COPD  (Chronic Obstructive Pulmonary Disease)  or  EMPHYSEMA



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COPD, short for Chronic Obstructive Pulmonary Disease, is a chronic condition or  an inflammatory disease of the lungs, in which the alveoli, or the terminal air sacs of the respiratory tract of the lungs, have lost their elasticity and become stretched out and filled with stale air. As a result, the tiny blood vessels in the sacs cannot perform their normal function of picking up a fresh supply of oxygen while getting rid of carbon dioxide and other waste products; thus the breathing process gets laboured and rather inefficient. This disease is progressive, and over a period of time it obstructs the flow of air in the lungs and subsequently causes and results in almost constant difficulty in breathing.

Prolonged exposure to cigarette smoke, gases or particulate matter can lead to this condition. The condition transcends all age brackets meaning it can affect anyone from young teenagers to aged adults. People who contract this disease are at an enhanced probability of developing cardiovascular complications and and associated pulmonary ailments !

COPD is essentially an 'inhaled smoke' or the 'chimney' disease - thus its main cause being smoking tobacco or getting regularly exposed to particulate smoke/fumes from cooking and/or heating. Almost 25% of habitual smokers develop this malady. However, even smokers often dismiss it as ''smokers' cough'' or a 'respiratory bother'. Chronic bronchitis may also be one of the underlying causes of this disease. Our lungs depend on the intrinsic elasticity of the air sacs and the bronchial tubes that help facilitate the passage of air through the lungs. COPD causes these passages to lose their elasticity thus rendering them partially ineffective. Two clinical terms may be important to mention here - surfactant & atelectasis. The surfactant in lungs (pulmonary surfactant) is a qualitative mixture of proteins & lipids, secreted into the alveolar space by the epithelial type II cells of the lung's surface. The primary function of this important biochemical is to lower the surface tension at the air/liquid interface within the alveoli of the lung. It is thus a surface-active lipoprotein complex (phospholipoprotein). These lipoprotein constituents of the surfactant have both hydrophilic & hydrophobic regions along their molecular skeleton. Biochemically, the primary lipid component of surfactant, dipalmitoylphosphatidylcholine (DPPC) enables reduction of surface tension by adsorbing to the air-water interface of alveoli, with hydrophilic head groups in the water and hydrophilic tails facing towards the passing air in the lung. This special chemical thus increases pulmonary compliance, as, equally importantly, prevents atelectasis (collapse of lungs) at the end of expiration, and to facilitate re-employment of the collapsed airways.

Compliance is the ability of lungs and thorax to expand. Surfactant decreases the alveolar surface tension, as seen in cases of premature infants suffering from infant respiratory distress syndrome. At the end of the expiration, compressed surfactant phospholipid molecules decrease the surface tension to very low, near-zero levels. Pulmonary surfactant thus greatly reduces surface tension, increasing compliance allowing the lung to inflate much more easily, thereby reducing the work of breathing. It reduces the pressure difference needed to allow the lung to inflate. The lung's compliance decreases and ventilation decreases too when lung tissue becomes diseased and fibrotic. Alveoli can generally be compared to gas bubble in water, as the alveoli are wet and surround a central air space. The surface tension acts at the air-water interface and tends to make the bubble smaller.

Most patients aren't really aware of their developing symptoms of COPD ... until the lungs have suffered widespread damage, especially if they continue with their smoking routine. The routine symptom  is productive coughing (expectorating sputum) ... this is usually accompanied by appreciable breathing difficulty and tight chestedness. Prolonging symptoms include definite weakness, may be accompanied by weight loss as well. Just as in 'bronchitis' there may be frequent exacerbations of COPD bouts. As the disease progresses the frequency of such bouts increases.

The primary cause of emphysema is smoking, although air pollution, occupational exposure to toxic chemicals and gases, chronic bronchitis  and other lung disorders, and even an inherited tendency to develop the condition may also be responsible. Diagnosis begins with gathering background information about the patient, especially in regard to smoking or any history of bronchitis and/or asthma. This is followed by a physical examination with particular attention to lung function. A definitive diagnosis required a simple test called spirometry (picture at the top, above), in which the subject takes deep breath and then exhale as much air as he/she can  as quickly as possible. The test indicates whether the subject can empty the lungs normally. Other diagnostic studies include lung X-rays, lung scans, and blood studies to check for signs of infection and measure levels of oxygen and carbon dioxide reaching the body's tissues.

Emphysema has no cure as such, but proper medical treatments can relieve its symptoms, slow the progression of the disease, and help to delay any impending disability. Drug therapy usually includes the use of bronchodilators - medications that relax the airways and facilitate the flow of air in and out of the lungs. These drugs are usually taken at regular intervals several times a day, rather than only when symptoms appear. Corticosteroid drugs, in either oral or inhaled form, may be prescribed to counter lung inflammation, and even antibiotics may be given, not only to treat airway infections but also as prophylaxis to prevent them. Annual flue shots (pic below) are a particularly important preventive measure, as is immunization against pneumococcal pneumonia, because these illnesses can in fact be life-threatening for any person who has emphysema. Some severe cases may even require supplemental oxygen, administered through tube in the nostrils. This can be administered at home, although hospitalization is sometimes necessary. An experimental operation in which 20 to 30 percent of the damaged lung tissue is removed has brought dramatic improvement to some patients with advanced emphysema. Reducing the size of the distended lungs allows more room for the remaining tissue to inflate while healing. Still, the operation doesn't anyhow halt the progression of the disease.