Chronic Obstructive Pulmonary Disease, abbreviated as COPD, is an umbrella term which refers to the group of lung infections and diseases that include emphysema, chronic bronchitis, and diseases of the small airways. Most people feel breathlessness, which is caused due to impairment of gaseous exchange that happens because of prolonged damage to the lungs over a period of time.

Symptoms such as fatigue, reduced tolerance to exercise, muscular dysfunction, breathlessness even after simple tasks like walking, anxiety, panic, depression, and mood disorders are associated with major chronic disorders of the respiratory system.

Pulmonary Rehabilitation:

Physiotherapy is an effective intervention to treat patients suffering from COPD. It is the part of a formal supervised, multidisciplinary, and an intensive Pulmonary Rehabilitation Program that helps in treating manifestations of the conditions like COPD and Asthma. It consists of exercises to improve and maintain good lung capacity, resistance training, aerobic exercises, and support to behavioural and lifestyle changes for promoting self- efficacy. Your physiotherapist will choose from the different techniques and positions used to remove the unwanted excess sputum from the lungs and airways. The main purpose of the Pulmonary Rehabilitation is to help in improving the psychological and physical conditions of the pulmonary patients, along with training them for health enhancement techniques. Also, it should be noted that Pulmonary Rehabilitation is the cornerstone of care for patients suffering from COPD that uses integrated care by exploring underutilized opportunities.

Benefits of Pulmonary Rehabilitation: 

There are well-researched evidences of the improvement in the capacity of exercising, less breathlessness and fatigue, better control over condition, and an overall improvement in the quality of life of the patients suffering from COPD and Asthma.

Also, undergoing Pulmonary Rehabilitation lowers the rate of admissions, and re-admissions in hospitals due to recurrence of the symptoms and the related conditions.

It has also been reported that if Pulmonary Rehabilitation is properly undertaken, there is nearly no need for systematic health review to check COPD.

Pulmonary Rehabilitation, being a comprehensive program, helps in restoring fitness and easy breathing through breathing techniques, nutrition, exercise, relaxation, emotional support, medications, self-management, and other strategies for a better life, mainly by helping the lungs and the heart to function better.

How It Works?

Exercise is the key to any Pulmonary Rehabilitation Program for helping the lungs and the heart to function better and adjust to the condition. Some of the following exercises can be recommended based on the medical history of the patient:

1. Lower Body Exercise focuses on the workout of legs via running on a treadmill or climbing the staircase for rigorous training.

2. Upper Body Exercise includes working up the muscles of the arm and the chest by tasks as simple as lifting arms against gravity.

3. Breathing Exercise helps people with weak breathing and increasing their breathing and lung capacity.

4. Strength Training helps in building endurance and better stamina through activities like weight-lifting.

Other than exercise, Pulmonary Rehabilitation Program focusses on helping patients build an understanding of their situation and amend their lifestyles accordingly. This includes helping them understand their medication plan, teaching them to use their inhalers right, quitting smoking, consuming a healthy and balanced diet, and other methods as may be suitable based on their specific condition. Also, they are made aware of their symptoms so that if there is any recurrence, it can be immediately reported to the concerned health professional. They are trained through counseling to manage and deal with panic, anxiety, and depression caused due to their condition.

Take Away: Pulmonary Rehabilitation Program is an effective intervention and the cornerstone of care for improving the psychological and physical conditions of the pulmonary patients, along with training them for health enhancement techniques. It helps in treating manifestations of the conditions like COPD and Asthma.

Pulmonary Rehabilitation For COPD & Asthma!

COPD, short for Chronic Obstructive Pulmonary Disease, is an inflammatory disease of the lungs. The disease obstructs the flow of air in the lungs and subsequently causes difficulty in breathing. Prolonged exposure to cigarette smoke, gases or particulate matter can lead to this condition. The condition transcends all age brackets meaning it can affect anyone from young teenagers to aged adults. People who contract this disease are at an increased likelihood of developing cardiovascular conditions and lung diseases, in addition to a horde of other conditions.

Causes of COPD
1. The chief cause of COPD is smoking tobacco and being subjected to fumes from cooking and heating. A study estimated that in and around 25% of long-standing smokers develop symptoms of this condition. Yet, statistics show that COPD is often misdiagnosed until an elaborate evaluation is diagnosed.
2. Conditions like Emphysema and chronic bronchitis are also known to cause the disease. Your lungs depend on the intrinsic elasticity of the air sacs and bronchial tubes that help facilitate the passage of air through the lungs. Chronic Obstructive Pulmonary Disease causes these passages to lose their elasticity thus rendering them partially ineffective.

Symptoms of COPD 
The symptoms of COPD do not appear until the lungs are significantly damaged and the condition tends to deteriorate if smoking persists. Apart from coughing and production of sputum, other apparent symptoms include:
1) Difficulty in breathing
2) Stiffness and tightness of chest
3) A persistent cough
4) Fatigue and weakness
5) Weight loss
6) Frequent allergic reactions of the respiratory glands

Along with the aforementioned symptoms, patients who are diagnosed with COPD are likely to experience bouts of exacerbation, during which their symptoms heighten and tend to grow worse for several days.
Although anyone can contract the condition, certain people are at an increased risk of condition. Such risk factors include:
a) Chronic smoking
b) A medical history of asthma
c) Exposure to chemicals and dusts
d) Weakening of the immune system with increasing age
e) Heredity
If you experience or entertain symptoms or suspicions of this disease, consulting a pulmonologist is duly advised.

Causes and Symptoms of COPD

Chronic obstructive pulmonary disease is a long-term condition of the lungs where the flow of air to the lungs is restricted (obstructed). Symptoms include cough and breathlessness. The condition is most often caused by smoking and the most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucus-thinning (mucolytic) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms.

What causes COPD?
Smoking is by far the biggest risk factor for COPD. The lining of the airways becomes inflamed and damaged by smoking. Cigarette smoking is the biggest risk factor.

Air pollution may cause some cases of COPD, or make the disease worse. Air pollution can be indoor air pollution or outdoor air pollution. Indoor air pollution seems to be involved in more cases of COPD than outdoor air pollution. Indoor air pollution includes fumes from indoor fires or stoves, and dust, fumes or chemicals present in some workplaces. The combined effect of exposure at work to air pollutants and smoking increases the chances of developing COPD.

A small number of people have a hereditary (genetic) risk of COPD due to very rare protein deficiencies that can lead to lung, liver and blood disorders. (The condition is called alpha 1 antitrypsin deficiency. Less than 1 in 100 cases of COPD are due to this.


COPD symptoms-


Cough is usually the first symptom to develop. It is produced with phlegm (sputum). It tends to come and go at first, and then gradually becomes more persistent (chronic). You may think of your cough as a 'smokers cough' in the early stages of the disease. It is when the breathlessness begins that people often become concerned.
Breathlessness (shortness of breath) and wheeze may occur only when you exert yourself at first. For example, when you climb the stairs. These symptoms tend to become gradually worse over the years if you continue to smoke. Difficulty with breathing may eventually become quite distressing.

Sputum - the damaged airways make a lot more mucus than normal. This forms sputum. You tend to cough up a lot of sputum each day.

Chest infections are more common if you have COPD. A sudden worsening of symptoms (such as when you have an infection) is called an exacerbation. Wheezing with cough and breathlessness may become worse than usual if you have a chest infection and you may cough more sputum. Sputum usually turns yellow or green during a chest infection. Chest infections can be caused by germs called bacteria or viruses. 
Other symptoms of COPD can be vaguer. Examples are weight loss, tiredness and ankle swelling.

What is the difference between COPD and asthma?


COPD and asthma cause similar symptoms - in particular difficulty breathing (breathlessness). However, they are completely different diseases. Briefly:

In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are persistent (chronic). Treatment to open up the airways is therefore limited.

In asthma, there is inflammation in the airways which makes the muscles in the airways narrow (constrict). This is temporary so the narrowing comes and goes. So, the symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.

COPD is more likely than asthma to cause an ongoing cough with phlegm (sputum).

Waking at night with breathlessness or wheeze is common in asthma and uncommon in COPD.

COPD is rare before the age of 35, whilst asthma is common in under-35s.

There is more likely to be a history of asthma, allergies, eczema and hay fever (so-called atopy) in people with asthma.

Do I need any tests?

The most common test used in helping to diagnose the condition is called spirometry. This is a breathing test. You will be asked to breathe or blow into a small machine called a spirometer which will measure how well your lungs are working. This test can help make a diagnosis of COPD.


A chest X-Ray show signs of COPD and can be used to help exclude other serious conditions (including lung cancer). Occasionally, a special CT scan of the chest - high-resolution CT - is needed. A blood test to make sure you are not anemic is often helpful.

A pulse oximeter is a device which can be clipped on to your finger. It measures your heart rate (pulse) and the amount of oxygen in your circulation (oxygen saturation). Lower levels than normal tend to be found in people who have COPD, especially if you have a flare-up (exacerbation) of your symptoms.

COPD treatment-

Smoking cessation is the most important step towards treatment.
Inhalers

The main treatments are medications given in devices called inhalers. The medicine within the inhaler is in a powdered form which you breathe in (inhale). The medicines in standard inhalers reach the lungs better if used with a spacer device. Inhalers include one, two or even three types of medicines. They may include:


A bronchodilator agent - this is a medicine which opens up (dilates) the airways. Some work quickly but don't last very long; others are longer-acting.
A steroid - these reduce the inflammation in the airway, thereby reducing the swelling. This, in turn, adds to the space available for air to pass.
A medicine which helps to dry up the secretions produced by the airways.
Home oxygen
This may help some people with severe symptoms or end-stage COPD. It does not help in all cases. Unfortunately, just because you feel breathless with COPD it does not mean that oxygen will help you. Great care has to be taken with oxygen therapy. Too much oxygen can actually be harmful if you have COPD.
Regular follow up in OPD is an essential part of treatment success.

Chronic Obstructive Pulmonary Disease - Know More About It!

Spirometry is a common medical test that is conducted in order to detect whether your lungs are working properly. This is done by detecting the amount of air you can inhale and exhale along with the time taken to complete both of these procedures. Spirometry is useful to diagnose any underlying medical condition like asthma, Chronic Obtrusive Pulmonary Disease, persistent coughing or problem during breathing. If you are receiving treatment for chronic lung disorder, spirometry is also useful to check whether or not your lungs are responding to the specific kind of treatment.

Procedure: The process of spirometry involves the use a mouthpiece and a tube adjoined with a machine which displays the recorded results. Before the onset of the procedure, which generally takes place in a hospital, you will be prescribed by the doctor to wear comfortable clothing which will not restrict your normal breathing process and will be asked to have a light meal before the procedure. The procedure will be conducted while you are sitting. 

Spirometry takes an estimated amount of 15 minutes to get over with. The nurse will put a clip on your nose in order to close your nostrils. After that, you have to take a deep breath and then breathe out as hard as possible on the tube for a few seconds. You have to make sure that there's no air leakage during this procedure by putting your lips tightly over the tube. In order to arrive at a stable result, you have to conduct the test three times at least. If the results are hugely diverse, then you have to take the test again. The highest result among the three tests is usually denoted as the ultimate test result.

Risks: Spirometry is generally a low-risk inducing procedure. But in some cases, it might cause loss of breath, moments after the procedure. Also, spirometry should not be conducted if the patient has recently had a heart attack or surgery of the eye, abdomen or chest. If you are suffering from vomiting tendencies and you have regular instances of blood in your cough, you should also avoid spirometry.

The Procedure and Risks of Spirometry

Pulmonary hypertension mainly occurs due to narrowing of the arteries of the lungs as a result of which the flow of blood is restricted. In this kind of condition, blood fails to carry oxygen to your heart and thus your heart gets adversely affected. The blood pressure of your body will get increased to a great extent if this situation remains untreated, thus leading to bdreadful consequenses, specifically situation like heart failure, serious pulmonary diseases, blood clots in lungs and congenial heart defects, etc.

There are certain forms of pulmonary hypertension, which are serious in nature and worsen with time, so much so that they are even fatal at times. It also includes forms which are non curable in nature, however, in order to improve the quality of life, symptoms can be reduced with proper treatment. The treatment for pulmonary hypertension is often complex and it takes some time to find the most appropriate treatment and requires extensive follow-up care. Your doctor might also need to change your treatment if it's no longer effective. However, when pulmonary hypertension is caused by another condition, your doctor will treat the underlying cause whenever possible.

Common treatments for pulmonary hypertension:

Medications

1. Blood vessel dilators (vasodilators): vasodilators open narrowed blood vessels. They are one of the most commonly prescribed vasodilators for pulmonary hypertension is epoprostenol (flolan, veletri). The drawback to epoprostenol is that the effect lasts only for few minutes. This drug is continuously injected through an intravenous (iv) catheter via a small pump that you wear in a pack on your belt or shoulder.

2. Ventavis: another form of the drug, iloprost (ventavis), can be inhaled six to nine times a day through a nebulizer, a machine that vaporizes your medication. Because it's inhaled, it goes directly to the lungs.

3. Treprostinil (tyvaso, remodulin, orenitram): it is another form of the drug, which can be given four times a day and can be inhaled or can be taken as an oral medication and can also be administered through injection.

4. Endothelin receptor antagonists: these medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. These drugs may improve your energy level and symptoms. However, these drugs shouldn't be taken if you're pregnant. Also, these drugs can damage your liver and you may need monthly liver monitoring.

6. Sildenafil and tadalafil: sildenafil (revatio, viagra) and tadalafil (cialis, adcirca) are sometimes used to treat pulmonary hypertension. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily.

6. High-dose calcium channel blockers: these drugs help relax the muscles in the walls of your blood vessels. They include medications, such as amlodipine (norvasc), diltiazem (cardizem, tiazac, others) and nifedipine (procardia, others). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension respond to them.

7. Soluble guanylate cyclase (sgc) stimulator: soluble guanylate cyclase (sgc) stimulators (adempas) interact with nitric oxide and help relax the pulmonary arteries and lower the pressure within the arteries. These medications should not be taken if you're pregnant. They can sometimes cause dizziness or nausea.

8. Anticoagulants: your doctor is likely to prescribe the anticoagulant warfarin (coumadin, jantoven) to help prevent the formation of blood clots within the small pulmonary arteries. Because anticoagulants prevent normal blood coagulation, they increase your risk of bleeding complications. Take warfarin exactly as prescribed, because warfarin can cause severe side effects if taken incorrectly. If you're taking warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working. Many other drugs, herbal supplements and foods can interact with warfarin, so be sure your doctor knows all of the medications you're taking.

9. Digoxin: digoxin (lanoxin) can help the heart beat stronger and pump more blood. It can help control the heart rate if you experience arrhythmias.

10. Diuretics: commonly known as water pills, these medications help eliminate excess fluid from your body. This reduces the amount of work your heart has to do. They may also be used to limit fluid buildup in your lungs.

11. Oxygen: your doctor might suggest that you sometimes breathe pure oxygen, a treatment known as oxygen therapy, to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people who have pulmonary hypertension eventually require continuous oxygen therapy.

Surgeries

1. Atrial septostomy: if medications don't control your pulmonary hypertension, this open heart surgery might be an option. In an atrial septostomy, a surgeon will create an opening between the upper left and right chambers of your heart (atria) to relieve the pressure on the right side of your heart.

2. Lung transplantation: in some cases, a lung or heart lung transplant might be an option, especially for younger people who have idiopathic pulmonary arterial hypertension.

Reducing complications

1. The complications need to be reduced by taking proper health care. Healthy diet needs to be taken regularly along with proper medications. Smoking should be stopped and exercising sessions should be attended daily without any fail

2. Overweight or obesity needs to be controlled properly for reducing the complications. Specialized caring strategies need to be maintained for avoiding severe kinds of health complications that are quite annoying.

Pulmonary Hypertension: How to Treat It?

Chronic Bronchitis is a result of inflamed bronchioles (pipes carrying air to alveoli or balloons) that can produce mucus and lead to coughing and difficulty in breathing. When smoking causes inflammation of the bronchioles, constriction or squeezing takes place. This results in wheezing because air is travelling through narrowed tubes.

Emphysema, in short, is basically a dead lung. As smoke travels farther down your respiratory tract, the air sacs in your lungs (alveoli), start popping out or dying. Your bank of alveoli gets depleted over time as you continue your habits. You will notice as you increase your heart rate whether its by running or walking a flight of stairs this activity requires your red blood cells to move faster through the alveoli and have less time to receive oxygen from the lung. This leads to having less oxygen on red blood cells whose job is to deliver oxygen to the rest of the body.

Symptoms

In COPD, Both the airways(pipes) and lung parenchyma are affected by the disease and airflow limitation is progressive. COPD has been predominantly seen in patients above 40-yearold and frequent smokers.

The symptoms indicative of COPD are as follows:

 

1) Chronic cough - Also referred to as smoker's cough, the cough is relentless and does not subside with regular cough treatment. This is one of the first indications of COPD.
2) Mucus buildup - There is constant built up of mucus which gets expelled during coughing. The person never feels completely clear of mucus, and the regular cough expectorants do not help relieve the symptoms.
3) Fatigue associated with limited activity - As noted earlier, the reduced capacity of the organs limits their activities. Therefore, regular activities like walking short distances or climbing stairs can induce fatigue.
4) Shortness of breath - The above fatigue is associated with shortness of breath, even with small physical exertion. A person with COPD will see marked tiredness and reduced ability to perform routine chores and feel a tightness in the chest.
5) Wheezing - Passage of air through the obstructed air tubes produces a whistling sound or wheezing. It is more pronounced when there is mucus accumulation in the airways.

Rarely, Frequent respiratory infections, more frequent flu attacks, swelling of the feet and ankles, cardiovascular disease, weight loss, and morning headaches.

Treatment 

While there is no cure for COPD, once it sets, the following are some ways to slow its progression and reduce severity of the symptoms:

1) Bronchodilators - Dilate the air tubes and ease flow of air
2) Corticosteroids - Help reduce inflammation and thereby improve airflow through the tubes
3) Flu vaccination - Helps curb the frequent flu attacks
4) Antibiotics - To contain infections
5) Pulmonary rehabilitation - A combination of breathing exercise and patient education to improve lung function.
6) Oxygen therapy - In very severe cases, oxygen may be required.
7) Lifestyle changes - Eating healthy foods, preventing exposure to dust and smoke, quitting smoking, breathing exercises, bi-annual medical check-ups to monitor lung functions are essential.

Knowing that you have COPD is the first step towards managing COPD, which can be managed effectively.

COPD Is Broken Down To Clinical Scenarios - Chronic Bronchitis & Emphysema!

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