Insidious lung disease. What should you know about COPD?

Chronic obstructive pulmonary disease (COPD) is a serious respiratory disease. It is one of the most common causes of death in the world. – Prevention is the most important. Because a disease that occurs so often, for which we do not have causal treatment, requires prevention – says Prof. Władysław Pierzchała, pulmonologist, internist, chairman of the Section of Obstructive Diseases at PTCHP, founder and head of the Pneumonology Department at the University Clinical Center of the Medical University of Silesia.

1. COPD, or chronic obstructive pulmonary disease, is a dangerous disease of the respiratory system that does not cause symptoms for many years
2. In Poland, almost 2 million people suffer from it
3. Modern treatment of COPD has only been possible for several years. We have two groups of medications that relax the airways – says prof. Władysław Pierzchała
4. The most important thing, however, is prevention, because there is no causal treatment – adds the pulmonologist
5. More information can be found on the Onet homepage

COPD patients are more likely to get infections

Journalists for Health Association: I have the impression that people with chronic obstructive pulmonary disease were a bit forgotten during the pandemic …

Prof. Władysław Pierzchała: Like most chronically ill people. These patients did not always have access to a doctor, and they were sometimes concerned about visiting the clinic due to the risk of infection. Patients who, for various reasons, cannot reach me for an appointment, are, however, monitored during teleportation – I just need to know how they cope with the disease.

Chronic obstructive pulmonary disease is chronic by name, but severe in its course. Should patients with COPD take special care against infectious diseases?

Definitely yes. All infectious diseases affecting the lungs and those transmitted by airborne droplets affecting only the upper respiratory tract are dangerous for people with ventilation insufficiency. And COPD is nothing more than the narrowing of the airways and the impairment of the purification function of pollutants via the mucociliary transport of the bronchi. Therefore, any bacteria or viruses that reach the respiratory tract will have more free access to the body of a COPD patient than a healthy person. It is similar with smokers.

How can COPD patients protect themselves?

Isolation is only preventive to a certain extent. Because we know that certain bacteria and viruses exacerbate COPD, immunization is the primary weapon. The most dangerous bacteria are pneumococci, and the flu virus is one of the most dangerous viruses. The whooping cough stick is dangerous. Even if vaccines do not fully protect against infection, they will certainly reduce the risk of a severe course of the disease.

What are the main risk factors for COPD

You were one of the first doctors in Poland who became interested in COPD years ago.

The interest of the medical world in this disease resulted from the need to protect the health of the employees of industrial plants. Miners, steel workers, and workers exposed to gas and dust air pollution were under special medical supervision. The first European research was carried out in Nord-Pas-de-Calais – a northern region of France, where Polish miners also worked. Hence the interest of doctors from Silesia and the transfer of research to the native soil. It turned out that these fit, strong men had ventilation insufficiency. Among the causes of this phenomenon, apart from pollution, was cigarette smoking.

1. Pulmonologist: air pollutants damage virtually all tissues and organs

This theory is supported by disease data from countries where tobacco consumption is high: China and India. Interestingly, COPD in women is more common where there is smoke in homes or kitchens due to the burning of biological materials, such as the faeces of ruminants.

What are the epidemiological data on this disease in the world and in us today?

The situation in Poland is relatively good at the moment. We have less municipal pollution, it is not appropriate to smoke cigarettes, although too many people still do it. There are therefore fewer risk factors, but still around 5 percent. of the population have COPD. The percentage of patients in the world is similar. That’s a lot.

How is COPD treated?

How is COPD treated in a modern way?

Modern treatment of COPD has only been possible for several years. We already know the nature of bronchial inflammation and which drugs improve or slow down the deterioration of ventilation. We have two groups of airway relaxants: the first are beta-amimetics with a long action of at least twelve hours, and the second are cholinolytics. Both groups act on receptors in the lungs to improve lung ventilation and bronchial clearance.

Sometimes an additional anti-inflammatory drug used in asthma is needed, i.e. an inhaled steroid or a steroid that inhibits neutrophilic inflammation, also available in Poland, oral roflumilast.

1. Fans of popular drinks are more likely to have asthma and COPD

These are indeed modern, most effective drugs. The key thing, however, is that they were combined in one preparation. The patient now does not need to take several medications, at different times, in a different dose. In one inhaler, it has three anti-inflammatory and relaxant drugs in appropriate doses, in two receptor mechanisms. This is the best option at the moment. Unfortunately, we still do not have a causal drug that effectively eliminates neutrophilic inflammation in the lungs.

If the patient follows the doctor’s recommendations, is there any chance that the disease will not get worse?

Yes, the risk of exacerbations will decrease. Importantly, any exacerbation results in a deterioration of lung function. If there are fewer of them, or if drugs can eliminate them altogether, the patient will live longer and later will suffer from respiratory disability.

Needless to say, he can’t smoke …

COPD – what should the prevention look like?

During a pandemic, we are most often talking about vaccination against COVID-19. Now, in the fall, also about the flu. However, there are other vaccinations, recommended not only for children, but also for adults, especially those suffering from chronic diseases.

We vaccinate children against whooping cough because the whooping cough bacillus causes acute laryngitis and may even cause suffocation. However, thanks to pneumococcal vaccination, children can avoid not only pneumonia, but also a severe disease that sometimes leads to disability, i.e. pneumococcal meningitis.

1. COPD is the third leading cause of death in the world

Adults should also be vaccinated. Coughing in the course of whooping cough impairs ventilation of the lungs, and the bacterium also damages the epithelium of the respiratory tract. In this way, it lowers the innate immunity, i.e. the mucosal barrier in the bronchi, throat and nose. It also reduces the production of locally acting immunoglobulin A.

All this exacerbates inflammation and significantly worsens the health of a person with COPD. So patients, especially those who have frequent exacerbations, should be vaccinated against whooping cough.

What should you know about COPD?

The most important thing is prevention. Because a disease that occurs so frequently and for which we have no causal treatment, requires prevention. Both its formation and progression. The possibilities are huge: first, stop smoking and avoid air pollution. Secondly, physical activity is necessary to maintain adequate muscle mass. It doesn’t have to be a competitive sport, a walk is enough. The third element is to avoid viral and bacterial infections. We can only do this by vaccinating against influenza, pneumococcus and whooping cough.

Now against COVID-19 …

Yes, beyond any doubt. People with chronic obstructive pulmonary disease belong to the group of increased risk of developing the disease and severe course of the disease, therefore they should be vaccinated not only with two doses, but also with a third, booster dose.

Authorized press interview prepared by the Journalists for Health Association in connection with the World COPD Day, November 2021.

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2. How does smog kill? The problem is more serious than we think
3. Cardiovascular diseases are killing Poles. “We don’t care about our hearts, doctors are too passive”

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