COPD

COPD: Clinical Symptoms And Complications

COPD, Chronic Obstructive Lung Diseases, is characterized by an increase in airflow resistance caused by partial or complete obstruction at any level in the respiratory tract. In this group of diseases, Forced Vital capacity (FVC) is either normal or slightly decreased. The Expiratory Flow rate or Forced Expiratory Volume at the first second is much reduced. Therefore, the ratio of FEV to FVC1 is significantly decreased. 

In this inflammatory lung disease, the patients suffer from breathlessness, sputum production, persistent cough, and fever. COPD is most commonly caused by smoking tobacco and other similar substances. 

In the USA, COPD affects 10% of the adult population. Surprisingly, it is the fourth leading cause of death in the USA.

COPD is a group of four inflammatory lung conditions. These conditions are briefly discussed below.

Chronic Bronchitis

Chronic bronchitis is the occurrence of persistent productive cough for at least three consecutive months in at least two consecutive years. This condition is most commonly observed in cigarette smokers and urban dwellers. According to some studies, 20%-25% of men who belong to the age group of 45-65 develop this lung disease. 

In the initial phase of chronic bronchitis, the persistent cough produces sputum. However, this sputum does not block the airway. As the condition advances, more sputum is produced, which leads to obstruction.

In some patients, hyperresponsive airways, wheezing, asthmatic bronchitis, and intermittent bronchospasm develop. The characteristic feature of chronic bronchitis is hypersecretion of mucus, which blocks the airway. The morphological analysis of chronic bronchitis reveals hyperemic and swollen mucosal lining of larger airways. The edema fluid and a layer of mucinous and mucopurulent secretions form a layer to cover the mucosal lining. The edematous secretions block the bronchi and bronchioles. The diagnostic feature of chronic bronchitis is the enlargement of mucus-secreting glands in the trachea and bronchi.

The clinical features of chronic bronchitis include:

  • Persistent cough
  • Sputum
  • Hypercapnia
  • Hypoxemia
  • Cyanosis

The complications of chronic bronchitis include:

  • Pulmonary hypertension
  • Cardiac failure
  • Recurrent infections
  • Respiratory failure

Bronchiectasis

Bronchiectasis is the permanent dilation of bronchi and bronchioles. It is caused by the destruction of smooth muscles and supporting elastic tissue as a result of chronic, necrotizing infections. Bronchiectasis is a secondary lung disease that occurs as a complication of persistent infection and obstruction. It gives rise to a characteristic complex of symptoms in which persistent cough and a significant amount of purulent sputum are most dominant. The diagnosis of bronchiectasis depends upon the history provided by the patient and the status of bronchial dilation.

Bronchiectasis usually affects the lower lobes of the lungs bilaterally, especially those airways which are vertical. However, when it is caused by aspiration of a foreign object or a tumor, then only one lobe or segment of the lung is affected. The most severe involvement is found in the more distal bronchi and bronchioles. 

The airways are dilated as much as four times their normal diameter. Surprisingly, the extraordinary dilation of airways can be observed on gross examination out to the pleural surface.

The clinical features of bronchiectasis include:

  • Severe, persistent cough
  • Mucopurulent and fetid sputum
  • Dyspnea
  • Rhinosinusitis
  • Hemoptysis

COPD

Persistent coughing is a hallmark clinical feature of bronchiectasis. | Source: Freepik.com

The complications of bronchiectasis include:

  • Obstructive ventilator defects
  • Hypoxemia
  • Hypercapnia
  • Pulmonary hypertension
  • Cor pulmonale

 

Asthma

Asthma is a prevalent chronic inflammatory disorder of the airways. In this condition, there are recurrent episodes of cough, wheezing, chest tightness, breathlessness, especially at night or early in the morning. The hallmarks of asthma include reversible and intermittent airway obstruction, increased mucus secretion, chronic bronchial inflammation with eosinophils and hypertrophy, and smooth muscle cells’ hyperactivity.

COPD

Asthma patients suffer from extreme breathlessness and often use an inhaler or nebulizer. Source: Freepik.com

The morphological analysis of the respiratory tract in asthmatic patients reveals occlusion of bronchi and bronchioles by thick mucus plugs. They contain Curschmann spirals, which are whorls of shed epithelium, and Charcot Leyden crystals, which are crystalloids composed of eosinophil protein galectin-10. Other morphological features include thickened airway wall, fibrosis of the sub-basement membrane, increased vascularity of submucosa, metaplasia of goblet cells, increase in the size of submucosal glands, and hypertrophy and hyperplasia of bronchial muscle.

Clinical features of asthma include:

  • Severe dyspnea
  • Wheezing
  • Hypercapnia
  • Acidosis
  • Severe hypoxia

Emphysema

Emphysema is the permanent enlargement of the air spaces. These spaces are located distal to the terminal bronchioles. The destruction of their walls accompanies the permanent enlargement. However, no fibrosis takes place. Based on anatomic distribution, emphysema is classified into four types:

  • Centriacinar emphysema
  • Panacinar emphysema
  • Distal acinar emphysema
  • Irregular emphysema

Morphological analysis reveals enlarged air spaces and the destruction of alveolar walls without fibrosis.

The clinical features of emphysema include:

  • Dyspnea
  • Weight loss
  • Barrel chest
  • Hunch-over posture
  • Hyperventilation, adequate oxygenation of blood takes place hence called pink puffers
  • Obese, hence classed blue bloaters
  • Hypoxia
  • Cyanotic

Complications of emphysema include:

  • Hypoxia-induced pulmonary vascular spasm
  • Secondary pulmonary hypertension
  • Cor pulmonale
  • Respiratory failure

Bonus video: Symptoms & Diagnosis of COPD

 

FAQs


What are the 4 stages of COPD?

What are the four stages of COPD?
  • Stage I: Mild COPD.
  • Stage II: Moderate COPD.
  • Stage III: Severe COPD.
  • Stage IV: Very severe COPD.

What causes COPD?

The cause of COPD is usually long-term exposure to irritants that damage your lungs and airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if you inhale them. Exposure to other inhaled irritants can contribute to COPD.

What is the most painful type of arthritis?

Gout is one of the most painful forms of arthritis. This condition is caused by elevated levels of uric acid, a bodily waste product, in the bloodstream. Symptoms of gout occur when uric acid crystals accumulate in the joints and surrounding soft tissue, causing an inflammatory response in the affected areas.

What are the early warning signs of COPD?

Signs and symptoms of COPD may include:
  • Shortness of breath, especially during physical activities
  • Wheezing
  • Chest tightness
  • A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
  • Frequent respiratory infections
  • Lack of energy
  • Unintended weight loss (in later stages)

Is COPD curable?

There’s currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms. Treatments include: stopping smoking – if you have COPD and you smoke, this is the most important thing you can do. Also, ensure you eat a healthy and nutrient-filled diet.

How do most COPD patients die?

This found that the major causes of death were an acute-on-chronic respiratory failure, heart failure, pulmonary infection, pulmonary embolism, cardiac arrhythmia, and lung cancer. Much less is known of the circumstances of death and the specific causes of death of COPD patients in the community.

What does a COPD attack feel like?

You may suddenly experience more mucus clogging your bronchial tubes, or the muscles around your airways may constrict significantly, cutting off your air supply. Symptoms of a COPD flare are; Breathlessness or shortness of breath. Either feeling like you can’t breathe deeply or gasping for air.

Can I live for 20 years with COPD?

The American Lung Association reports that COPD is the third leading cause of death in the United States, but as a chronic, progressive disease, most patients will live with the disease for many years. The disease is not curable, yet it is possible to achieve some level of normalcy despite its challenges.

What is the last stage of COPD?

End-stage, or stage 4, COPD is the final stage of chronic obstructive pulmonary disease. Most people reach it after years of living with the disease and the lung damage it causes. As a result, your quality of life is low. You’ll have frequent exacerbations, or flares — one of which could be fatal.

Is COPD classed as a terminal illness?

COPD is terminal. People with COPD who do not die from another condition will usually die from COPD. Until 2011, the Global Initiative for Obstructive Lung Disease assessed the severity and stage of COPD using only forced expiratory volume in 1 second (FEV1)

 

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