Question

Describe a respiratory condition utilizing proper medical terminology and common treatment for that condition.

Answer 1

Chronic Obstructive Pulmonary Disease (COPD): It is treatable and preventable disease which is characterised by slowly progressive persistent airflow limitation. It is associated with enhanced chronic inflammatory response of lungs and airways to the noxious particles which are primarily caused by cigarettes smoking. Previously definition of the COPD includes two diseases, chronic bronchitis and emphysema.

Aetiology: The main leading cause for the development of COPD is cigarette smoking. Cigarette smoking causes direct irritating effect on the lungs. Due to the irritation by smoking, Hyperplasia of the cells occur. Due to the irritation, production of the mucus is increased.

Ciliary activity is reduced by the smoking which leads to the ineffective airway clearance. Other factors for developing COPD includes occupational chemicals and dust, Air pollution, severe recurring respiratory infections, alpha-antitrypsin deficiency, genetics.

Pathophysiology: In COPD chronic inflammation of the lung parenchyma, pulmonary blood vessels, and airways occurs. Due to the noxious particles and gases due to smoking and air pollution will leads to the following changes in the lungs.

1. Inflammation of the central airways due to the release of the inflammatory mediators, oxidative stress, inflammatory cells like neutrophils, macrophages, lymphocytes.
2. Remodelling of the peripheral airway will occur.
3. Parenchymal destruction occurs due to imbalance between proteinase and ant proteinase.
4. Pulmonary vascular changes like thick vessels, inflammatory cells infiltrate, collagen deposition occurs and destruction of the capillary bed.

All these changes will lead to the COPD pathology which includes mucus hypersecretion, cilia dysfunction, airflow limitation, alveolar destruction, loss of elastic recoil, cor pulmonale, pulmonary hypertension, systemic effects. COPD leads to hypoxia, reduction of the pulmonary vascular bed, acidosis and hypercapnia. All these changes leads to pulmonary hypertension and right ventricular hypertrophy. This results in Cor pulmonale and right-sided heart failure.

Clinical features: First symptom to develop in COPD is chronic intermittent cough. Cough maybe unproductive. Significant airflow limitation is present even without cough and sputum. Patient’s complaints about heaviness of the chest, unable to take deep breaths, gasping, air hunger.

During the progression of the disease, symptoms and dyspnoea interferes with the daily activities of the patient. In late stages dyspnoea is present even at rest. Wheezes and decreased breath sounds are present on physical examination. Patient frequently complains about anorexia, weight loss and fatigue. During the Course of time hypoxemia may develop with hypercapnia.

Collaborative care: Diagnosis is based on history and physical examination, pulmonary function tests, chest x-ray, serum alpha-antitrypsin levels, ABG analysis, six-minute walk test, COPD Assessment Test(CAT) and BODE index.

Collaborative therapy includes cessation of the smoking, treatment of exacerbations, air way clearance techniques, breathing exercises and retraining.

Treatment: Drug therapy includes using of inhaled bronchodilators like anticholinergics or long-acting beta2-agonists. Pneumovax immunization and influenza vaccination should be done. Surgical treatment includes Lung volume reduction and Lung transplantation.