Chronic obstructive pulmonary disease: Why does it occur and who is at risk?

Chronic obstructive pulmonary disease (COPD) is a serious chronic disease of the bronchi and lungs that results from the action of various external insults on the lung tissue in combination with internal factors.

As a result, they cause irreversible (irreversible) damage, which causes permanent obstruction of the bronchi and lungs, and also leads to an increased inflammatory response of the airways when re-inhaling harmful substances. 

The resulting obstruction worsens the breathing - pulmonary ventilation, the patient breathes laboriously, wheezing, coughs, while engaging the auxiliary respiratory muscles. If the condition lasts for a long time, these compensatory mechanisms are not sufficient, they fail, and there is a pathological widening of the airways.

COPD is a combination of two diseases

COPD   is basically a combination of two diseases that arise in a certain context, respectively. they follow each other and develop.

Chronic bronchitis is the first to occur, as a direct consequence of airway obstruction.
The principle consists in the deposition of harmful substances in the lung partitions, in the narrowing of the respiratory space, and in the reduction of the lung volume.
It is manifested by shortness of breath, coughing, and wheezing sounds when breathing.

If the effect of the negative factor persists and the disease is not treated, the condition progresses.
The progression of the condition and the involvement of compensatory mechanisms, in this case, the auxiliary respiratory muscles, creates a pathological widening of the airways - emphysema.

Depending on the type of inhaled pollutants, the condition is often complicated by the development of lung cancer.

In the worst cases, respiratory insufficiency (insufficiency), respiratory failure and death of the patient occur.

Although the most common cause of COPD is smoking, and thus the toxins contained in inhaled cigarette smoke, it is far from a single factor.

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Why does COPD arise?

This disease is caused mainly by exogenous but also endogenous factors, it can also be a combination of them.

The patient himself (smoking, dusty domestic environment), society as such (polluted environment, exhaust gases, and emissions), or the hazardous working environment (chemical fumes) are responsible for inhaling unwanted gases. These are all exogenous factors.

We consider genetic influences, ie heredity, to be endogenous factors, and it has recently been found that nutritional influences are also behind the development of obstructive disease.

Table with the most common COPD risk factors:

Inorganic particles

Inhaled pollutants, therefore, include inorganic particles. We include in this group all polluting and harmful substances that do not have an organic (living) origin.

These include various elements and metals in which their vapors are inhaled, for example during their processing.

Most often, workers are exposed to them, who come into contact with them regularly and for a long time.

It is a wide range of elements. These include lead, mercury, vanadium, harmful gases such as stibane, arsenic, phosgene, chlorine, hydrogen cyanide, sulphane, ammonia, oxides, and sulfur compounds, aniline, phenols, formic acid, naphthalene, benzene….

Other corrosive gases are also dangerous, and even construction workers working with cement are at risk.

In today's modern age, attention is increasingly focused on the high risk of using solid fuels in the home and insufficient ventilation. This causes constant inhalation of pollutants and a higher risk of developing COPD.

Interesting:
The most common cause of COPD is cigarette smoke, which contains several harmful substances.
These have been shown to be harmful to human health, causing a number of diseases, including obstructive pulmonary disease.
Examples are nicotine, other alkaloids, tar, carbon monoxide, nitrogen oxide, hydrogen cyanide, formaldehyde, arsenic, nickel, cadmium, benzene, polonium, radon and others.
Substances inhaled in cigarettes contain radioactive, carcinogenic (carcinogenic), mutagenic (substance causing gene mutations) and teratogenic (fetal damaging) substances.

Organic particles

Bacteria, viruses, spores, fungi are organic pathogens that can also be inhaled by humans. Because these microorganisms are all around us, the risk of infection is constant.

Not only do they cause infections of various organs and systems, but even by repeated or regular inhalation, they cause recurrences of the disease.

These recurrent infections are caused by several factors, such as weakened immunity, other associated diseases, poor social conditions (cold, moisture, dirt), or an environment where there is increased contact with other people (school, work).

As with other organs, these microorganisms and recurrent inflammation damage them to some extent in the lungs. The degree of lung tissue damage can be individual for each individual, and thus its susceptibility to COPD is also individual.

Genetics

Genetics has been shown to be involved in the development of COPD. It is caused by α1-antitrypsin deficiency (AAT).

An α1-antitrypsin value less than 10% of the normal value (0.78g to 2g) indicates that a patient with COPD is at risk for earlier pulmonary emphysema.

If such a patient is exposed to several pathological insults at the same time, he is more likely to develop chronic obstructive pulmonary disease or may have a much more severe degree.

The chronic obstructive pulmonary disease has been developing at a slow pace for years.
Therefore, the disease does not manifest itself in the beginning and the patient appears to be healthy.

The initial changes in the lungs are not serious enough to let themselves be known, which facilitates their further progression.

They do not force the patient to see the initial symptoms of the disease, because they are often attributed to age. It is, for example, lower physical performance, or shortness of breath during greater physical activity. He manages normal activities without any problems.

However, significantly reduced physical activity with at the same time an increased rate of shortness of breath and irritation to cough , or seizure cough, is already worth attention. Patients usually see a doctor when they notice these symptoms.

The condition escalates until, after a minimum of effort, serious breathing problems occur. This tends to worsen with persistent exposure to exogenous insults (eg smoking), with common respiratory infections, or in a horizontal position, especially at night. 

Breathing is faster, shallower, and significantly more strenuous. Expertly, we call such breathing tachypnoea.

Respiratory effort and significant respiratory effort cause an increase in blood pressure and a fast heart rate. It is a compensatory mechanism that aims to transport blood and oxygen to non-oxygenated tissues and organs as soon as possible.

Another typical manifestation is a dry irritating cough. In the beginning, it is sporadic and later goes into chronicity. It occurs especially at night during sleep. Over time, it becomes a productive cough as the secretion of mucus in the lungs increases and the patient coughs up sputum.

Restricted breathing space (spasm, mucus) causes wheezing sounds and screams when breathing.
The biggest problem is exhalation, when the patient only expels air from the lungs with great effort, while making a typical whistling sound, the so-called expiratory stridor.
At the same time, he is forced to engage the auxiliary respiratory muscles.

All these breathing difficulties result in impaired lung function and hypoxia, which is a lack of oxygen in the body. It is manifested by hypertension and tachycardia, but later, when a person is no longer able to compensate for the lack of oxygen, blue discoloration of the skin and mucous membranes (cyanosis, especially of the acral parts) occurs blood pressure and heart rate decrease.

In patients with COPD, there is so-called chest hyperinflation. Their chest explicitly resembles a barrel, and therefore it is also called a barrel-shaped chest.

Important:
COPD does not only damage the lungs themselves!
It also has systemic consequences!
Diseases of other organs are also associated, eg heart - pulmonary heart.

Diagnosis of COPD is usually not difficult. The reason is that the vast majority of patients visit a doctor only when the disease is already beginning to manifest.

And it is not the occasional cough that brings the sick. They enter the outpatient clinic with a chronic and persistent cough and noticeable shortness of breath, whether after more or less effort.

Manifestations of the disease and the key anamnestic data (smoking, risky work environment) almost always lead the doctor to the correct diagnosis.

Targeted screening methods will only confirm the presumed diagnosis of chronic obstructive pulmonary disease.

Spirometry

A spirometric examination is used not only to diagnose lung diseases but also to determine their severity. It reveals to us the degree of airflow limitation in the airways.

It is the basis for determining the severity of the disease, an important indicator in monitoring the course of the disease, and a springboard for setting up subsequent therapy, or its change.

Spirometric criteria are determined on the basis of the volume of air exhaled in one second, the so-called one-second forced expiratory volume of the lungs (FEV-1), and the entire volume of air exhaled during forced exhalation, the so-called exhalation capacity (FVC).
Evaluation of these values ​​is practiced after acute bronchodilation (enlargement of the bronchi), which is usually induced by drugs (bronchodilators).

Table with COPD criteria based on spirometry:

Bronchoscopy

Due to its invasiveness, bronchoscopy is performed only in some cases. It is usually indicated in patients not only for the purpose of diagnosis but for the removal of mucus plugs.

It is an invasive endoscopic examination method in which a bronchial tree is examined using an endoscope.

The doctor assesses visual changes in the bronchial mucosa, changes in their lumen (narrowing/obstruction), or detect obstruction (mucus plug).

Thus, this method is not only diagnostic but also therapeutic.

The disease has been asymptomatic for a long time. We also understand the term long-term for several years. Not only does the patient not experience any difficulties, but the pathological changes in his lungs do not limit him in any way in his life.

Later, slight coughing occurs, to which the patient does not attach serious importance. 

The cough intensifies over the years until it becomes chronic. It is associated with increased secretion of mucus in the lungs, and its expectoration, ie dry irritant cough, becomes a productive cough.

Subsequently, other manifestations will break out, in which shortness of breath is in the foreground. At first, it is noticeable only with greater physical activity, later it appears in the performance of normal activities, finally after minimal effort.

As a result of this prolonged breathing problem, the body is also insufficiently oxygenated, and therefore fatigue and muscle atrophy are associated in the later stages of the disease. 

COPD takes place in several stages:

COPD and vaccination

In many literature or Internet portals, you will read that vaccination against influenza and pneumococcal infections is recommended in patients with chronic obstructive pulmonary disease. 

1. Influenza vaccination - recommended for all patients with COPD, regardless of age and stage of the disease
2. Vaccination against pneumococcal infections - recommended preferably for patients over 65 years of age, and for patients with advanced COPD

It is logically beneficial for patients with such severe lung disease to be protected against any respiratory tract infections which, together with the underlying disease, could have fatal consequences, thus causing the patient's death.

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Optional vaccination when appropriate

However, not only logic but also several scientific studies have shown that vaccination is important!

Vaccine patients reduced the number of hospitalizations required and increased survival .
It is these infections that have resulted in frequent exacerbations of the disease in more than one third of patients.
Thus, vaccination also reduces the incidence of exacerbations .