CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Definition:

COPD is a chronic and progressive respiratory disease characterized by irreversible or partially reversible airflow obstruction, due to chronic inflammation of the airways and lung tissue. It includes two main conditions:

• Chronic bronchitis: productive cough for at least 3 months in 2 consecutive years.

• Pulmonary emphysema: destruction of alveoli with loss of lung elasticity.

Epidemiology:

• COPD is one of the leading causes of morbidity and mortality worldwide.

• Around 300 million people are affected globally.

• It is more common in individuals over 40, especially smokers.

• It is the fourth leading cause of death worldwide (according to WHO).

Pathology (mechanisms):

• Chronic inflammation caused by inhalation of harmful substances (e.g., cigarette smoke).

• Thickening of bronchial walls and excessive mucus production.

• Alveolar destruction (emphysema) → reduced gas exchange surface.

• Pulmonary hyperinflation → difficulty in exhalation.

• Reduced lung elasticity.

Causes and risk factors:

• Cigarette smoking (main cause, 80–90% of cases).

• Exposure to environmental and occupational pollutants (dust, vapors, chemicals).

• Air pollution.

• Recurrent respiratory infections during childhood.

• Genetic factors (e.g., alpha-1 antitrypsin deficiency).

• Older age, male sex (although the gender gap is decreasing).

• Sedentary lifestyle.

Diagnosis (explained):

1. Medical history (smoking, symptoms, exposure to risk factors).

2. Physical examination: wheezing, barrel chest, dyspnea.

3. Spirometry (key test):

• FEV1/FVC < 0.70 post-bronchodilator → confirms obstruction.

• GOLD Classification (Severity from 1 to 4 based on FEV1).

4. Chest X-ray / Chest CT scan: to assess emphysema.

5. Arterial blood gas analysis: to check oxygenation and CO2 levels.

6. 6-minute walk test (6MWT) or exercise testing.

Therapy (explained):

COPD is not curable, but it can be managed and slowed down.

1. Smoking cessation → most effective intervention.

2. Bronchodilator medications (inhaled):

• Long-acting beta2-agonists (LABA): e.g., salmeterol, formoterol.

• Long-acting muscarinic antagonists (LAMA): e.g., tiotropium.

3. Inhaled corticosteroids (ICS) in selected cases.

4. Long-term oxygen therapy (in cases of chronic respiratory failure).

5. Pulmonary rehabilitation: physical exercise, education, nutritional support.

6. Vaccinations: influenza, pneumococcal vaccines.

7. Antibiotics during bacterial exacerbations.

Nursing care:

• Monitoring respiratory parameters (rate, SpO2, signs of dyspnea).

• Patient education:

• Correct use of inhalers.

• Importance of medication adherence.

• Recognizing signs of exacerbation.

• Psychological support for anxiety/depression.

• Infection prevention: hygiene, vaccinations.

• Assistance with mobility to prevent deconditioning.

• Nutritional support: in cases of cachexia or obesity.

• Oxygen therapy management: proper use and oxygen saturation monitoring.

Advice and prevention:

• Quit smoking as early as possible.

• Avoid exposure to dust, smoke, and pollutants.

• Engage in regular physical activity, tailored to patient capacity.

• Maintain a balanced diet.

• Manage comorbidities (e.g., hypertension, diabetes).

• Keep vaccinations up to date (influenza, pneumococcal).

• Have regular medical checkups and follow treatments.