(*hanya terdapat dalam Bahasa Inggeris sahaja)
COPD (Chronic Obstructive Pulmonary Disease) is a term that is used to include chronic bronchitis, emphysema, or a combination of both conditions. Asthma is also a disease where it is difficult to empty the air out of the lungs, but is not included in the definition of COPD. It is not uncommon, however for a patient with COPD to also have some degree of asthma.
What is chronic bronchitis?
Chronic bronchitis is a condition of increased swelling and mucus (phlegm or sputum) production in the airways. Airway obstruction occurs in chronic bronchitis because the swelling and extra mucus causes the inside of the airways to be smaller than normal. The diagnosis of chronic bronchitis is made based on symptoms of a cough that produces mucus or phlegm on most days, for three months, for two or more years (after other causes for the cough have been excluded).
What is emphysema?
Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. The alveoli are normally stretchy and springy, like little balloons. In emphysema, the walls of some of the alveoli have been damaged, lose their stretchiness and trap air. Since it is difficult to push all of the air out of the lungs, the lungs do not empty efficiently and therefore contain more air than normal. This is called air trapping and causes hyperinflation in the lungs.
What causes COPD?
COPD can be caused by many factors, although the most common cause is cigarette smoke. Environmental factors and genetics may also cause COPD. For example, heavy exposure to certain dusts at work, chemicals, and indoor or outdoor air pollution can contribute to COPD. The reason why some smokers never develop COPD and why some never smokers get COPD is not fully understood. Hereditary (genetic) factors probably play a role in who develops COPD.
How do I know if I have COPD?
Shortness of breath, cough, and/or mucus production, that does not go away, are common signs and symptoms of COPD and indicate the need for a visit to your health care provider and evaluation for the need of a breathing test called spirometry. Spirometry is a simple test that measures airway obstruction. COPD is divided into mild, moderate and severe groups, depending on the level of airflow obstruction. Other tests includes CXR, CT scan of the lung, pulse oximeter, and blood tests (Haemoglobin level and blood gas).
What are the treatments for COPD?
Stopping smoking is the most important treatment. No other treatment may be needed if the disease is in the early stage and symptoms are mild.
Short-acting bronchodilator inhalers
An inhaler with a bronchodilator medicine is often prescribed. These relax the muscles in the airways (bronchi) to open them up (dilate them) as wide as possible. The same inhalers may be used if you have asthma. Examples are Ipratropium and Salbutamol.
Long-acting bronchodilator inhalers
These work in a similar way to the short-acting inhalers, but each dose lasts at least 12 hours. Long-acting bronchodilators may be an option if symptoms remain troublesome despite taking a short-acting bronchodilator. Examples are Tiotropium and Salmeterol.
A steroid inhaler may help in addition to a bronchodilator inhaler if you have more severe COPD or regular flare-ups (exacerbations) of symptoms. Steroids reduce inflammation. Steroid inhalers are only used in combination with a long-acting beta-agonist inhaler. Examples of these combination inhalers brand are Spiriva and Seretide.
Theophylline is an oral bronchodilator medicine that is sometimes used. It is used in stable COPD rather than in an acute exacerbation.
A mucolytic medicine such as Bromhexine makes the phlegm (sputum) less thick and sticky, and easier to cough up. This may also have a knock-on effect of making it harder for germs (bacteria) to infect the mucus and cause chest infections
A short course of antibiotics is commonly prescribed if you have a chest infection, or if you have a flare-up of symptoms which may be triggered by a chest infection.
This may help some people with severe symptoms or end-stage COPD. It does not help in all cases. Great care has to be taken with oxygen therapy. Too much oxygen can actually be harmful if you have COPD. Oxygen needs to be taken for at least 15-20 hours a day to be of benefit. Oxygen can be given with a face mask or through little tubes that sit just under your nostrils. Portable oxygen is available in cylinders, but if you need long-term oxygen therapy (LTOT), for long periods of the day, an oxygen concentrator is required.
What else is helpful?
This is an option in a very small number of cases. Removing a section of lung that has become useless may improve symptoms. Sometimes large air-filled sacs (called bullae) develop in the lungs in people with COPD. A single large bulla might be suitable for removal with an operation. This can improve symptoms in some people.
Two immunisations are advised. A yearly 'flu jab' protects against possible influenza and any chest infection that may develop due to this. Another is immunisation against pneumococcus (a germ that can cause serious chest infections). This is a one-off injection and not yearly like the 'flu jab'.
Regular exercise and lose weight
Studies have shown that people with COPD who exercise regularly tend to improve their breathing, ease symptoms, and have a better quality of life. Obesity can make breathlessness worse. If you are overweight or obese it is harder to exercise, and exercise makes you more breathless. If you are obese the chest wall is made heavy by fat. This means that you have to work much harder to breathe in and take a good breath, to inflate the lungs and expand the chest.
COPD is usually caused by smoking.
COPD should be considered as a possible diagnosis in anyone who smokes, or has ever smoked and has persistent (chronic) problems. These can be cough with lots of phlegm (sputum), breathlessness or wheeze, and chest infections which come back (are recurrent).
Symptoms usually become worse if you continue to smoke.
Symptoms are unlikely to get much worse if you stop smoking.
Treatment with inhalers often eases symptoms, but no treatment can reverse the damage to the airways.
A flare-up (exacerbation) of symptoms, often during a chest infection, may be helped by increasing the dose of usual treatments. This may be combined with a short course of steroid tablets and/or antibiotics.