Chronic Obstructive Pulmonary Disease (COPD)

COPD/Emphysema

What is Chronic Obstructive Pulmonary Disease (COPD)?

Breathing is something a lot of us take for granted until something like chronic obstructive pulmonary disease (COPD) threatens to take it away. Before we can understand anything about COPD, we must have a brief understanding of the respiratory tract and how we breathe. When you breathe, air goes in either through your nose or mouth. The air then makes its way down to your throat and eventually your lungs. Within your lungs are small airways known as bronchioles and alveoli. Once air reaches the alveoli, it is transferred to your blood which then disseminates it all over the body.

Chronic obstructive pulmonary disease or COPD is the umbrella term for a few lung diseases such as chronic bronchitis and emphysema. With this disease, parts of the respiratory tract are damaged, thereby preventing or restricting the natural process of breathing. COPD often exists with other conditions, known as comorbidities, such as lung cancer, cardiovascular disease, and osteoporosis, hence it is a growing cause of death or morbidity worldwide and is responsible for poor quality of life1,2,3. The prevalence of COPD in Singapore is approximately 2% or 87,819 patients in the community4

There are two main types of COPD5:

  • Chronic bronchitis: irritation to the bronchus can result in inflammation and excess production of mucus. When this happens, the bronchial tube becomes narrow, making it difficult for air to pass through. Cilia or the little hair-like structures that line the bronchial tube are usually responsible for moving mucus along. However, cilia can get damaged by bronchitis or tobacco smoke, making them stiff and unable to move, which in turn means that mucus is now stuck in the bronchial tube.
  • Emphysema: prolonged exposure to smoke and other irritating gases and particulate matter breaks down the walls of the alveoli. This makes it hard for gaseous exchange to take place between the blood vessels and the alveoli. 

Individuals with COPD often have both chronic bronchitis and emphysema together and it is a disease that can get progressively worse as time goes on. However, COPD is treatable and with proper management, the symptoms can be controlled.

Illustration of Chronic Obstructive Pulmonary Disease

What are the common causes of COPD in Singapore?

The causes of COPD are5:

  • Smoking: recognised as the main cause of COPD; this is true even if you do not smoke, but live or work in an environment where you are constantly exposed to tobacco smoke.
  • Alpha-1 antitrypsin deficiency: lacking this protein can cause emphysema even if you are not a smoker.
  • Certain gases: exposure to household fumes from cooking can cause COPD.
  • Pollution: air pollution can also cause COPD.

What are the symptoms?

The symptoms of COPD are very similar to other lung-related medical conditions, these are:

  • Cough: prolonged phlegmy cough
  • Breathlessness: dyspnoea or shortness of breath
  • Difficulty taking deep breaths
  • Wheezing: whistling sound when breathing
  • Chest tightness
  • Unexplained weight loss
  • Lethargy
  • Frequent respiratory infections

Is COPD painful?

Yes, individuals often experience chronic pain with COPD.

Who is at risk of COPD in Singapore?

Anyone can get COPD, however, there are several factors that increase a person’s risk of COPD, these are:

  • Smoking: the most significant risk factor. Long-term exposure to things that irritate your lungs such as tobacco smoke increases your risk of COPD.
  • Asthma: individuals with asthma are at an increased risk of COPD, this is particularly true for people with asthma and who smoke.
  • Occupational exposure: certain occupations expose you to a high level of dust and chemicals. Long-term exposure to these irritants can irritate and inflame your lungs.
  • Burning fuels: exposure to the fumes from burning fuel for cooking increases your risk.
  • Genetics: alpha-1 antitrypsin deficiency is one of the causes of COPD and it is a genetic condition passed down from family members.
  • Age: the older you get, the higher your risk.

How is COPD diagnosed in Singapore?

The symptoms of COPD are very similar to other respiratory conditions, so the following diagnostic tests will have to be conducted:

  • X-ray: an x-ray of your chest will be taken and from there, your respiratory specialist will be able to identify if you have COPD.
  • Computed tomography scan (CT-scan): like an x-ray but clearer and more detailed, a more accurate picture of your lungs can be seen for signs of COPD.
  • Lung function tests: spirometry or peak flow readings can be used to check on how well your lungs are functioning.
  • Arterial blood gas analysis: checks the levels of oxygen and carbon dioxide in your blood which is a direct relation to how well your lungs are functioning.
  • Blood/laboratory test: can be used to check for the cause of your symptoms or to rule out other possible causes.

What are the treatment options for COPD in Singapore?

The treatment for COPD is aimed at alleviating or managing symptoms. Treatment options include: 

  • Bronchodilators: help to relax the muscles around your airways, thereby preventing airway constriction. 
  • Anti-inflammatory medications: help to reduce inflammation, swelling, and mucus production. 
  • Supplemental oxygen: used if you have low oxygen levels.
  • Antibiotics: individuals with COPD are more prone to respiratory infections which are often caused by bacteria. Antibiotics will help to stop bacterial infections.
  • Vaccination: respiratory infections are very dangerous for individuals with COPD, hence vaccinations against the flu, COVID-19, and pneumonia are extremely important.
  • Anti-cholinergics: helps prevent your airway muscles from tightening.
  • Pulmonary rehabilitation: helps improve your activity level.

The most effective treatment for COPD is to stop smoking or remove yourself from a smoky environment.

Frequently asked questions

Is COPD contagious?

No, it is not.

What is the difference between COPD and asthma?

COPD and asthma share many similar symptoms. However, COPD is caused by smoking and occupational exposure to hazardous fumes, whereas asthma is usually set off by allergens.

Can COPD remain mild?

Most people with COPD have a mild disease. It can remain mild if proper management of symptoms is taken. The most important step is to quit smoking so that COPD does not progress further.

References

  1. Fanny W Ko, K. P. (2016). Acute exacerbation of COPD. Respirology, 1152-1165.
  2. A Sonia Buist, M. A.-M. (2007). International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet, 741-750.
  3. F W S Ko, D. S. (2008). Worldwide burden of COPD in high- and low-income countries. Part III. Asia-Pacific studies. International Journal of Tuberculosis and Lung Disease, 713-717.
  4. Pradeep Paul George, B. H. (2016). Evaluation of a disease management program for COPD using propensity matched control group. Journal of Thoracic Disease.
  5. Edvardas Bagdonas, J. R. (2015). Novel aspects of pathogenesis and regeneration mechanisms in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 995-1013.
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