Chronic obstructive pulmonary disease

Overview of Chronic obstructive pulmonary disease

• Exacerbations and comorbidities contribute to the overall severity in individual patients.
• Extra-pulmonary effects include weight loss and skeletal muscle dysfunction commonly associated comorbid conditions include cardiovascular disease, cerebrovascular disease, the metabolic syndrome, osteoporosis, depression and lung cancer. [1]
• The prevalence of COPD is directly related to the prevalence of tobacco smoking and, in low- and middle-income countries, the use of biomass fuels.
• Current estimates suggest that 80 million people worldwide suffer from moderate to severe disease. [1]

Indian epidemiology then other

Causes of Chronic obstructive pulmonary disease

• Cigarette smoking represents the most significant risk factor, and the risk of developing COPD relates to both the amount and the duration of smoking.
• It is unusual to develop COPD with less than 10 pack years and not all smokers develop the condition, suggesting that individual susceptibility factors are important. [1]

Types of Chronic obstructive pulmonary disease

The two most common conditions of COPD are chronic bronchitis and emphysema. Some physicians agree that asthma should be classified as a chronic obstructive pulmonary disease, while others do not.

1. Chronic bronchitis
   Chronic bronchitis is a long-term inflammation of the bronchi (breathing passages in the lungs), which results in increased production of mucus, as well as other changes.

• These changes may result in breathing problems, frequent infections, cough, and disability.

 2. Pulmonary emphysema
Emphysema is a chronic lung condition in which alveoli (air sacs in the lungs) may be:

• Destroyed
• Narrowed
• Collapsed
• Stretched
• Over-inflated

This can cause a decrease in respiratory function and breathlessness. Damage to the air sacs is irreversible and results in permanent "holes" in the lung tissue.

3. Asthma
Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems. The characteristics of asthma include the following:

• The lining of the airways become swollen and inflamed.
• The muscles that surround the airways tighten.
• The production of mucus is increased, leading to mucus plugs. (5)

Risk factor of Chronic obstructive pulmonary disease

• Exposure to air pollution
• Breathing second hand smoke
• Working with chemicals, dust and fumes
• A genetic condition called Alpha-1 deficiency
• A history of childhood respiratory infection [4]

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Pathophysiology of Chronic obstructive pulmonary disease

• COPD has both pulmonary and systemic components The presence of airflow limitation combined with premature airway closure, leads to gas trapping and hyperinflation, reducing pulmonary and chest wall compliance.
• Pulmonary hyperinflation also flattens the diaphragmatic muscles and leads to an increasingly horizontal alignment of the intercostals muscles, placing the respiratory muscles at a mechanical.
• The work of breathing is therefore markedly increased, first on exercise, when the time for expiration is further shortened, but then, as the disease advances, at rest Emphysema may be classified by the pattern of the enlarged airspaces as centri acinar, pan acinar or Para septal.
• Bullae form in some individuals. This results in impaired gas exchange and respiratory Failure.[1]

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Sign & Symptoms of Chronic obstructive pulmonary disease

• COPD should be suspected in any patient over the age of 40 years who presents with symptoms of chronic bronchitis and/or breathlessness.
• Cough and associated sputum production ‘smoker’s cough’.
• Breathlessness
• Physical signs are non-specific, correlate poorly with lung function, and are seldom obvious until the disease is advanced. Breath sounds are typically quiet.
• Crackles may accompany infection but, if persistent, raise the possibility of bronchiectasis.
• Tuberculosis [1]

Clinical examination of Chronic obstructive pulmonary disease

Appearance of the Patient

• Cyanosis
• Tachypnea
• Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
• Elevated jugular venous pulse (JVP)
• Peripheral edema can be observed.

Lungs

Inspection

• Hyperinflation (barrel chest)

Percussion

• Hyper resonance

Auscultation

• Prolonged expiration; wheezing
• Diffusely decreased breath sound
• Additional sounds – coarse crackles with inspiration. (6)

Diagnosis of Chronic obstructive pulmonary disease

• The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity.
• Using a stethoscope to listen to the lungs can also be helpful. Pictures of the lungs (such as x-rays and CT scans) can be helpful
• Sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and carbon dioxide in the blood. [2]

Differential diagnosis of Chronic obstructive pulmonary disease

• Asthma
• Congestive heart failure
• Bronchiectasis
• Tuberculosis
• Obliterative bronchiolitis (7)

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Chronic obstructive pulmonary disease

• A chest X- ray is essential to identify alternative diagnoses, such as cardiac failure, other complications of smoking such as lung cancer, and the presence of bullae.
• A blood count is useful to exclude anaemia or polycythemia, and in younger patients with predominantly basal emphysema, α1-antiproteinase should be assayed.
• Measurement of lung volumes provides an assessment of hyperinflation.
• Emphysema is suggested by a low gas transfer value (p. 653). Exercise tests provide an objective assessment of exercise tolerance and a baseline for judging response to bronchodilator therapy or rehabilitation programmed; they may also be valuable when assessing prognosis.
• Pulse oximetry of less than 93% may indicate the need for referral for a domiciliary oxygen assessment.
• The assessment of health status provides valuable clinical information.
• HRCT is likely to play an increasing role in the assessment of COPD, as it allows the detection, characterization and quantification of emphysema and is more sensitive than a chest X-ray for detecting bullae. [1]

Treatment of Chronic obstructive pulmonary disease

1. There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse.
2. Persons with COPD must stop smoking. This is the best way to slow down the lung damage.
3. Medications used to treat COPD include:

• Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or
• Inhaled steroids to reduce lung inflammation.
• Anti-inflammatory medications such as Montelukast(Singulair) and roflimulast are sometimes used.

4. In severe cases or during flare-ups, you may need to receive:

• Steroids by mouth or through a vein (intravenously)
• Bronchodilators through a nebulizer
• Oxygen therapy
• Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)

5. Antibiotics are prescribed during symptom flare-ups, because infections can make COPD
6. You may need oxygen therapy at home if you have a low level of oxygen in your blood.
7. Walk to build up strength.
8. Use pursed lip breathing when breathing out (to empty your lungs before the next breath)
9. Things you can do to make it easier for yourself around the home include:

• Avoiding very cold air
• Making sure no one smokes in your home
• Reducing air pollution by getting rid of fireplace smoke and other irritants

10.Surgery may be used, but only a few patients benefit from these surgical treatments:

• Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema
• Lung transplant for severe cases [2]

Prevention of Chronic obstructive pulmonary disease

• Don’t rub your eyes, as this can transmit germs to your nasal passages via the tear ducts.
• Quitting smoking and avoiding secondhand smoke (the smoke from a burning cigarette or cigar and the smoke exhaled by a smoker) are important steps you can take to protect your lungs from infection.
• Follow your doctor’s medication guidelines.
• Get enough sleep and rest.
• Manage your stress.
• Talk to your doctor or healthcare provider about getting a flu shot every year and get the pneumonia vaccine if you haven’t had one.
• Be careful to avoid infection when traveling. In areas where the water might be unsafe, drink bottled water or other beverages (order beverages without ice). Swim only in chlorinated pools.(8)

Homeopathic Treatment of Chronic obstructive pulmonary disease

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Chronic obstructive pulmonary disease

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

1. Aconitum Napellus:

• The first remedy that is often indicated at the onset of the infection. It is effective only within the first twenty-four hours.
• Useful when there is a short, dry cough, a temperature and an irritation of the throat, chest and trachea.
• There is a chilly restlessness, anxiety and a full, bounding pulse, with general weakness.

2. Antimonium Tartaricum:

• Useful when there is a accumulation of considerable loose, rattling, moist mucus in the chest.
• For children breathing and a loose cough, but little phlegm is expectorated.
• There may be vomiting and labored breathing. Pronounced physical and mental exhaustion.

3. Belladona:

• A high temperature, dry cough, a pounding, pulsating headache and a flushed face with a dry, hot skin.
• The cough is worse at night and when lying down.

4. Bryonia Alba:

• A painful, violent, dry, stitching cough with a headache and pain in the chest wall.
• Worse with coughing and better when supporting the area with both hands.
• The expectoration is yellow and often blood streaked. The cough is worse after meals.
• Patient drinks large quantities of fluids at long intervals.

5. Iodum:

• Difficult expansion of chest, blood-streaked sputum; internal dry heat, external coldness.
• Inspiration difficult. Croupy cough with difficult respiration; wheezy.
• Cold extends downwards from head to throat and bronchi. Great weakness about chest.
• Palpitation from the least exertion. Iodum cough.

6. Calcarea carbonica:

• Extreme Dyspnoea. Suffocating spells, tightness, burning and soreness in chest.
• Chest very sensitive to touch, percussion or pressure. Longing for fresh air.
• Bloody expectoration.

7. Phellandrinum:

• Respiratory remedy. Good remedy for offensive expectoration and cough phthisis.
• Tuberculosis, affecting generally the middle lobes. Everything tastes sweet.
• Dyspnoea and continuous cough early in morning.
• Cough, with profuse and fetid expectoration; compels him to sit up. Hoarseness.[3]

Diet & Regimen of Chronic obstructive pulmonary disease

• Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds, fruits and vegetables.
• Eat a good source of proteinase least twice a day to help maintain strong respiratory muscles.
• Good choices include milk, eggs, cheese, meat, fish, poultry, nuts and dried beans or peas. [2]
• Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables.

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References use for Article Chronic obstructive pulmonary disease

[1] Davidsons Principles and Practice of Medicine

[2] Chronic obstructive pulmonary disease – PubMed Health

[3] Homoeopathic Therapeutics By Lilienthal

[4]https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd

[5]https://stanfordhealthcare.org/medical-conditions/chest-lungs-and-airways/chronic-obstructive-pulmonary-disease/types.html

[6]https://www.wikidoc.org/index.php/Chronic_obstructive_pulmonary_disease_physical_examination

[7]

[8]https://my.clevelandclinic.org/health/diseases/8709-chronic-obstructive-pulmonary-disease-copd#prevention

Frequently Asked Questions

What is Chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive, and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Chronic obstructive pulmonary disease?

• Aconitum Napellus
• Antimonium Tartaricum
• Belladona
• Bryonia Alba
• Iodum
• Calcarea carbonica
• Phellandrinum

What are the causes of Chronic obstructive pulmonary disease?

• Cigarette smoking
• Exposure to air pollution
• Breathing second hand smoke
• Working with chemicals, dust and fumes
• A genetic condition called Alpha-1 deficiency

What are the symptoms of Chronic obstructive pulmonary disease?

• Chronic bronchitis and/or breathlessness
• Cough and associated sputum production ‘smoker’s cough’
• Breath sounds are typically quiet