What is the Meaning of COPD?
There are many types of Chronic Lung Diseases. The most common type of lung disease is "obstructive lung disease" This is called COPD. It is the abbreviation of the term chronic Ostrictive Lung Hdisease. The term actually refers to a group of diseases that share a common feature; This common feature is the difficulty in removing air from the lungs. This condition is called expiratory obstruction (obstruction in breathing).
Under the COPD label, there can generally be three disease conditions with similar features. 1- Chronic bronchitis, 2- emphysema, 3- asthma. Although each of these three diseases develops due to different factors, they all have expiratory obstruction (blockage or narrowing while exhaling) as a common feature. In terms of treatment, it is not important to distinguish between these three diseases; Because most people with COPD have a combination of symptoms of these three diseases, intertwined like the Olympic rings. The symptoms of these diseases are similar to each other. In terms of scientific research, it is important to separate the diseases that fall under the concept of COPD from each other for their treatment.
CHRONIC BRONCHITIS
In chronic bronchitis, the cells lining the inside of the bronchi (airways) The layer (mucosa) swells due to inflammation. Secretory cells in this mucosa and under the mucosa increase in number and develop excessively. For this reason, they produce excessive amounts of mucus.
Swelling of the mucosa narrows the airways, making breathing difficult. Excessive mucus formation further increases the narrowing of the airways; It even causes some of them to become completely blocked. The effort to expel excess mucus in the form of phlegm causes chronic cough. Due to these abnormalities, the lungs become infected (inflamed) more easily. As a result of repeated infections, diseases may occur in the lung structure. In some patients with chronic bronchitis, permanent enlargement of the airways (bronchi) and destruction of cartilage structures (bronchiectasis) may occur. in the alveoli (lung air sacs) fibrosis (hardening of the tissue structure by losing its properties) may occur. Narrowing of the bronchial tubes makes it difficult for air to enter and exit. When some of the bronchi become completely blocked with mucus plugs, oxygen does not reach the alveoli (air sacs) that they ventilate, carbon dioxide cannot be removed, and the alveoli may collapse. This condition is called atelectasis.
Due to all these changes, chronic cough, sputum production and shortness of breath occur, which are the triple symptoms of chronic bronchitis.
EMPHYSEMA
Emphysema is a disease that consists of excessive swelling and rupture of the walls of the alveoli (air sacs). As the alveolar walls rupture, one, two, three, four or more sacs merge and become a larger sac. As a result, the number of alveoli (air sacs) decreases and the remaining ones become extremely enlarged. As a large air gap (sac) is formed as a result of the merging of many tiny sacs, its elasticity decreases. In other words, in patients with emphysema, the "elasticity" of the lung is reduced. To visualize the problems that arise, let's look at how a balloon inflates and deflates. To fill air into a balloon, you inflate it by blowing; An active “work” is done during inflation. As soon as we stop blowing and take our mouth off the balloon, the air comes out of the balloon's mouth even though no work has been done, and the balloon returns to its previous state, that is, it deflates. The deflation of the balloon depends on its elastic structure. Thanks to the balloon's own elasticity, it deflates and releases the air inside.
The inflation and deflation of the balloon is similar to the functioning of normal alveoli. We breathe (that is, we do work) to inflate our alveoli. When we release our chest after breathing, the lungs return to their pre-breathing volume, thanks to their elastic properties, without exerting any effort. In this respect, exhalation "Exhalation" (taking air out of the lungs) is a passive event. It occurs on its own. No work is wasted. In a person with emphysema, the lungs and alveoli act like a paper bag. Inflate a paper bag by blowing it with air What happens if you stop it? Nothing happens. The paper bag does not return to its original shape and remains filled with air. The wall of the paper bag is not elastic; does not shrink. To release the air inside an inflated paper bag, we need to squeeze it with both hands; We have to do additional work to get the air out. Patients with emphysema also need to do additional work (contracting their chest and abdominal muscles) to evacuate air from their lungs. Since the patient with emphysema can exhale by squeezing himself to exhale, they need to expend extra energy. In addition, the loss of elasticity of the lungs also affects the smaller diameter bronchial tubes. In order to remove air from these less elastic emphysema lungs, it is necessary to create higher pressure in the chest cavity and lungs. When this pressure increases, the diameter of small-diameter bronchi with weak walls narrows as they are crushed under pressure. It becomes more difficult for the air coming from the alveoli to evacuate through the narrowed small airways (bronchi). Collapse of the bronchial tubes, that is, narrowing of their diameter due to crushing (obstruction), also occurs when coughing. In this regard, cough in COPD increases bronchial narrowing. This narrowing also makes it difficult to cough up mucus. The accumulation of mucus, on the other hand, makes the lungs more susceptible to infections. Germs reproduce more easily and quickly in a liquid environment.
ASTHMA
Asthma disease is the swelling of the cell cover (mucosa) lining the inside of the bronchi and mucus secretion (secretion) due to the effect of some irritants (irritants). It is a disease characterized by an increase in These changes lead to narrowing of the bronchi. The same irritants cause the muscles surrounding the wall of the bronchi to contract (spasm). This spasm causes the diameters of the already narrowed bronchi to narrow further as a result of swelling of the mucosa. When these changes occur, the patient experiences sudden shortness of breath attacks. Sometimes asthmatics experience cough and whistling attacks. There are many irritants that cause asthma, such as upper respiratory tract infections, cold air, dark fog and cigarette smoke. BUT! The most important difference between asthma and chronic bronchitis and emphysema is that the symptoms may disappear completely after a while and the patient's complaints completely improve and return to normal. Another very important difference that distinguishes asthma from emphysema is that the alveolar walls are not destroyed in asthma.
In some asthmatics, allergy causes inflammation and therefore narrowing of the membrane (mucosa) covering the inside of the bronchi. Substances that cause allergies and are called ALLERGENS are proteins. In asthmatics, allergens enter the body through the bronchi (airways) through inhalation. Allergy only occurs in people called atopic. In atopic people, some immune substances are formed in the body against allergens. If an atopic person encounters allergens again, inflammation occurs and asthma attacks occur. In addition to bronchial spasm in allergies, skin rashes, stomach or intestinal disorders, itching sensation in the larynx, tightness, etc. It may also be possible.
The bronchial muscles of most people with asthma respond to external irritations much more than those of normal people. (hypersensitivity, hyperreactivity). Therefore, inhaled irritants, even in small amounts, can cause bronchial spasm in people with hypersensitivity. However, the same irritants do nothing in non-atopic patients. This overreaction of the bronchi is also found among other family members of the patient (that is, it is an inherited tendency)
Only severe forms of asthma with persistent shortness of breath are included in the COPD group
HOW DOES COPD OCCUR?
The cause of Chronic Obstructive Pulmonary Disease, other than asthma, has not been precisely explained. Most likely, the causes of emphysema, chronic bronchitis and asthma are different from each other. However, some features are common to all three diseases. For example, it is possible that a hereditary tendency plays a role in the formation of these three disorders.
Air pollution, exposure to dust and fumes in the air of workplaces, and especially lung infections aggravate the complaints of all COPD patients. Allergy plays a role in asthmatics; but it has no effect on emphysema and chronic bronchitis. Chronic Obstructive Acute It is very difficult to take precautions for some of the factors that cause lung disease. BUTpreventing only one factor is in one's hands: staying away from cigarette smoke. As research conducted in recent years has definitely shown, the most important cause of COPD is cigarette smoke. Although emphysema and chronic bronchitis occur in many smokers, these diseases are extremely rare in non-smokers; Asthma becomes very severe as a result of smoking.
WHAT ARE THE SYMPTOMS OF COPD?
The first symptom that attracts the attention of a person with emphysema is the shortness of breath that occurs with movement (climbing stairs or walking fast). This symptom of shortness of breath is not taken into consideration at first, and patients often attribute it to "lack of exercise" or "old age".
The first symptom of chronic bronchitis is cough and sputum production. These symptoms are interpreted as "chest cold" at the beginning of the disease.
These symptoms usually begin during a respiratory infection; But unlike a simple cold in normal people, complaints last for weeks. After a while, shortness of breath with movement is added to this cough. When a patient with complaints of cough, sputum production and shortness of breath contracts the flu or another type of lung infection, the complaints may suddenly become much more severe.
In fact, emphysema and chronic bronchitis are very common in smokers. However, in some smokers, emphysema symptoms predominate, while in others, chronic bronchitis symptoms predominate.
Asthma usually occurs in young people who do not smoke. Complaints of cough, shortness of breath, and wheezing in the form of whistling occur suddenly in the form of a crisis. These crises (seizures) initially come and go from time to time. People with asthma do not experience complaints outside of seizure periods, and their lung functions may be normal or close to normal. The biggest difference between asthma and chronic bronchitis and emphysema is that it can return to normal. Cough with a slight whistling effect in some asthmatic patients
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