Dr SK VARUN
DAINIK NATION BUREAU
Air pollution smoking and occupational dust are responsible for COPD. Smog in Delhi is equivalent to 40 cigarettes smoking per day.
Chronic obstructive pulmonary disease (COPD) is defined as a disease state characterized by airflow limitation that is not fully reversible COPD is the third leading cause of death and affects > 10 million persons in the United States. COPD is also a disease of increasing public health importance around the world. Estimates suggest that COPD will rise from the sixth to the third most common cause of death worldwide by 2020.
Cigarette smoke exposure may affect the large airways, small airways and alveoli. Changes in large airways cause cough and sputum, while changes in small airways and alveoli are responsible for physiologic alterations. Emphysema and small airway pathology are both present in most persons with COPD; however, they do not appear to be mechanically related to each other, and their relative contributions to obstruction vary from one person to another.
Although the causal relationship between cigarette smoking and the development of COPD has been absolutely proved, there is considerable variability in the response to smoking. Although cigar and pipe smoking may also be associated with the development of COPD，the evidence supporting such associations is less compelling, likely related to the lower dose of inhaled tobacco byproducts during cigar and pipe smoking. Increased respiratory symptoms and airflow obstruction have been suggested to result from exposure to dust and fumes at work.
Several specific occupational exposures, including coal mining, gold mining, and cotton textile dust， have been suggested as risk factors for chronic airflow obstruction. Although nonsmokers in these occupations can develop some reductions in vital capacity, the importance of dust exposure as a risk factor for COPD, independent of cigarette smoking, is not certain for most of these exposures. However, among coal miners, coal mine dust exposure was a significant risk factor for emphysema in both smokers and nonsmokers. In most cases, the magnitude of these occupational exposures on COPD risk is likely substantially less important than the effect of cigarette smoking. Exposure of children to maternal smoking results in significantly reduced lung growth. In pregnancy, tobacco smoke exposure also contributes to significant reductions in postnatal pulmonary function.
The three most common symptoms in COPD are cough, sputum production, and exertional dyspnea, many patients have such symptoms for months or years before seeking medical attention. Although the development of airflow obstruction is a gradual process, many patients date the onset of their disease to an acute illness or exacerbation. It has been shown that middle aged smokers who were able to successfully stop smoking experienced a significant improvement in the rate of decline in pulmonary function, returning to annual changes similar to that of nonsmoking patients. Thus all patients with COPD should be strongly urged to quit smoking and educated about the benefits of quitting.
In general bronchodilators are used for symptomatic benefit in patients with COPD Although a recent trial demonstrated an apparent benefit from the regular use of inhaled glucocorticoids on the rate of decline of lung function. Patients with COPD should receive the influenza vaccine annually.
senior Consultant physician and diabetologist
department of internal medicine
Synergy Institute of Medical Sciences Dehradun UK.