Chronic obstructive pulmonary disease (COPD): Definition, diagnosis and treatments

COPD: definition

Chronic obstructive pulmonary disease or COPD is a group of chronic inflammatory diseases affecting the airways (especially the bronchi). It is a severe form of bronchitis and is characterised by a narrowing of the airways, inflammation and hypersecretion of mucus.

With time, it leads to permanent and progressive obstruction of the airways, causing breathing difficulties and is associated with a destruction of the lung parenchyma called emphysema.

• 90% of COPD cases are caused by tobacco smoke (active and second-hand smoke). It is estimated that 30% of smokers are affected. Smoking causes a very high mucus secretion, facilitating infections which in turn cause mucus secretion, creating a vicious circle.
• 10% of cases diagnosed are due to occupational exposure (silica, coal dust, some solvents, some agricultural products, etc.).

Historically, COPD affected men more frequently than women, but today it affects almost as many men as women. This is mainly due to an increase in smoking among women. It is important to note that women tend to develop earlier and more severe forms of COPD than men.

The symptoms of COPD are not specific to it, making its early diagnosis difficult. The symptoms typically include: cough, shortness of breath (dyspnoea) and sputum. Their onset is insidious, appearing gradually and worsening over time. 

There may also be episodes of exacerbations (attacks of worsening symptoms) which indicate a more general worsening of the disease and may result in hospitalisation.

Diagnostic methods

As the frequency and severity of symptoms increase, a series of tests will be recommended: pulmonary function testing (PFT). This is carried out using a spirometer. Spirometry measures the amount (volume - FEV-1, forced expiratory volume in one second) and/or speed (flow) of air that can be inhaled and exhaled. These results allow an assessment of the patient's lung capacity.

A six-minute walk test may also be performed. The objective of this test is to walk as far as possible for a given time (6 minutes). It will give an indication of the impact of COPD on the patient's daily life.

Available treatments

Depending on the severity and frequency of symptoms, the choice and number of combinations may vary. This is a non-exhaustive list of the different treatments available.

Non-drug treatments: 

The first step is to stop smoking and avoid exposure to other lung irritants. Physical activity can also be introduced where possible, as well as pulmonary rehabilitation.

Medicinal treatments:

Drug treatment may also be introduced. This treatment is based on bronchodilators as for the treatment of asthma, as well as corticosteroids and oxygen therapy for the more severe forms. 

Here are some examples:

• Short-acting inhaled bronchodilators when needed: Salbutamol (VentolinⓇ, SalamolⓇ) and terbutaline (Bricanyl TurbuhalerⓇ).
• Long-acting inhaled bronchodilator for daily use (background therapy): Salmeterol (SereventⓇ or NeoventⓇ), formoterol (ForadilⓇ), or terbutaline (Bricanyl TurbuhalerⓇ) and bambuterol (BambecⓇ), taken orally (reserved for patients who have difficulty inhaling).
• Inhaled corticosteroids: Budesonide (Symbicort TurbohalerⓇ), fluticasone (FlixotideⓇ) or beclomethasone (QvarⓇ). These drugs are never taken alone in the treatment of COPD, they are always taken in combination with one or more bronchodilators and in the presence of bronchodilator-resistant exacerbations.
• Oxygen therapy: in case of respiratory failure.

However, none of these treatments can cure COPD, they can only limit the progression of the disease and sometimes suppress some symptoms.

Regular reassessments of treatment are recommended in order to reduce medication dosage if possible or needed. In addition, good compliance with the treatment and the correct use of inhalers allows for better care.

COPD and COVID-19

COPD is a condition that makes the patient susceptible to infections, especially viral infections. In these times of global pandemic, it is normal to wonder whether it represents a risk factor for COVID-19.

Unfortunately, there is still no definitive answer to this question. Of the studies that have been conducted worldwide, none has clearly identified COPD as a risk factor. Indeed, the number of patients and/or the knowledge of their comorbidities are limiting factors.

However, based on the current data, having COPD does not increase the risk of developing COVID-19. On the other hand, it could lead to more severe forms in some cases. 

The recommendations are clear on one thing: you should not stop your corticosteroid or bronchodilator treatment. Even if you have COVID-19, this treatment does not make the disease caused by the virus worse. 

If you are interested in this topic, feel free to read this article too: Everything you need to know about COPD and the Coronavirus!

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