COPD: A co-morbid disease

The most significant risk factor for COPD is long-term cigarette smoking.
COPD: A co-morbid disease
Representational pic

COPD is an umbrella term used to describe progressive lung diseases that includes emphysema, chronic bronchitis, and refractory (non-reversible) asthma. The Official American Thoracic Society and European Respiratory Society define COPD as a preventable and treatable ailment state characterized by airflow limitation that is not fully reversible. Emphysema and chronic bronchitis are the two most common conditions that contribute to the pathogenesis of COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It is characterized by a daily cough and sputum production. On the contrary, emphysema is a pathological state in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of cigarette smoke and other irritating gases and particulate matter.  It is a currently incurable disease, however, with the right diagnosis and treatment, there are many things one can do to manage COPD and breathe better. People can live for many years with COPD and enjoy a normal life. COPD have at least one coexisting medical condition often conceptualized as 'comorbidities'. These coexisting ailments vary in severity and impact. In United States, more people die from COPD than from any other ailment excluding cardiovascular disease and cancer. People with COPD are at increased risk of developing coronary heart disease, lung cancer, and a host of other diseases as well. COPD is treatable and with proper management, most people with COPD can achieve good symptom control and quality of life, as well as the reduced risk of other associated conditions. As far Kashmir region is concerned, a prevalence of 17% in males and 15% in females aged ≥40 years in spirometrically diagnosed COPD patients has been reported. This statistical figure clearly point towards its high prevalence in Kashmir valley. In our recent investigation published in Springer's LUNG, collaborated with Dr. Naveed Nazir Shah, Professor & Head, Government Chest Disease Hospital, Dalgate, Srinagar and Dr. Khalid Majid Fazili, Professor & Head, Department of Biotechnology, University of Kashmir, our results unfolded alpha-1 anti-trypsin (AAT) deficiency and hepatic pathology (obstructive jaundice) in COPD cases in Kashmir valley. AAT is a sensitive anti-inflammatory protein that has an ability to dampen the inflammatory response on lungs driven by environmental irritants like smoking. Therefore, the reduced level of serum AAT driven by environmental irritants can increase the level of protease secretion at the site of inflammation, thereby accelerating the symptoms of COPD. Therefore, in this context, environmental risk factors including cigarette smoking, poorly ventilated kitchens, occupational smoke exposure are key players that may lead to the AAT-deficiency driven pathogenesis of COPD.  


COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over a period of time, more particularly, if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months in a year for two consecutive years. Other signs and symptoms of COPD may include shortness of breath, especially during routine physical activities, wheezing, chest tightness, to clear your throat first thing in the morning, due to excess mucus in the lungs, white, yellow or greenish, blueness of the lips or fingernail beds (cyanosis), frequent respiratory infections, lack of energy, unintended weight loss (in later stages of COPD), swelling in ankles, feet or legs. The most significant risk factor for COPD is long-term cigarette smoking. The more years one smoke and the more packs one consume, the greater is the risk. Pipe, cigar and marijuana smokers may also be at risk, as well as people exposed to large amounts of second-hand smoke. The combination of asthma and smoking increases the risk of COPD even more. Long-term exposure to chemical fumes, vapours and dust in the workplace can irritate and inflame the lungs. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD. It develops slowly over years, so most people are at least 40 years old by the time symptoms begin. 

AAT deficiency, an uncommon genetic disorder, is the cause of some cases of COPD. Other genetic factors likely make certain smokers and even nonsmokers more susceptible to catch COPD in early age. COPD can cause many complications, including: (1) People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung parenchyma. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. (2) For reasons that are not fully understood, COPD can increase the risk of heart disease, including heart attack. Quitting smoking may reduce this risk. (3) People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk and (4) COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

Diagnosis: We recommend ethnic Kashmiris, who fall in the age group between 40–60 years, suffering from intermittent respiratory infections, breathlessness (dyspnea) while performing normal activities like brisk walking, climbing upstairs, cough of more than six months of duration, hemoptysis, swollen feet, cyanosis, purple coloration of lips, to undergo stringent screening that includes high resolution chest tomography (HRCT), pulmonary function test (PFT), serum AAT quantification, arterial blood gas (pCO2 and pO2) analyses, and host of other screening tests as well.   

Prevention: Unlike some other diseases, COPD has a clear cause and a clear path of prevention. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now. Occupational exposures like chemical fumes, dust and non-ventilated kitchens are some of the main risk factors for the development of COPD. Therefore, it is imperative to avoid such exposure in order to mitigate the extent of inflammatory assault on lungs. 

Dr. Arif Bashir is Ph.D in Clinical Biochemistry. He is an invited referee of Springer's Tumor Biology, The Netherlands.                                                                                                                                                                    

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