Early Detection and Integrated Care Strategies for COPD

Information from the Taiwan Society of Pulmonary and Critical Care Medicine indicates that more than 40% of the public are unaware of COPD, and nearly 50% of the respondents did not seek medical assistance even though they had suffered persistent symptoms of “cough, phlegm, and shortness of breath” for three weeks.

COPD’s causes and impacts
COPD can be triggered by various environmental and lifestyle factors. In developed countries, smoking is the primary cause, while in developing regions, long-term exposure to polluted air and harmful gases is a major contributor. These inhalation injuries trigger inflammatory responses in the lungs, leading to progressive airway obstruction that affects different parts of the respiratory system:
· Large airways (bronchi): Chronic inflammation can cause chronic bronchitis , leading to a persistent cough and increased phlegm production.

• Small airways (bronchioles): Fibrosis may develop, further restricting airflow and making breathing more difficult.
• Alveoli: In the event of alveolar destruction, emphysema will occur, making the lungs lose their elasticity and further aggravating airway obstruction.

Dr. Chen Kuan-Yuan, physician in Shuang Ho Hospital’s Department of Pulmonary Medicine, points out that airway obstruction significantly impairs gas exchange, leading to shortness of breath, chest tightness, and chronic coughing. In severe cases, patients may even struggle to breathe while at rest.

Beyond the respiratory system,  COPD can also trigger systemic inflammatory response, which when related to comorbidity effects linked with cardiovascular diseases, osteoporosis, diabetes, lung cancer, etc., can hamper quality of life and shorten patients’ lifespan. Early diagnosis and intervention are critical in managing COPD progression and preventing severe complications.

The importance of early diagnosis
Normally physicians will use a spirometer (lung function device) to test the patients’ lung function, asking patients to inhale and exhale as fully as they can. If the test result based on the amount and speed of the air being blown out suggests airflow obstruction, this serves as the main basis for diagnosing COPD. It is also an important indicator of disease severity.

A major concern for COPD patients is acute exacerbation, a sudden worsening of symptoms characterized by difficulty breathing, worsened coughing, and increased sputum (mucus or phlegm). An acute exacerbation will affect patient’s lung function, and may lead to accelerated lung function loss, lowered quality of life, increased hospitalization rates, and even an elevated risk of death.

• For COPD patients whose first hospitalization is for an acute exacerbation, the fatality rate during hospitalization is approximately 4%.
• If the patient is moved to the ICU, the fatality rate rises to 10%. The fatality rate is as high as 8.3% for patients who need ventilators.
• Even when a patient is successfully discharged, steroids used during hospitalization may have caused muscular deterioration. This can lead to disability, thus increasing risks of subsequent readmission.

Treatment and home healthcare for COPD patients
Early diagnosis allows for effective management of COPD. Physicians typically prescribe inhalers to deliver medications such as bronchodilators to relieve their symptoms. Depending on disease severity, anti-inflammatory drugs and additional respiratory therapies may also be recommended. In addition, non-pharmaceutical therapies including pulmonary rehabilitation plans (such as smoking cessation, breathing training, and exercises) also play an important role in the course of treatment and in improving patients’ lung function and quality of life. Pulmonary rehabilitation plans can begin with simple training that can be done at home, for example, the pursed lip breathing technique (breathing in through the nose and out through pursed lips). These plans can help prevent the large airways from collapsing, and relieve breathing difficulties.

Dr. Chen highlights that Shuang Ho Hospital aims for COPD detection , offering free lung function screening services to people aged 18 and over. If you’d like to know more about your health, and if you often experience shortness of breath or suffer from chronic cough or coughing up phlegm, Dr. Chen recommends getting a lung screening as early as possible. If you have any questions or need further consultation, you’re welcome to visit Shuang Ho Hospital’s Pulmonary Clinic, where expert physicians can provide complete diagnosis and suggestions for you.