COPD: symptoms, stages, what life expectancy?

Ihas chronic obstructive pulmonary disease Or COPD East a chronic inflammatory disease of the bronchi which is 85% attributable to smoking (active or passive). In other cases, it is caused by prolonged exposure to toxic products or air pollution. There are many stadiums evolution of the disease according to the severity (symptoms, complications…). What are its warning symptoms? His causes ? How to do the diagnostic ? What are the best treatments to treat it? What life expectancy ? Lighting.

What is the definition of COPD?

Chronic Obstructive Pulmonary Disease, also known as COPD, is a chronic respiratory disease very frequented. She is responsible for many deaths each year in France and a deterioration in the living conditions of affected patients. Chronic obstructive pulmonary disease causes chronic bronchial inflammation and difficulty breathing. It is avoidable because caused in nearly nine out of ten cases by the consumption of tobacco, but it can also concern certain people who work or live in a place very exposed to smoke or certain pollution. The management of chronic obstructive pulmonary disease involves many medical and paramedical treatments. “Although by definition the bronchial obstruction in this disease is not fully reversible, the treatment reduces the respiratory disability and global feeling felt by people affected by COPD”, explains Dr. Gilles Jebrak, pulmonologist at Bichat Hospital.

How does COPD evolve?

“For a long time, we classified COPD according to the severity of bronchial obstruction, measured by a test called the Lung Function Test (EFR for short). We then distinguish 4 stages of gravity bronchial obstruction ranging from mild (stage 1) to very severe (stage 4). But there are other criteria of severity such as the frequency of episodes of exacerbations, and the degree of breathlessness felt”, details the pulmonologist.

What causes COPD?

► The main cause of chronic bronchitis is the tobacco. Tobacco is responsible for more than 85% of COPD. This risk increases with the number of years of smoking but also with the quantity of cigarettes smoked each day.

► The cannabis, increasingly consumed, especially among young people, also represents an important risk factor for COPD. Stopping exposure to inhaled toxins, including tobacco, remains the first therapeutic approach to give oneself every chance of avoiding the progression of the disease towards respiratory failure.

► Exposure to pollutants present in certain environments, in particular professional ones, represent risk factors for COPD. There domestic pollution provoked the nitric oxide, nitrogen dioxide emitted by gas stoves, water heaters, gas stoves, fireplaces, radiators and tobacco smoke is a significant risk factor. Sulfur dioxide from burning coal and fuel oil is another risk factor.

► The atmospheric pollution caused by road traffic and industries represents a significant risk factor for COPD. The onset of bronchial infections in childhood can also promote the onset and progression of COPD, especially if they occur early. Some studies point out the existence of predisposing genes at the onset of COPD.

What are the risk factors for COPD?

“The people most affected are the people over 45 and the prevalence of COPD increases beyond this age”, explains the specialist. In France, the number of women affected is steadily increasing due to the increase in the number of smokers and should join the number of men affected by this disease. Socially disadvantaged populations are more affected by this pathology. The reasons are many: difficulties in accessing healthcare, smoking, working conditions exposing to professional pollutants, malnutrition…

What are the symptoms of COPD?

The first symptoms are banal, like a shortness of breath occurring during an effort or wet cough accompanied by sputum, due to mucosal hypersecretion secondary to bronchial inflammation. “We are talking about chronic bronchitis when there is a daily productive cough, for at least 3 consecutive months and two years in a row, without any other respiratory disease that could explain these symptoms But to speak of COPD, it is necessary to demonstrate that there is a chronic obstruction of the bronchi, therefore a measurement of respiratory function”, describes the pulmonologist.

2/3 of patients are unaware of their pathology.

When to consult in case of COPD?

You need to see a doctor as soon as the first signs appear in order to avoid the appearance of complications: shortness of breath for efforts that do not bother people of the same age and physical condition, frequent cough, occurring several times a day, several months a year, need to spit often. The first manifestations of chronic bronchitis are rarely worrying, not encouraging consultation. However, these symptoms, moderate at the beginning of the disease, sneakily getting worse over the years. Next to 75% of patients with COPD are undiagnosed. 2/3 of patients are unaware of their pathology and 50% of patients are not treated correctly.

How is COPD detected?

Because chronic obstructive pulmonary disease is a poorly understood disease, its diagnosis is often late. It is generally the persistence of a cough or shortness of breath that leads a smoking patient to consult. To diagnose a possible COPD, the doctor carries out a medical examination by quantifying in particular the quantity and duration of exposure to tobacco, then a clinical examination. He can prescribe additional examinations such as:

• I’respiratory function exploration (EFR) to assess lung volumes and airflow in the bronchi. It confirms the diagnosis of COPD and assesses the severity of bronchial obstruction. This painless examination requires special equipment: all you have to do is blow into a mouthpiece connected to a computer. The EFR is reimbursed by the health insurance fund.

► a test done in the aftermath of this EFR which shows the improvement in the obstruction of the bronchi after use of a bronchodilator drug: this obstruction is very little reversible in this pathology;

► a blood test with analysis of blood gases which makes it possible to measure in particular the level of oxygen and carbon dioxide in the blood. The measurement of blood gases, carried out using a blood sample in an artery, makes it possible to evaluate the impact of COPD on the exchange capacities between oxygen and carbon dioxide. “In the advanced forms of COPD, the oxygen level decreases, and in the most severe forms the carbon dioxide level increases, because the obstruction of the small bronchi prevents the entry of oxygen from the atmosphere until ‘in the alveoli, even the evacuation of carbon dioxide to the outside’, emphasizes Dr. Jebrak.

► a lung x-ray (the examination may be normal despite the presence of COPD. Only the examination of the breath, the EFR, allows the diagnosis).

► sometimes a test which assesses the respective role of respiratory impairment, cardiac repercussions and impact on muscle function.

It is essential to look for COPD in a smoking person with a chronic cough whether or not accompanied by spitting. The under-diagnosis of COPD is very important because this pathology most often begins with banal manifestations, such as cough and expectoration. These manifestations can evolve slowly and slyly for several years before the patient really feels embarrassed. Quitting smoking remains the first measure to adopt.

What are the treatments for COPD?

If he is impossible to completely eliminate the obstruction of the bronchi in COPD, there are many treatments that improve the daily lives of patients. When COPD is diagnosed early, it becomes possible to start appropriate treatment in order to limit the impact of the disease. Of course, thesmoking cessation and any exposure to inhaled toxins is imperative. This is the first treatment. “We must then insist on the importance of fighting against a sedentary lifestyle, and we must encourage people with COPD to maintain physical activity, or even offer them respiratory rehabilitation. Maintaining a healthy lifestyle is essential. reports the specialist. Prevention of respiratory infections is imperative with systematic production of certain vaccines. Annual vaccinations against influenza, and one (not annual) against pneumococcus can prevent certain exacerbations. “To avoid undesirable effects, the drugs are offered by inhalation, which requires learning to use the device that allows them to be inhaled”, recommends Dr. Gilles Jebrak. The drugs can be used alone or in combination in metered dose inhalers, powder inhalers or during nebulizations. Among the drugs, “of the corticosteroids with anti-inflammatory properties to fight against inflammation of the bronchi, but in COPD this inflammation is not as sensitive as that observed in asthma. Thus their interest is discussed in this disease”, emphasizes the specialist; treatments to dilate the bronchi, bronchodilators. There are two types of inhaled bronchodilators: beta mimetics and anticholinergic bronchodilators. They work by dilating the smooth muscles located around the bronchi. In the advanced stages, depending on the oxygen and carbon dioxide levels measured by blood gases, the use of a oxygen therapy or to a ventilatory support can be discussed with the pulmonologist. In case of respiratory infection, antibiotic therapy is indicated, even for simple bronchitis without pneumonia.

What are the complications of COPD?

There are three types of complications during COPD as detailed by the pulmonologist:

► The evolution towardschronic respiratory failure due to the impossibility of the sick lungs to assume their priority role, that of bringing oxygen to the pulmonary vessels. It is at this stage that the doctor can prescribe prolonged oxygen. Destruction of lung tissue leads to emergence emphysemairreversible and very disabling lesion, where the lung loses its elasticity.

► episodes of sudden worsening of bronchial inflammation, called exacerbations, often triggered by a respiratory infection or exposure to pollution. They can be responsible for acute respiratory failure, sometimes fatal.

► Theappearance of other diseases, in particular cardiovascular, osteo-muscular and psychiatric, because inflammation of the respiratory system has consequences for the whole body. These diseases contribute to the disability, even to the mortality of COPD.

What is the life expectancy with COPD?

Therapeutic advances and the development of care have considerably increased life expectancy. But COPD represents 3% of deaths in France. By 2030, it could be the 4th leading cause of death in the country as reported by the Association Respiratory Health.

Thanks to Dr. Gilles Jebrak, pulmonologist at Bichat Hospital.