Chronic Obstructive Pulmonary Disease
Chronic Bronchitis and Pulmonary Emphysema are commonly found diseases, almost entirely resulting from the inhalation of toxic pollutants, which can be in the form of gas or dust. This leads to inflammation and destruction of the respiratory system, including the bronchi and lungs. These diseases almost always occur together. Some patients may have more severe bronchitis, whereas others may have more severe emphysema. It’s rare for patients to have just one condition. Thus, the medical community collectively refers to these conditions as Chronic Obstructive Pulmonary Disease (COPD).
Symptoms
Common history includes heavy smoking over a long period and chronic coughing. Initially, coughing mostly occurs in the morning after waking up, presenting as a dry cough or with a small amount of clear sputum. Patients easily catch colds. At this stage, fatigue symptoms may not be present or, if they are, they are not severe. Eventually, patients will experience difficulty breathing and increased breathlessness, which worsens over time even if smoking cessation occurs, and may lead to death due to respiratory failure.
Diagnosis
Aside from a history of smoking and patient symptoms, lung function tests are more sensitive for diagnosis than X-rays. Often, patients with advanced Chronic Obstructive Pulmonary Disease may still have normal chest X-rays. Lung function tests can detect airway constriction during exhalation earlier than other methods.
Medication Treatment
Patients’ symptoms, such as difficulty in breathing and breathlessness during physical activity, lead to a decline in both physical and mental health. The difficulty breathing is due to bronchial constriction caused by inflammation, muscular spasms around the bronchi, mucus in the bronchial tubes, and small airways (Bronchiole) being pressurized to close (Expiratory Dynamic Airway Compression) during exhalation. Therefore, there are five types of drugs used:
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Anti-inflammatory drugs, such as Corticosteroids
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Bronchodilators
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Mucolytics
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Antibiotics, when there is a respiratory infection
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Supplementary oxygen at home as necessary
Currently, appropriate medication may improve lung function and potentially extend life. Several drugs are in the testing phase and may prove effective. Early treatment when patients experience an exacerbation of the disease is crucial, characterized by increased coughing, more sputum, pus-like sputum change, and increased difficulty breathing. Delay in treatment leads to more difficulties, and most patients eventually die from respiratory failure, often following a respiratory infection, when seeking medical help too late.
Surgical Treatment
Surgery is less commonly performed compared to the number of patients and is considered for alleviating disease symptoms. In patients with large emphysematous bullae and surrounding lung tissue still functioning well, removing these bullae may reduce breathlessness. For end-stage patients, surgery might help but suitable patients must be carefully selected, and only a minority benefit from surgery. This includes patients whose disease is primarily in the upper lobes of the lung and is patchy, with some remaining healthy lung tissue. Lung Volume Reduction Surgery (LVRS) may improve the function of respiratory muscles, particularly the diaphragm. Lung Transplantation is also an option, but should only be performed at specialized centers.
Non-medical Treatment
Patients experiencing breathlessness and difficulty breathing may not only suffer from lung diseases. Many who have difficulty working due to general and/or respiratory muscle weakness (Peripheral and Respiratory Muscle Dysfunction) are a result of lack of exercise. Therefore, appropriate patient rehabilitation is a primary duty of Pulmonary Physical Therapy and Rehabilitation, regardless of whether patients are at a normal state, experiencing exacerbation, or recovering from an illness. Besides teaching correct breathing techniques and exercises to improve respiratory muscle efficiency and mucus clearance, the following are also important:
- Proper nutrition and weight
- Besides mental support, encouragement to become more self-reliant and socially active is crucial
- Educating patients and families about the disease, symptoms, and medications for better self-care
- Home visits by healthcare professionals, whether through phone calls or house visits, and ensuring all involved medical personnel are informed and collaboratively review the patient’s condition
- Pulmonary Physical Therapy and Rehabilitation are vital for patient care
Additionally, comprehensive care covering all aspects of the illness is necessary to reduce patient fatigue, improve quality of life, reduce family burden, enable more self-reliance, decrease hospital visits, reduce work absenteeism, and increase life expectancy. Treatment is not solely medication-based but also includes non-medical approaches such as:
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Avoiding inhalation of toxic pollutants, especially quitting smoking
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Evaluating disease severity for appropriate treatment
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Detecting and treating other concurrent diseases, such as heart disease
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Appropriate nutrition and weight
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Patient’s mental health
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Restoring pulmonary and overall physical strength
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Preventing and treating disease exacerbations early
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Educating patients to understand the disease and self-care practices
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Training families to provide correct care for patients
Pulmonary and Respiratory System Center
The Pulmonary and Respiratory System Center at Bangkok Hospital is ready to provide comprehensive patient care in one place. With a team of skilled doctors, nurses, physical therapists, and multidisciplinary professionals trained specifically in respiratory diseases, we carefully attend to every detail of patient care, including:
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Out-Patient Chest Clinic care
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Emergency Room Department care when patients have acute symptoms
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In-Patient Service Ward care for patients with severe symptoms who cannot be managed at home and require hospital treatment
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The Respiratory Care Unit for patients with severe respiratory symptoms, respiratory failure, and possibly requiring Mechanical Ventilator support
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Pulmonary Physical Therapy and Rehabilitation for appropriate breathing and mucus clearance techniques, muscle strength restoration, nutritional advice, emotional support to reduce depression, activity stimulation, and educating patients and their families about the disease and correct care practices
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Pulmonary Function Tests Unit for diagnostics and treatment guidance
The effective cooperation of all units is crucial for improving the patient’s quality of life.
