A brief primer on COPD 

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by chronic inflammation of the airways and obstruction of airflow in and out of the lungs. It is a term used to describe a group of lung conditions, including chronic bronchitis, emphysema, and alpha-1 antitrypsin deficiency. 

Here are some key features and information about COPD:

• Chronic Bronchitis: In chronic bronchitis, the airways become inflamed and narrowed. This leads to increased production of mucus, causing a persistent cough and difficulty in breathing.
• Emphysema: Emphysema involves the destruction of the air sacs (alveoli) in the lungs, which reduces the surface area for oxygen exchange. This results in shortness of breath and reduced lung function.
• Alpha-1 antitrypsin deficiency: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that primarily affects the lungs and liver. It is also known as alpha-1 proteinase inhibitor deficiency or A1AD. This condition is caused by mutations in the SERPINA1 gene, which leads to a deficiency of a protein called alpha-1 antitrypsin (AAT) in the bloodstream.
• Symptoms: Common symptoms of COPD include shortness of breath, chronic cough, excessive mucus production, and wheezing. These symptoms often worsen over time.
• Management: While COPD is a chronic and progressive disease, there are ways to manage and alleviate its symptoms. This may include smoking cessation, the use of bronchodilators or corticosteroids to open the airways and reduce inflammation, oxygen therapy, pulmonary rehabilitation, and lifestyle changes, such as exercise and a healthy diet.
• Causes: The primary cause of COPD is smoking. Long-term exposure to other lung irritants such as air pollution, chemical fumes, and dust can also contribute to the development of COPD. In some cases, genetic factors may play a role.
• Prevention: The most effective way to prevent COPD is to avoid smoking and minimize exposure to lung irritants. For those who have already been diagnosed with COPD, early intervention and lifestyle changes can help slow the progression of the disease.

COPD is a serious condition that can significantly reduce a person's quality of life and may lead to severe complications if left untreated. Therefore, it's important for individuals at risk (e.g., smokers and those with a history of exposure to lung irritants) to seek medical attention and follow recommended treatments and lifestyle changes to manage the disease.

Typical symptoms of COPD

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Typical symptoms include:

• Shortness of breath (dyspnea): This is often the most prominent symptom, especially during physical activities
• Chronic cough: A persistent cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
• Wheezing: A whistling or squeaky sound when you breathe.
• Chest tightness: A feeling of constriction or pressure in the chest.
• Fatigue: Feeling tired or lacking energy, often due to the increased effort required to breathe.
• Frequent respiratory infections: COPD can make you more susceptible to respiratory infections like colds, flu, RSV or pneumonia.
• Difficulty breathing: Especially during physical exertion or in severe cases, even during rest.
• Excess mucus: Excess mucus production is a common feature of COPD. Chronic bronchitis, which is one of the conditions that falls under the umbrella term of COPD, is characterized by inflammation and irritation of the bronchial tubes, leading to increased mucus production. This excess mucus can contribute to symptoms such as coughing and can exacerbate breathing difficulties. Additionally, in some cases, the mucus may become thick and difficult to clear from the airways, further complicating breathing and increasing the risk of respiratory infections.

These symptoms can vary in severity and may worsen over time, especially if the condition is not properly managed. It's essential for individuals experiencing these symptoms to consult a healthcare professional for proper diagnosis and management. 

Testing for COPD

There are several tests that can be used to diagnose chronic obstructive pulmonary disease (COPD), including:

• Spirometry: This test measures how much air a person can inhale and exhale and how quickly they can exhale.
• Lung function tests: These tests measure how well the lungs are working and can include tests such as diffusion capacity and arterial blood gases.
• Chest X-ray: This test can show if there is any damage to the lungs or if there are any other conditions that may be causing symptoms similar to COPD.
• CT scan: A CT scan can provide more detailed images of the lungs and can help to identify specific areas of damage or other conditions.
• Pulse oximetry: A simple test that measure the level of oxygen in your blood.
• Alpha-1 blood test: Testing for alpha-1 antitrypsin deficiency (AATD) typically involves a combination of blood tests and genetic testing. The initial test is to measure the level of alpha-1 antitrypsin (AAT) in the blood. A low level of AAT suggests a deficiency. A deficiency of alpha-1 antitrypsin allows these proteases to damage the lung tissue, which can lead to various lung problems, including emphysema. AATD can result in early-onset and more severe forms of these lung conditions, often in individuals who are non-smokers.

A combination of tests may be used to confirm the diagnosis of COPD. Your doctor will also take into account your symptoms and medical history to determine the best course of action.

Pulmonary Rehabilitation

Pulmonary rehabilitation is a program of exercise and education that can help people with COPD manage their symptoms, improve their physical fitness, and increase their ability to perform daily activities. Some specific benefits of pulmonary rehab for people with COPD include:

• Improved breathing: Pulmonary rehab can help people with COPD improve their lung function, which can make it easier for them to breathe.
• Increased exercise tolerance: Pulmonary rehab can help people with COPD increase their endurance and stamina, which can make it easier for them to perform daily activities.
• Reduced shortness of breath: Pulmonary rehab can help people with COPD reduce the frequency and severity of shortness of breath.
• Improved quality of life: Pulmonary rehab can help people with COPD improve their overall quality of life by reducing symptoms, increasing physical activity and reducing hospitalization.

It's important to note that pulmonary rehabilitation is tailored to the individual needs of the patient and can vary depending on the stage and severity of the disease, and the person's overall physical condition.

Common vaccinations for people with stable COPD

Common vaccines recommended for people with stable chronic obstructive pulmonary disease (COPD) include: High-dose influenza (flu) vaccine, pneumococcal vaccine, respiratory syncytial virus (RSV) vaccine and less frequently the tetanus, diphtheria, and pertussis (Tdap) vaccine. It's important to note that vaccine recommendations may be updated over time as individual health conditions can vary. Therefore, it's best to consult with a healthcare provider to determine the most appropriate vaccination schedule for someone with COPD. Your healthcare provider will make recommendations based on your health status and will make adjustments if there are changes to federal vaccine guidelines.

Influenza Vaccines

Older Canadians suffer disproportionately from flu-related morbidity and mortality. Adults 65+ represent 15% of the Canadian population. However, during influenza season they account for 70% of the hospitalizations. Complications of influenza often result in COPD exacerbations which can then trigger heart attacks and stroke. Influenza vaccination can reduce serious illness such as lower respiratory tract infections. Vaccines containing either killed or live inactivated viruses are recommended as they are more effective in elderly people with COPD. Studies suggest that people with COPD, particularly the elderly, had decreased risk of ischemic heart disease when they were vaccinated with the high-dose influenza vaccine. Learn more: www.copdcanada.info/influenza-myths-and-facts/

Pneumococcal Vaccines

Pneumonia is caused by an infection in the lungs. The infection affects the air sacs in the lungs rather than the tubes that carry air to and from the lungs. Infected parts of the lung fill up with fluid, which contains white blood cells that fight the infection. Pneumonia is caused by germs (tiny organisms that can cause disease). Viruses, bacteria and fungi are types of germ that can cause pneumonia. Pneumococcal vaccinations, pneumococcal conjugated vaccine (PCV20 or PCV15) and pneumococcal polysaccharide vaccine (PPSV23), are approved for adults 65 years and older. They are also approved for adults aged 19-64 years if they have an underlying medical condition such as chronic lung disease (including COPD, emphysema, and asthma), a history of cigarette smoking or have undergone a solid organ transplant. Pneumococcal vaccination is universally recommended for adults in these age groups. Learn more: www.copdcanada.info/pneumonia/

Respiratory syncytial virus (RSV) vaccines

Respiratory syncytial virus (RSV) is a common respiratory virus that can cause severe illness in individuals with chronic obstructive pulmonary disease (COPD). RSV primarily affects the lungs and respiratory tract, leading to symptoms such as coughing, wheezing, and shortness of breath. In individuals with COPD, RSV infection can exacerbate existing respiratory issues and potentially lead to serious complications. One effective way to prevent RSV infection in individuals with COPD is through vaccination. The RSV vaccine can help to reduce the risk of developing severe respiratory complications associated with the virus. Learn more: www.rsvandme.ca/older-adults

Co-administration of RSV vaccines

NACI recommendations states that given the need of older adults to be protected with multiple vaccines, concurrent administration of an RSV vaccine with other adult vaccines is acceptable and supported. The recommendations also state that if possible, RSV vaccines should be given at least 6 weeks before or after non-seasonal vaccines (for example, diptheria-tetanus or shingles) to avoid inadvertently attributing an adverse event from another vaccine to the RSV vaccine.

Tdap Vaccine:

Tetanus, diphtheria, and pertussis (whooping cough) are preventable through the Tdap vaccine. Adults are recommended to receive a Tdap vaccine once, followed by a Td (tetanus and diphtheria) booster every 10 years. Learn more: https://tinyurl.com/yzdx6hw3