Chronic obstructive disease. How does it affect the patient's quality of life?

Chronic obstructive pulmonary disease (COPD) is a worldwide problem, not only in terms of health, but also in terms of society and economy.

• COPD, together with bronchial asthma, are the two most common chronic lung diseases.
• COPD affects about 10% of the total population, representing up to 600 million patients, and affects up to 3 million people a year.
• It affects 4% to 6% of men and about 1% to 4% of women.
• The rising number of new cases of COPD and its high mortality rate have made it the fifth most common cause of death.
• Experts' negative forecasts suggest that COPD may move up two places this year.
• It affects only adults and its incidence increases with age (disease of the elderly).

Premature deaths as a result of the disease are not the only problem that worries not only patients but, of course, doctors too.

Like stroke, COPD causes permanent disability and thus significantly affects the patient's quality of life.

Not only does it limit him in normal activities(shortness of breath ⇒ reduced physical performance), but a patient with a need for continuous oxygenation must be connected to oxygen inhalation at home in more severe cases.

COPD does not only damage the lungs!

Patients with COPD do not only require the help of a pulmonologist. When decompensation and damage to other organs occurs, they also require various specialists (cardiologist, nephrologist, psychiatrist, diabetologist, oncologist, anaesthesiologist, A&E doctors).

This is because they are at a much higher risk of other associated diseases besides chronic obstructive pulmonary disease. The most common are cardiovascular diseases, other pulmonary complications, oncological diseases, the development of diabetes, bone thinning, but also psychological problems.

What is COPD?
How does it manifest?
What are the risk factors for developing the disease?
How does it affect life?
What treatments and prevention options are available?

These and a wealth of other interesting information are presented in this article.
Read with us...

Chronic obstructive bronchopulmonary disease

Chronic obstructive bronchopulmonary disease (COPD) is a chronic, slowly progressive disease. It results in permanent obstruction of the bronchial tubes and lungs, as well as an increased inflammatory response of the airways to chronic inhalation of pollutants and gases.

The disease is a combination of chronic bronchitis (cough, stridor), emphysema (pathological enlargement of the airways) and chronic airway obstruction. It develops over years without any symptoms.

TIP:
Chronic bronchitis and smoking closely related
Smoking, cigarettes and their impact on health

Worsening obstruction in the lungs leads to their insufficiency and death of the patient.

The condition is irreversible, permanent, with a tendency to progress, and only the manifestations of the disease are treated. It cannot be cured completely.

Based on the degree of obstruction, COPD is divided into several categories according to the GOLD classification (There is also a new classification, A, B, C, D, but for clarity, the older classification still used by doctors is described.

Table showing the GOLD classification of COPD

What is happening in the lungs?

Gases and other pollutants cause damage to the structures of the lungs and destruction of the lung parenchyma. As a consequence, their functions are also impaired.

By multiplying the goblet cells and increasing the volume of the submucosal glands in the lungs (hypertrophy), mucus secretion first increases.

Excessive mucus production and inflammatory changes in the walls of the airways create obstruction. This narrows the lung space and reduces airflow.

How does COPD manifest itself externally?

Patients with chronic obstructive disease may not know they have the disease at the outset.

The changes in the lungs take years to develop. It is only the manifestations of the disease, which are often irreversible, that force patients to see a doctor.

The most common reason for seeking medical attention is shortness of breath, reduced physical performance due to breathing problems and a chronic unrelenting cough.

1. First, COPD patients develop increased post-exertional dyspnoea, similar to that of cardiac patients. This becomes more severe, occurring after minimal exertion and at rest. It worsens during common respiratory infections, which the patient used to overcome without much difficulty, and also at night.
2. At first, breathing is faster and shallower (tachypnoea). Later, it is significantly weakened and the patient has to engage the accessory respiratory muscles (visible movements of the chest and abdomen).
3. Patients mainly have a problem with exhalation. Increased resistance in the airways causes less air to be expelled through the lungs and makes exhalation difficult.
4. When breathing, there are often symptoms of airway obstruction, which manifest externally as whistling sounds (stridor) or audible creaking in the lungs.
5. In severe cases, a blue discolouration of the acral parts (cyanosis of the lips, nose, ears, fingertips) occurs. It is caused by insufficient oxygenation of the tissues as a result of impaired lung function.
6. Another typical manifestation of COPD is a productive cough, which becomes chronic over time. The cough occurs mainly during sleep and is moist. The patient coughs up more or less mucus of varying consistency. Pus may also be present. Increased mucus production resides in the winter period.
7. Patients experience hyperinflation of the chest. Externally, the chest resembles a barrel. It is called a barrel chest.
8. COPD not only damages the lungs themselves, but also has systemic consequences. Heart disease, e.g. cor pulmonale - the so-called pulmonary heart, to the point of failure, and diseases of other organs are also associated.

Table with grades of COPD based on manifestations according to
mMRC (Modified Medical Research Council grading)

Who is at risk of developing chronic obstructive pulmonary disease?

Although the introduction to the article may be confusing, COPD has many causes. It is not just harmful cigarette smoke. Cigarettes are a major factor in triggering the disease, but far from the only one.

Let's take a look together at the main proven causes of chronic obstructive pulmonary disease.

External risk factors

External factors causing obstruction of the lungs include inhaled harmful particles, reactive gases or microorganisms.

The most serious negative factor is cigarette smoke, which contains a mixture of harmful substances, namely carcinogens, teratogens and others.

COPD is also caused by various inorganic particles that may be present in the working environment.
These include dust particles of carbon, silicon or aerosols of sulphur, chlorine and other elements.
Vapours from corrosive gases are also a danger for some workers.
Workers on construction sites working with cement or in other industries, such as metal production and processing, are also at risk.

Nowadays, attention is also focusing on the risk of the home environment. Long-term use of solid fuels and inadequate ventilation cause chronic inhalation of pollutants, increasing the chances of COPD and other health problems.

In addition to inorganic particles, organic particles are also a problem.
This group of pathogens consists of bacteria, viruses, moulds and spores.
Repeated inhalation of micro-organisms and the damage they cause to the lungs, especially untreated damage (casus socialis, unsuitable conditions, moulds, repeated infections, lack of funding for treatment and removal of the causative factor), lead to chronic lung damage and COPD.

Internal risk factors

Internal risk factors include genetic predisposition and nutritional factors.

A well-established genetic determinant of COPD is α1-antitrypsin (AAT) deficiency.
A level of less than 10% of normal (0.78g to 2g) predisposes a patient to earlier development of emphysema.
If such a patient is simultaneously exposed to extrinsic risks, he or she may develop the disease earlier. He or she may eventually have a more severe stage.

How does COPD affect a patient's quality of life?

After the birth of a child, the first breath is taken. From this moment on, breathing is an integral part of everyone's life until the death of the organism.

Life for patients with severe COPD is not easy. What we take for granted can become a struggle for survival.

Chronic bronchopulmonary disease makes it difficult to do what you normally don't even notice. Breathing.

Reduced physical activity

The milder form of chronic obstructive disease does not manifest itself in any significant way. Initially, the patient only gasps during major physical activity. Outwardly, it manifests itself as a more rapid shortness of breath during activities that the patient previously managed without difficulty (hiking, sports, dancing, work performance).

In the moderate form of the disease, breathing problems occur even during normal activities that do not require much effort (going to the store, climbing stairs, cleaning the house).

Patients with severe COPD are no longer as self-sufficient as they used to be. Even minimal exertion causes dyspnea (a short walk, going to the toilet). They require not only family assistance, but also oxygen inhalation at home - DDOT.

Critical obstructive disease no longer allows the patient any activity. They are usually hospitalized in the hospital where not only their breathing and blood oxygen levels are monitored, but also their carbon dioxide levels and other vital signs.

Frequent awakenings at night

One of the reasons for frequent waking at night in COPD patients is shortness of breath, when normally the sleeper's body is in a horizontal position.
Breathing problems and shortness of breath force the sleeper to become vertical and therefore to adopt a sitting resting position to facilitate breathing.
In more severe cases, the sleeper sleeps sitting up.

It is not just breathing difficulties that cause the patient to wake up from sleep.
During sleep, the patient is at rest, breathing more shallowly and slowly. This helps mucus to accumulate in the lungs, or mucus and saliva flow into the throat, forcing and irritating him to cough.

Loss of social status

Patients with obstructive disease not only breathe heavily but also cough very often, coughing up phlegm.
Outwardly, they appear sickly and repulsive to others. Therefore, people tend to avoid them.

This is why, over time, some of them stop going to public places such as restaurants, bars, cinemas and libraries.
The way others look at them and walk away from them is unpleasant. Therefore, they prefer to voluntarily cancel social contacts.

Isolation, lack of opportunities

Patients are withdrawing into themselves, becoming more isolated. This is partly due to less contact with people, as described above, but it is not the only reason.

The patient's isolation is also caused by breathing difficulties. The patient loses stamina and is therefore unable to participate in certain activities even with close family members (holidays, sports, shopping).

In the worst case, the patient requires oxygen in the home environment.
This means having an oxygen machine with a manifold at home.
An oxygen tube is connected to the manifold and ends with an oxygen mask or goggles.
The patient is usually connected to oxygen for several hours a day, some of them constantly.

Mental problems, depression

Any major illness, as well as the restriction of activities caused by it, results in a poor psychological state of the patient.
A bad diagnosis and its consequences are not handled in the same way by every individual.
Each patient's experience is individual.

Most often there is bad mood, depression, tearfulness.

Those who do not know how to express their emotions struggle with nervousness, bad mood, irritability and aggression towards others.

Prevention and current treatment options for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a disease that results from irreversible damage to lung tissue.

This means that it is incurable. However, it is treatable to some extent. There are medications and options that make breathing and quality of life easier for the patient to some extent.

As with most diseases, the smaller the organ affected, the more effective the treatment. Prevention and education of the population is of the utmost importance, however.

Prevention of COPD

Given the high morbidity, disability and mortality of obstructive lung disease, prevention is of great importance.

Preventive measures are primary and secondary. The main emphasis is on primary prevention.

• Primary prevention of COPD - focuses on the elimination of risk factors
• Secondary prevention of COPD - is carried out in a patient who has already been diagnosed with the disease (treatment, dispensation)

Table with basic preventive measures

Medicines used to treat COPD

Pharmacological treatment, as well as non-pharmacological interventions, have been shown to improve lung function, improve exercise capacity, and thus improve the patient's quality of life.
It also helps to prevent disease progression, moderate disease manifestations, increase physical fitness, and thus improve the patient's overall health.

The mainstay of drug therapy remains inhaled bronchodilators with long-lasting action.

However, in order for the treatment to be effective, it is necessary to educate patients about their disease beforehand and to eliminate risk factors. This is sometimes a problem, especially for smokers who cannot give up their cigarettes.

The most commonly used medications for COPD:

• short-acting bronchodilators (relieve airway obstruction, facilitate breathing and expectoration of mucus)
• Long-acting bronchodilators (relieve symptoms of the disease, thereby improving exercise tolerance)
• anticholinergics (dilate the airways, facilitate breathing and expectoration of mucus, relieve symptoms)
• inhaled short-acting β2-sympathomimetics (used in acute cases of airway spasm)
• long-acting β2-adrenergics (used in severe cases of the disease, long-acting)
• inhaled corticosteroids (indicated for repeated exacerbations)
• oxygen therapy (oxygen treatment in severe cases or in respiratory failure)
• antidepressants (an important part of the treatment of the psychological effects of COPD)