Respiratory Diseases

Respiratory Area

According to WHO data, there are about 210 million people with COPD, 65 million with moderate to severe COPD, causing 3 million deaths globally. ^(1),(3),(19) It is estimated that by 2030, COPD will be the third cause of death in the world. ⁽¹⁾

COPD

COPD is defined as a frequent, preventable and treatable disease characterized by persistent respiratory symptoms and limitation of airway flow resulting from alveolar and/or airway changes caused by significant exposure to harmful particles and gases. ⁽²⁾

COPD has a high impact on both individuals and society

In addition to being a disabling disease associated with premature mortality, COPD is also associated with increased health care needs and hospital stays due to exacerbations. ^(1),(3),(4) The cost of COPD is more than just financial, as it affects the quality of life of patients and has a detrimental impact on their mental health ^(1),(2),(3)The prevalence of COPD is expected to increase in the coming decades. ^(2),(5)

Risk Factors ⁽²⁾

• SMOKING
• Exposure to polluting gases, dust or chemicals
• Family History (rare and more frequent in individuals of European descent)
• Poor lung development (decreased lung function)
• Nutrition and Socioeconomic Status
• Respiratory infections (in childhood)

How does COPD cause airflow limitation?

The typical airflow limitation of COPD is caused by narrowing and/or obstruction of the airways, loss of elastic retraction, or both ⁽⁶⁾.

^{Adapted from 6}

Symptoms

• Dyspnea is the distinctive symptom of COPD. It is usually persistent and progressive - also known as shortness of breath ⁽⁷⁾
• Chronic cough ⁽⁷⁾
• Wheezing ⁽⁷⁾

What is an exacerbation? ⁽⁸⁾

• It is an acute worsening of symptoms
• Increased shortness of breath during normal daily activities, with a consequent increase in the use of usual medication and/or need for medication.
• Sputum production, which can become more frequent than is normal for the patient, or be viscous;
• Cough that can occur due to increased sputum

Impact of exacerbations

• Increased airway inflammation
• Decreased quality of life ⁽⁸⁾
• Increased mortality rate ⁽⁸⁾
• Rapid decline in lung function ⁽⁸⁾

Associated illnesses ⁽⁹⁾

• Cardiovascular diseases ^(10),(11)
• Diabetes ^(12),(13)
• Depression⁽¹⁴⁾
• Osteoporosis^(14),(15)
• Lung cancer ⁽¹⁶⁾
• Weight loss ⁽¹⁷⁾

Diagnosis ⁽¹⁹⁾

The clinical diagnosis of COPD should be considered in any patient who has the following symptoms:

• Dyspnea, chronic cough or sputum

Airflow measurement by spirometry is required ⁽²⁾

• presence of air flow obstruction due to spirometric changes (FEV1/FVC ratio below 0.70 after bronchodilation) ⁽¹⁹⁾

^{Adapted from 19}

How are symptoms assessed?

• Medical Research Council (mMRC) modified dyspnea scale - assesses dyspnea intensity, ranging from zero to four.⁽²⁾
• COPD (CAT) assessment test questionnaire - Measures the impact of COPD on quality of life.⁽²⁾
• COPD clinical questionnaire (CCQ) - measures functional status, symptom and mental status), related to people with COPD.⁽²⁾
• Questionnaire about shortness of breath with daily activities (SOBDA) ⁽¹⁸⁾

Treatment objectives

1. Reduction of current symptoms ⁽²⁾:

• Relief of symptoms;
• Improved tolerance to physical exercise;
• Improved health status.

2. Reducing future risks consists of ⁽²⁾:

• Preventing disease progression;
• Preventing and treating exacerbations;
• Decreased mortality.

Treatment

The main therapeutic measures are ⁽²⁾:

• Quit smoking
• Medicines - Bronchodilators (used according to the severity of the disease and the presence or absence of exacerbation)
• Respiratory rehabilitation
• Oxygen therapy
• Proper nutrition and lifestyle

Acronyms:
COPD - Chronic Obstructive Pulmonary Disease
WHO - World Health Organization
FEV1 - Forced expiratory volume in 1 second
FVC - Forced Vital Capacity
GOLD - Global Initiative for Chronic Obstructive Lung Disease
mMRC – Modified Medical Research Council dyspnea scale
CAT – Scores de COPD assessment test
CCQ – Clinical COPD Questionnaire
SOBDA – Shortness of Breath with Daily Activities Questionnaire

^{Medinfar-2020-05-FL-02 drafted in April 2020}