Chronic obstructive pulmonary disease

It is a progressive disease with great morbidity and mortality, representing the fourth cause of death in Spain, with a directly attributable mortality rate in people over 75 years of age of 176 deaths per 100,000 inhabitants per year.

Chronic obstructive pulmonary disease is a process characterized by a decrease in respiratory flows that do not change markedly during periods of several months of follow-up. It is the chronicity, irreversibility and invariability of the obstruction that characterizes copd, and may or may not be accompanied by bronchial hyperresponsiveness.

This is due to a reaction of the bronchial mucosa to continuous irritants, with thickening of the mucosa, increased mucus production, increased muscle layer in the bronchi, all of which cause the diameter of the bronchial lumen to decrease. , so that the passage of air to and from the alveoli is limited. Likewise, the mucosal sweep and defense function is canceled, which produces a greater susceptibility to infection.

copd encompasses 3 entities, which to a greater or lesser degree are usually observed simultaneously in all patients:

• Chronic bronchitis: clinical term, consisting of the presence of cough and expectoration for at least 3 months of the year, for a minimum of 2 consecutive years, once other respiratory processes with increased chronic mucous secretion have been excluded. We speak of simple chronic bronchitis when it is not accompanied by airway obstruction, which can happen early in the process.
• Emphysema: pathological term, consisting of permanent and irreversible dilation and destruction of the air spaces distal to the terminal bronchus, excluding the presence of fibrosis.
• Small airway disease: changes similar to those of the larger bronchi, but in the terminal bronchioles and areas adjacent to the alveoli.

There are multiple factors that influence the development of copd

smoking

It is the most important factor, relating both to the number of cigarettes consumed and the number of years that it has been smoked. A higher rate of chronic bronchitis has been described among those who stop smoking and light it again and also among pipe smokers, compared to cigar smokers. smoking low-tar cigarettes does not decrease the frequency of respiratory symptoms. The effects of passive smoking on lung function are equivalent to those found in active smokers of less than 10 cigarettes a day. smoking is the origin of 80-90% of copd cases, although only 15% of smokers develop significant obstruction. Between 6-10% of the cases are non-smokers.

Professional exposure to both organic and inorganic particles

There is an established relationship between the intensity of exposure and the development of the disease.

• Predisposing factors: Only congenital alpha 1 antitrypsin deficiency has been demonstrated, while the rest are probable or possible factors, such as family history or uncorrected bronchial hyperresponsiveness for long periods.
• Gender and age: They are probably related to the cumulative effect of the risk factors to which the elderly have been exposed throughout their lives and in part due to the effect of aging, with increased respiratory symptoms and decreased lung function.

The symptoms of copd can be classified according to which type predominates in the patient:

In chronic bronchitis, patients present incessant cough and expectoration mainly in the morning, obesity with cyanosis (bluish tint of the skin and mucosa, due to carbon dioxide retention and lack of oxygen in the blood) and progressive dyspnea until resting in phases. advanced. Develop early secondary cardiac abnormalities by difficulty of the passage of blood through the lungs. The clinic usually begins at 40-55 years of age, being progressive.

In the elderly with emphysema, dyspnea predominates, with coughing and expectoration being less important. They are usually thin, with blowing breath and only at the end do they have cyanosis and cardiac involvement. The clinic appears between 50 and 75 years.

The diagnosis is based on a good medical history and a careful examination, being the ideal, if the patient collaborates, to obtain a certain diagnosis, the performance of respiratory function tests. In them, by analyzing respiratory flows, lung capacity, the presence of bronchial spasm and the main level of involvement can be assessed. Although there are a series of radiological signs suggestive of this disease on the chest X-ray, it actually serves to rule out other diseases and complications.

The treatment of copd is based, first of all, on the smoking cessation, which has been shown as the only preventive measure and that improves the prognosis of the process. Annual influenza and pneumococcal vaccination is also important to reduce the risk of superinfections that lead to a decrease in respiratory function.

The specific treatment consists of bronchodilators, drugs that decrease mucus production and corticosteroids to reduce inflammation of the bronchial mucosa. How and when each of them are started must be established by the treating physician, depending on the clinical and functional involvement of the patient. The use of inhaled medication is preferable, for which there are multiple mechanisms to administer it (pressurized cartridges without and with spacer chambers, dry powder, nebulisations, etc.). It should be the health personnel who know the patient who recommends the ideal method of administration of the drugs, depending on the characteristics of each case.

In case of flare-ups, it may be necessary to increase inhaled therapy, along with administration of antibiotics and corticosteroids orally, and even the administration of oxygen. In extreme cases, inhaled oxygen can be prescribed at home, chronically, even in periods without worsening.

Another fundamental aspect is to establish general measures

• Adequate nutrition, ensuring the intake of proteins and carbohydrates; in addition, weight must be lost in the case of obese people.
• Pulmonary rehabilitation to mobilize secretions and increase the efficiency of breathing and coughing. Physical exercise adapted to the functional situation of the elderly should be encouraged, preferably free ambulation, walking.
• Avoid dangerous or ineffective medications, such as those that facilitate bronchial contraction, sedatives, etc.
• Ensure optimal hydration; about 1.5 liters of fluids per day is recommended, under normal sweating conditions.
• Control of concomitant diseases, such as heart, vascular, diabetes, etc.
• Treatment of psychosocial complications such as lack of autonomy and depression or anxiety through an assessment and social and psychological support.