent, racking cough especially at night.
- Pain in throat and head, obliged to swallow sputum.
- May cough continuously to loosen it. Cough immediately relieved by cold drinks. During coughing urine passes.
5. Kali Bich
- Bronchitis oscillating between acute and torpid; inverterate bronchitis.
- Irritation, vascular congestion and moderate muco-purulent secretion accompanied by periosteal or rheumatic pains.
- Cough resonant, whistling, loud and rattling in chest.
- Expectoration: Yellow, bluish or slate colored. Tongue mucus adherent, filamentous and sometimes fetid.
- Burning sensation in trachea and bronchi.
- Aggravation in winter, must sit up on bed to breath.
- Amelioration by bending forward.
6. Silicea
- Indicated for bronchial affection of rachitic children, obstinate cough provoked by cold drinks.
- Copious, transparent or purulent expectoration; pain soreness and weakness of chest. Amelioration by inhaling moist air, warm air.
- Tough, gelatinous and tenacious expectoration.
- Breathlessness when lying on back or on stooping.
- Cough aggravates by cold drinks, expectoration of pus.
Modern medicine treatment for COPD
Multiple approach is required to manage the case of COPD. Apart from medication; diet and exercise also plays an important role.
1. Bronchodilators
Bronchodilators helps to relax the muscles of airways.
Short acting Beta agonists (SABA) gives an immediate relief.
- Albuterol
- Levalbuterol
Long acting Beta agonists (LABA) is mainly for maintenance therapy.
- Aclidinium
- Formoterol
- Salmeterol
2. Antimuscarinic antagonists
Antimuscarinic antagonists blocks M3 receptors in smooth muscles and prevent bronchoconstriction.
Short acting muscarinic antagonist (SAMA), gives an immediate relief within 10 to 15 minutes.
Long acting muscarinic antagonist (LAMA), is for maintenance therapy.
3. Inhaled corticosteroid (ICS)
ICS decreases inflammation and thus reduces exacerbation. These are usually used in combination.
- Fluticasone
- Budesonide
Treatment with ICS may lead to increase in chances of causing pneumonia.
4. Oral Steroids
Oral steroids are recommended for patient having severe COPD exacerbation. Short course is suggested. Long term use leads to side effects like; weight gain, diabetes, osteoporosis, cataract and recurrent infection.
5. Phosphodiesterase 4 inhibitors
Phosphodiesterase 4 inhibitors reduces inflammation by inhibiting breakdown of intracellular cyclic AMP. Roflumilast is commonly used medication. Common side effects are weight loss and diarrhea.
6. Theophylline
Theophylline is cost effective medicine. It helps to improve breathing. Common side effects are nausea, headache, tachycardia and tremor.
7. Antibiotics
Antibiotics are helpful in acute bronchitis, pneumonia and influenza.
Lung therapy
Apart from medication; additional lung therapy helps to improve the quality of life.
Oxygen therapy and pulmonary rehabilitation programme.
Surgical treatment
Surgery is suggested in those patient who do not response well to medication and those who suffer from severe emphysema.
- Lung volume reduction
- Lung transplant
- Bullectomy
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