Chronic bronchitis (chronic obstructive pulmonary disease (COPD))

What is it about ?

Chronic bronchitis (COPD) is a disease characterized by prolonged (chronic) inflammation of the small airways. The disease is said to be ‘obstructive’ because the inflammation narrows the airways.

Causes

The vast majority of patients with COPD are smokers over the age of 40. The risk of COPD increases with the number of years of smoking and the amount of cigarettes smoked.

But the disease also affects non-smokers. Possible causes include air pollution, passive smoking, and some hereditary diseases.

Symptoms

The following manifestations are characteristic of COPD:

• the chronic bronchitis : a productive cough (accompanied by phlegm) for at least three months a year, for two consecutive years;
• the’emphysema : the pulmonary alveoli are damaged, which reduces their elasticity and their ability to absorb oxygen.

Sometimes it’s hard to tell the difference with asthma. In addition, it is possible that a person suffers from COPD and asthma. Other conditions are also more common in people with COPD, such as cardiovascular disease, diabetes, the depression, the’osteoporosis and cancer.

What is its frequency?

The number of patients listed with the general practitioner with COPD varies between 1 in 200 in the 40-45 age group and 4 in 200 in the 80-85 age group.¹. The real numbers are higher, however, as COPD is often diagnosed late, if at all.

More than one in four long-term smokers will have slowly progressive airway obstruction.

COPD is more common in men, but the gap with women is gradually narrowing as more of them smoke.

How to recognize it?

If you often have a productive cough or if you feel more and more short of breath when you exert yourself, you may have COPD, especially if you smoke. Your complaints may get worse if you have a respiratory tract infection.

If you have COPD and notice a sudden worsening of your shortness of breath and mucus production, you may have acute COPD attack.

How is the diagnosis made?

The doctor can make the diagnosis and determine the severity of COPD based on a discussion, physical examination and a lung function test (spirometry). He may also proceed to a x-ray of the lungs to rule out other conditions. If you are already taking medicines for the airways (inhalers), the doctor will check whether you can continue to use them the day before the lung function test. This is because some inhalers can influence the test result.

Pulmonary function test (spirometry)

the lung function test allows the doctor to measure:

• the maximum number of liters of air you can inhale and exhale (forced vital capacity or FVC);
• the maximum amount of air you can exhale in 1 second (maximum exhale volume per second, FEV1).

These two results are also used to calculate a ratio: FEV1 / FVC or Tiffeneau index. If this index is less than 0.7 after inhaling a medicine that is supposed to open the airways (bronchodilator) you are suffering from a narrowing of the airways (COPD). In asthma, there is a marked improvement in FEV1 after inhalation, which is not the case in COPD. This test therefore helps the doctor to tell the difference between COPD and asthma.

What can you do ?

• The most important is tostop smoking. Unfortunately, if you continue to smoke, medication will not be able to slow the rapid deterioration of your lung function. If you stop, your lung function will not return to normal, but it will not deteriorate any faster than in a non-smoker. Your doctor will give you advice about your options for quitting smoking.
• Practice a physical activity regular. For example, you can walk briskly, cycle, swim or work out for half an hour a day. Physical activity and good physical condition are increasingly recognized as important factors in the treatment of COPD. They decrease the symptoms and the number of COPD attacks.
• It is also important to have a healthy and varied diet. One in 4 COPD patients is underweight, while others are overweight. If necessary, your doctor can refer you to a dietitian or a nutritionist for advice.
• If you are producing a lot of phlegm, you should spit them out well. To loosen mucus more easily from your airways, you can blow into an empty bottle through a straw.
• If you need to take medications, follow the advice of your doctor.
• Do you also vaccinate against influenza and pneumococcus (see below).

Contact your doctor promptly if:

• you have the impression that the treatment is not working;
• your symptoms are increasing;
• you want support or advice.

What can your doctor do?

Treatment and follow-up

A good diagnosis, including assessing the severity of the COPD, is important in order to start the right treatment. Good follow-up in consultation with the doctor is essential. Cardiovascular disease, diabetes, and cancer are more common in people with COPD. So be sure to be well monitored by your doctor.

Smoking cessation and physical activity are the cornerstones of treatment. The following elements can also be part of the therapeutic strategy.

Medications

Depending on the risk of COPD attacks and the symptoms, your doctor may prescribe one or more medications. Most often it will beinhalers. Your doctor will decide which type of inhaler is best for you. For example, there are dry powder inhalers, metered-dose inhalers (with inhalation chamber) or even self-triggered inhalers. The doctor or pharmacist should explain to you how to use the inhaler correctly.

The following are different forms of drugs prescribed alone or in combination for COPD:

• Short-acting bronchodilators (eg salbutamol, terbutaline, ipratropium): These drugs are only used for symptoms. The feeling of tightness subsides within 10 to 30 minutes.
• Long-acting bronchodilators (eg salmeterol, formoterol, tiotropium): The doctor prescribes these drugs in case of severe symptoms or when rapid-acting bronchodilators are not sufficient. These drugs should be taken every day.
• Inhaled corticosteroids (e.g. betamethasone, budesonide, fluticasone): Your doctor will only prescribe this type of medicine if there is an increased risk of COPD attacks. These drugs reduce the symptoms and the number of attacks of COPD.
• Theophylline : This medicine increases the effectiveness of bronchodilators, which is why it is sometimes prescribed in combination with other medicines. Its effect is unfortunately not very powerful. In addition, it can cause many side effects and interactions with other drugs.
• If you suffer from COPD crisis, the doctor may also prescribe other medicines, such as oral cortisone or antibiotics.

Oxygen therapy

If you are very short of breath, you may need to be given temporary oxygen. The general practitioner can make a request for this type of treatment from the medical adviser for a maximum of three months per year, based on your complaints and possibly an oximetry (measurement of the oxygen level) on the finger or the lobe of the hear.

If you have very severe COPD and are often very short of breath, the pulmonologist may measure the oxygen levels in your blood to determine if you are eligible for chronic oxygen therapy. Only a pulmonologist or a pediatrician can make a request to the medical adviser of the mutual fund.

Vaccinations

If you have COPD, your general practitioner will recommend a annual flu vaccination. In fact, the flu can lead to a severe attack of COPD, requiring hospitalization. A pneumococcal vaccination (pneumonia) can also be discussed.

Want to know more?

• Pulmonary alveoli in pictures – Health Passport
• COPD – FARES – Respiratory Affections Fund
• COPD (chronic bronchitis) – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Air pollution and health – mongeneraliste.be – SSMG – Scientific Society of General Medicine

• Tobacco: preparing the stop – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Stop smoking. It’s possible – Tabacstop – Foundation against cancer

• Flu – Vaccination-Info.be
• Meningitis, pneumonia and pneumococcal septicemia – Vaccination-Info.be

• The radiography, here, Where to find on this page of Cliniques St Luc UCL

• How to use inhalers – videos – Société Belge de Pneumologie
• Drugs used in COPD – CBIP – Belgian Center for Pharmacotherapeutic Information

Are you looking for more specialized help?

• Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
• Tobacco specialists – FARES – Respiratory Affections Fund
• Find a registered dietitian – Professional Union of French-speaking dieticians
• Find a nutritionist doctor – Belgian Society of Nutritionist Doctors

Sources

• Foreign clinical practice guide ‘Chronic obstructive pulmonary disease (COPD)’ (2000), updated on 09/16/2016 and adapted to the Belgian context on 04/13/2019 – ebpracticenet
  
• Foreign clinical practice guide ‘Chronic obstructive pulmonary disease (COPD)’ (2007), updated in 2015 – NHG – Nederlands Huisartsen Genootschap