Respiratory disorders
are common amongst old people. For many reasons they often remain
underestimated, undiagnosed and uncured, which could lead to premature death or
decrease the patient's expectancy of life.
Chronic obstructive
pulmonary disease (COPD) is one of the most common health issues, related to
the respiratory system. COPD affects more than 10% of the world population and
its prevalence increases with age (14% in patients aged over 65 years and 19%
for those over 70 years). COPD would probably become the third leading cause of
death and disability by the year 2020.
COPD is characterized by
• Obstruction of the airways- the bronchial walls become thicker as smooth muscles and glands that compose them overgrow
• Chronic inflammation of the lung- for reasons still unknown, the immune system cells produce a lot of substances, that cause persistent inflammation
• Emphysematous changes in the lungs- dilatation and destruction of the smallest breathing units- the alveoli
COPD is characterized by
• Obstruction of the airways- the bronchial walls become thicker as smooth muscles and glands that compose them overgrow
• Chronic inflammation of the lung- for reasons still unknown, the immune system cells produce a lot of substances, that cause persistent inflammation
• Emphysematous changes in the lungs- dilatation and destruction of the smallest breathing units- the alveoli
Causes
The causes for COPD development are on the first place smoking (COPD prevalence reaches 50% in heavy smokers) as he tobacco smoke deteriorates the normal structure and function of the respiratory apparatus. Polluted air and working in a polluted environment may also be a reason for lung dysfunction. Genetics also play role in the development of COPD- the deficiency of Alpha-1-antitripsin- an enzyme with protective effect, regarding the lungs, is responsible for early COPD.
The causes for COPD development are on the first place smoking (COPD prevalence reaches 50% in heavy smokers) as he tobacco smoke deteriorates the normal structure and function of the respiratory apparatus. Polluted air and working in a polluted environment may also be a reason for lung dysfunction. Genetics also play role in the development of COPD- the deficiency of Alpha-1-antitripsin- an enzyme with protective effect, regarding the lungs, is responsible for early COPD.
When it comes to
elderly, there are certain other factors that contribute to the appearance of
COPD. The elasticity of the lungs decreases with age, which causes bronchiolar
diameter to diminish, while alveoli enlarge. These changes result in decreased
expiratory flow and reduced surface for gas exchange. Contrary to the lungs,
the chest becomes more rigid with age. Costochondral and costovertebral
cartilages calcify, limiting the respiratory movements of the chest.
Respiratory muscles' strength also decreases. The mucociliary apparatus and the
cough, which are responsible for the clearance of the airways from foreign
substances, become less effective.
Furthermore the changes that occur in the immune system during ageing, also contribute to the development of COPD. For example, pro inflammatory substances increase their quantities with age and COPS is characterized by chronic inflammation of the lungs.
Furthermore the changes that occur in the immune system during ageing, also contribute to the development of COPD. For example, pro inflammatory substances increase their quantities with age and COPS is characterized by chronic inflammation of the lungs.
Symptoms
Many of the COPD symptoms are nonspecific and elderly patients tend to neglect them. They include:
• Dyspnea (difficulty to breath)- a lot of patients assume that the dyspnea is part of the ageing process and do not pay attention to it, except when it becomes severe. In addition, as the majority of the patients with COPD are smokers (or ex-smokers), they attribute their condition to the cigarettes. Dyspnea may also be explained with the presence of other diseases, mostly heart failure.
• Wheezing- as for the dyspnea, wheezing is often mistaken as a symptom long term smoking, or other conditions such as asthma or pneumonia.
• Cough- another common symptom of COPD that is underestimated for the same reasons as dyspnea and wheezing. Moreover, cough could be a side effect of some medications such as ACE-inhibitors, used in the therapy of hypertension and heart failure. Cough may or may not be accompanied by expectoration. In case that the sputum changes its quantity or color, acute exacerbation or added infection should be considered.
Many of the COPD symptoms are nonspecific and elderly patients tend to neglect them. They include:
• Dyspnea (difficulty to breath)- a lot of patients assume that the dyspnea is part of the ageing process and do not pay attention to it, except when it becomes severe. In addition, as the majority of the patients with COPD are smokers (or ex-smokers), they attribute their condition to the cigarettes. Dyspnea may also be explained with the presence of other diseases, mostly heart failure.
• Wheezing- as for the dyspnea, wheezing is often mistaken as a symptom long term smoking, or other conditions such as asthma or pneumonia.
• Cough- another common symptom of COPD that is underestimated for the same reasons as dyspnea and wheezing. Moreover, cough could be a side effect of some medications such as ACE-inhibitors, used in the therapy of hypertension and heart failure. Cough may or may not be accompanied by expectoration. In case that the sputum changes its quantity or color, acute exacerbation or added infection should be considered.
Diagnosis
The diagnose COPD is based on several tests:
• Chest X-ray or CAT may be useful to spot the emphysema and exclude other reasons for the patient's symptoms
• Spirometry- it is one of the most common tests for appreciating the function of the lungs. Spirometry is performed trough an instrument, called spirometer, which you blow into. Different measurements of the airflow are then conducted. Amongst them is the forced expiratory volume-1 (FEV-1), which represents the quantity of air you exhale during the first second of maximal expiration. Other important index is the forced vital capacity (FVC)- the maximal amount of air you exhale, after inhaling as much air as you can. The ratio between FEV-1 and FVC is used to determine whether there is bronchial obstruction or not
• Blood tests- such as blood gas analysis may be used additionally to confirm the diagnosis.
• Sputum could be testes for presence of microorganisms
The diagnose COPD is based on several tests:
• Chest X-ray or CAT may be useful to spot the emphysema and exclude other reasons for the patient's symptoms
• Spirometry- it is one of the most common tests for appreciating the function of the lungs. Spirometry is performed trough an instrument, called spirometer, which you blow into. Different measurements of the airflow are then conducted. Amongst them is the forced expiratory volume-1 (FEV-1), which represents the quantity of air you exhale during the first second of maximal expiration. Other important index is the forced vital capacity (FVC)- the maximal amount of air you exhale, after inhaling as much air as you can. The ratio between FEV-1 and FVC is used to determine whether there is bronchial obstruction or not
• Blood tests- such as blood gas analysis may be used additionally to confirm the diagnosis.
• Sputum could be testes for presence of microorganisms
Treatment
Several groups of medications are used in COPD treatment. Combinations between drugs vary from patient to patient, depending on his condition.
• Bronchodilators- medicaments that relax the smooth muscles of the bronchi and therefore facilitate the breathing. Bronchodilators could be with short action or with prolonged effects.
• Inhaled or oral corticosteroids- used to reduce inflammation
• Combined inhalers- contain both bronchodilators and steroid- to reduce the number of drugs the patient takes and therefore to increase his willingness to follow his treatment scheme
• Theophylline- helps the relaxation of the bronchi and has certain anti-inflammatory effect
• Phosphodiesterase-4 inhibitor: medicament of the newest generation, used for patient with severe COPD, not responding to other treatments
• Antibiotics- could be prescribed to treat exacerbations, when there is an added infection, but are not convenient for support treatment
• Surgical approaches for non-responding patients such as lungs transplant or lung volume reduction surgery are also available, but are rarely performed.
Several groups of medications are used in COPD treatment. Combinations between drugs vary from patient to patient, depending on his condition.
• Bronchodilators- medicaments that relax the smooth muscles of the bronchi and therefore facilitate the breathing. Bronchodilators could be with short action or with prolonged effects.
• Inhaled or oral corticosteroids- used to reduce inflammation
• Combined inhalers- contain both bronchodilators and steroid- to reduce the number of drugs the patient takes and therefore to increase his willingness to follow his treatment scheme
• Theophylline- helps the relaxation of the bronchi and has certain anti-inflammatory effect
• Phosphodiesterase-4 inhibitor: medicament of the newest generation, used for patient with severe COPD, not responding to other treatments
• Antibiotics- could be prescribed to treat exacerbations, when there is an added infection, but are not convenient for support treatment
• Surgical approaches for non-responding patients such as lungs transplant or lung volume reduction surgery are also available, but are rarely performed.
Conclusion
Apart from taking their medicine on a regular basis, patients should also be advised to stop smoking, have a healthy lifestyle and include some breathing exercises in their everyday life in order to improve their symptoms and quality of life.
Apart from taking their medicine on a regular basis, patients should also be advised to stop smoking, have a healthy lifestyle and include some breathing exercises in their everyday life in order to improve their symptoms and quality of life.
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