What is COPD?
Chronic obstructive pulmonary disease (COPD) is characterised by permanently reduced lung function. This leads to increased work of breathing and feelings of breathlessness. The airways have become chronically "narrowed”, to the extent that it becomes difficult to breathe. Typical symptoms include wheezing in the chest, coughing and spitting up sputum. COPD is a collective term used to describe chronic obstructive bronchitis and emphysema.
Who suffers from COPD?
COPD is primarily a result of the airways having been exposed over many years to agents such as tobacco smoke, but also industrial contamination. Asthmatics need not develop COPD, but asthmatics that smoke are at increased risk of developing chronic changes to the airways. On a worldwide basis it is estimated that 95% of individuals with COPD are smokers and have often smoked daily for more than 20 years.
Diagnosis of COPD:
COPD develops gradually, and it can take 30-40 years before the first symptoms appear. Inflammation leads to a narrowing of the airways and scar formation which cannot be detected by normal X-ray. However, a doctor can easily determine the presence of COPD by measuring the pulmonary function. The symptoms of COPD are similar to those of asthma, and distinguishing between the two conditions can be difficult.
The intensity of symptoms in COPD can vary. Some individuals have a mild form of the disease – without being particularly restricted in terms of their ability to carry out the activities of daily living, whilst others are invalided and require a continuous supply of oxygen. In some cases, individuals have both COPD and asthma.
Prevalence:
More than 20,000 Norwegians over the age of 18 years are believed to have developed COPD. This is more than double the number with asthma. The proportion that becomes unwell increases significantly with age. The worldwide occurrence of COPD is increasing rapidly, and the World Health Organisation ranks the condition as the world's 4th leading cause of mortality.
What happens in the airways?
- Increased quantity of mucous in the bronchi.
- Inflammatory changes (inflammation) of the mucosa.
- Spasm (constriction) of the musculature surrounding the bronchi.
- Destruction of support tissue for small and large airways. In COPD damage - and eventual destruction - of the support tissue surrounding the bronchi can be observed. This results in a tendency for the bronchioles to collapse when the individual breathes out.
Treatment of COPD:
The drugs can be administered in various forms including tablets, via inhalations and as injections into the veins. In the same way as with asthma, short-term and long-acting relief medicines (beta-2 agonists) are used together with drugs which expand the bronchi, such as anticholinergics and theophylline preparations.
Inhaled cortisone is used as a preventive medicine. Combination preparations (relief medicine in combination with preventive medicine) are also used in COPD.
Prevention of COPD:
COPD is a chronic illness, and damage to tissue is irreversible, either spontaneously or by use of drugs.
The most important preventive measure is cessation of smoking. Reduction in industrial emissions and active environmental work are other important factors, together with preventive work - aimed in particular at school and sixth form students.
COPD “The new women’s disease"
Women are affected to an increasing degree. The reason is that women, during the course of the past 10-20 years, have followed the smoking habits of men, and for the past 30 years the number of female smokers has equalled that of male smokers, approximately 30 %. During this time the proportion of deaths resulting from COPD has increased by almost 90 % amongst women. More recent data show that women have a lower tolerance to tobacco than men and develop tobacco-related lung diseases at a younger age, even though they have smoked for less time. The cause of this remains unclear but may be an interaction between female hormones and the harmful substances in tobacco.
The difference between COPD and asthma:
In asthma the symptoms will appear episodically, often with swings in pulmonary function on a daily basis. In COPD the symptoms appear gradually with less variation than in asthma. In asthma the pulmonary function is normal between episodes. In COPD the pulmonary function is reduced gradually with time.
Treatment institutions
There are several institutions for the investigation, treatment and rehabilitation of COPD, such as Selli, Granheim, Glittreklinikken, Røros, Valnesfjord and Skibotn. Several of these can offer a 4-week rehabilitation programme involving input from a multi-disciplinary team.