COPD: Can you Breathe Better?

COPD: Emphysema and Chronic Bronchitis

Usually, the term Chronic obstructive pulmonary disease includes two main conditions—“emphysema” and “chronic bronchitis”

Emphysema:

Emphysema usually refers to destruction of the tiny air sacs at the end of the airways in the lungs. As a result, the air sacs lose their shape and become floppy. This damage can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs gets reduced.

Chronic bronchitis:

In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell (inflammation). Lots of thick mucus forms in the airways, making it hard to breathe causing chronic cough.

Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.

That is why in COPD, less air flows in and out of the airways owing to one or more of the following:

• The airways and air sacs lose their elastic quality.
• The walls between many of the air sacs are destroyed.
• The walls of the airways become thick and inflamed.
• The airways make more mucus than usual and can become clogged.

Signs and Symptoms of COPD

Symptoms of Chronic Obstructive Pulmonary Disease (COPD) can be different for each person, but common symptoms are:

• Increased shortness of breath
• Frequent coughing (with and without mucus)
• Wheezing
• Tightness in the chest

Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.

It’s easy to think of shortness of breath and coughing as a normal part of aging, but these could be signs of COPD. COPD can progress for years without noticeable shortness of breath. That is why it is important to talk with your doctor as soon as you notice these symptoms. Ask your doctor about spirometry tests and pulmonary rehabilitation.

COPD Stages:

Not all Chronic obstructive pulmonary disease is the same

There are different types and stages of COPD. Each type may affect how well different treatments work, how your symptoms affect your everyday life, and how they progress.

The stages of COPD range from mild to very severe. If you have another health condition in addition to COPD (comorbidity), such as high blood pressure, heart disease, heartburn, depression, or diabetes, this can also affect your COPD and how it is managed.

Because COPD is a progressive lung disease, it will worsen over time. Based on your COPD symptoms severity and lung function tests (spirometry), your doctor will determine what stage your disease is at. Internationally, pulmonologists also use GOLD guidelines to identify the COPD stage. This takes your COPD assessment test score and your exacerbation history into account as well.

The Stages of COPD:

COPD has four stages

1. Mild COPD or Stage 1—Mild COPD with a FEV1 about 80 percent or more of normal.
2. Moderate COPD or Stage 2—Moderate COPD with a FEV1 between 50 and 80 percent of normal.
3. Severe COPD or Stage 3—Severe emphysema with a FEV1 between 30 and 50 percent of normal.
4. Very Severe COPD or Stage 4—Very severe or End-Stage COPD with a lower FEV1 than Stage 3, or people with low blood oxygen levels and a Stage 3 FEV1.

Related Reading: Stages of COPD and How to read FEV / PFT results

Diagnosis and Treatment of COPD

For some people, the stages of Chronic obstructive pulmonary disease develop slowly, but for some, the disease progresses rapidly. Seeing your doctor regularly is important, even if you’re feeling well. Your doctor will track your condition over time. This means that your doctor may recommend you have multiple pulmonary function tests, chest x-rays, CT scans and other types of testing.

Your doctor can keep track of how well your lungs and COPD treatment plan are working, so he or she can modify your treatment plan as your stage of COPD changes. As the stages of COPD increase, airflow becomes more limited.

Management of COPD:

Reducing the burden of COPD

There is no cure for COPD but early diagnosis and treatment are important to slow the progression of symptoms and reduce the risk of flare-ups.

WHO guidelines for COPD suggest following actions that people with COPD can take to improve their overall health and help control their Chronic obstructive pulmonary disease:

• Stop smoking – people with COPD should be offered support to quit smoking;
• Take regular exercise; (Pulmonary Physiotherapist can teach you breathing exercises as well as endurance building exercises best suited for you based on your pulmonary rehabilitation program)
• Get vaccinated against pneumonia, influenza and coronavirus

How is COPD treated?

Treating your COPD can greatly improve your quality of life. Treatment options that your doctor may consider include:

• Avoiding tobacco smoke and other air pollutants at home and at work (Stop smoking, if you do)
• Symptoms such as coughing or wheezing can be treated with medicines.
• Pulmonary rehabilitation, a personalized treatment program that teaches you how to manage your COPD symptoms to improve quality of life. Pulmonary rehabilitation plans may include learning to breathe better, how to conserve your energy, and advice on food and exercise.
• Avoiding lung infections. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumonia vaccines, are especially important for people with COPD.
• Supplemental oxygen from a portable oxygen tank or oxygen concentrator, may be needed if blood oxygen levels are low.

Understanding the stages of COPD is one of the first steps you can take in becoming more proactive in your healthcare. As your COPD progresses, continue working with your doctor to modify your treatment plan as needed. This will go a long way to reduce frequency of exacerbations.

In combination with your current medicines, consider talking with your doctor about pulmonary rehabilitation. Pulmonary rehabilitation (PR), including supervised exercise training, improves exercise tolerance, reduces dyspnoea, improves health-related quality of life, reduces fatigue, and reduces anxiety and depression. [2]

Related Reading: COPD Stages and what you need to know?

What to expect during Pulmonary rehabilitation for COPD?

Pulmonary rehabilitation offers an evidence-based approach for improving the psychological and physical condition of a COPD patient. In India, RespiRehab offers pulmonary rehabilitation as a uniquely customised plan of care for each patient for reduction of symptoms and improvement of lung function. At RespiRehab, your pulmonary rehabilitation program is designed after a detailed assessment of your current symptoms, condition and goals. Sessions are held thrice a week or bi-weekly and new goals are set for every session based on your progress.

[Related Reading: How does RespiRehab deliver improved lung capacity and reduce breathlessness? The Maths behind it ]

Pulmonary rehabilitation includes:

1. Education to improve your knowledge of your lung disease and educate you on avoiding lung irritants(eg. air pollution), maintaining a healthy behaviour (eg. exercise, nutrition) and reducing your reliance on expensive medical resources. It helps you best cope with your disease symptoms, controls breathing difficulties and thus better your quality of life.
2. Diet Advice: Most people are surprised to learn that the food they eat may affect their breathing. Your body uses food as fuel for all of its activities. The right mix of nutrients in your diet can help you breathe easier. Based on your assessment of COPD symptoms and COPD severity, your Pulmonary rehabilitation programme may also include guidance from an expert nutritionist. Be sure to mention to the dietitian:

• What foods you like
• What foods you don’t like and won’t eat
• Your daily schedule, including your exercise
• Other health problems or special dietary needs you have

3. Exercise is an important arm of pulmonary rehabilitation. Breathing exercises help improve lung efficiency and endurance. The exercises increase in intensity as the session progresses. There are also basic aerobic activities of upper limb and lower limb to tackle the deconditioning of muscles. All exercises are started off under the supervision of a pulmonary physiotherapist and video links are provided for patients to practise the exercises later.

Interestingly, properly designed pulmonary rehabilitation works to promote healing from within the lungs and is proven to improve breathing and quality of life. This has a direct impact on reducing the incidence of COPD exacerbations as well as hospitalisation. If you or a loved one has COPD, emphysema, chronic bronchitis or another chronic lung disease and would like to learn more about pulmonary rehabilitation, contact us at +91 9920991647 or ask for call back by clicking here.

This blog is based on the inputs from Dr Kavya Bhatia (PT). Dr Kavya is a senior cardio respiratory physiotherapist. She is very knowledgeable and versatile physiotherapist who has supported numerous pulmonary recoveries involving COPD, pulmonary fibrosis, ILD, Asthma and pandemic recoveries among elderly as well as young patients.

Scientific References:

[1] The top 10 causes of death (who.int)

[2] Kylie Johnston and Karen Grimmer-Somers, Pulmonary Rehabilitation: Overwhelming Evidence but Lost in Translation? 2010, Oct 18. doi: 10.3138/physio.62.4.368 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958065/