Chronic obstructive lung (pulmonary) disease (COPD) denotes a generalised obstruction to the flow of air in the lung which is only partially reversible, or completely irreversible as in chronic persistent asthma and chronic bronchitis and emphysema.
Chronic bronchitis is characterised by cough with or without expectoration for at least 3 months of the year for 2 consecutive years.
Emphysema is defined as distension of the air spaces distal to the terminal bronchioles with destruction of alveolar septa.
Chronic bronchitis and emphysema frequently coexist. Chronic bronchitis, over a period of time, often gets complicated by emphysema. Most of the times it is difficult to separate one from the other.
In India COPD is the commonest lung disorder following pulmonary tuberculosis and is equally prevalent in rural and urban areas. Males are more affected than females. Causes are Smoking, Occupational exposure to organic or inorganic dusts or noxious gases, Air pollution - industrial effluents, smoke from wood fires, Infections, especially viral lower respiratory infection in infancy, Familial and genetic factor, e.g., alpha 1-antitrypsin deficiency
Smoking is the most common single factor leading to chronic bronchitis and emphysema. It impairs the mucociliary defence mechanisms of the lung and produces hypertrophy and hyperplasia of mucus-secreting glands. It also induces polymorphonuclear leucocyte injury by releasing proteolytic enzymes. Acute increase in airways resistance is also encountered following inhalation of smoke as a result of stimulation of submucous receptors and vagally-mediated smooth muscle constriction.
It is now well established that small airway obstruction is the earliest demonstrable mechanical defect in cigarette smokers and that obstruction may disappear on stopping smoking. Hooka and bidi smoking is just as harmful as cigarette smoking.
Ischaemic heart disease
Peripheral vascular disease
Foetal effects (smoking mothers)
Low birth weight
Increase foetal and neonatal mortality
Decreased fertility in males
Cognitive impairment (in elderly)
Risks of passive smoking
Increased cancer risk
The incidence of COPD is higher in industrialised areas. In India, indoor pollution caused by burning of cowdung and wood for cooking is also blamed as a contributory factor.
Individuals engaged in occupations where they are exposed to inorganic or organic dusts or noxious gases are more prone to develop the disease.
Acute respiratory infections may play an important role in the aetiology as well as progression of the disease. Viral respiratory infections in infancy may cause airways obstruction later in life.
Familial aggregation of chronic bronchitis and emphysema may be due to overcrowding, indoor air pollution and passive smoking. Besides all these, studies of monozygotic twins have indicated a genetic predisposition to the development of chronic bronchitis.
The main symptoms of chronic bronchitis are cough, expectoration and dyspnoea. In the beginning, cough is present only in winter months, but with passage of time the cough gradually becomes continuous and productive. These patients are more prone to upper respiratory infections which often go down to the chest, causing the sputum to become green or yellow and copious resulting in acute exacerbation of cough. At first, exacerbations are mild and subside without causing loss of working hours. Later these exacerbations become severe; the patient often becomes febrile and develops wheeze and dyspnoea. As the disease progresses, symptom-free periods between exacerbations become shorter and exacerbations last longer. The patient starts developing increasing disability. There is a group of patients who have carbon dioxide retention, and are referred to as "blue-bloaters" because of the presence of respiratory failure (cyanosis) and congestive heart failure (oedema). On physiological and radiological evaluation, these patients have been found to have predominantly chronic bronchitis with variable degree of centrilobular emphysema. This group of patients has been contrasted from another group described as "pink-puffers", who have predominant emphysema. They manage to maintain arterial oxygen levels within the normal range by hyperventilation until a late stage of their disease. These represent two ends of a continuous spectrum with chronic bronchitis at one end and emphysema at the other. Most patients will have some features of both of these.
Avoidance of smoking, adequate control of atmospheric pollution in industry, use of ideal cooking fuel and prompt treatment of recurrent bronchopulmonary infections help in the prevention of this disease. Even in an established case, implementation of these measures helps in preventing further deterioration of lung function.
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