Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary disease that is particularly common in the elderly. Patients with COPD have symptoms like chronic cough, sputum production and dyspnea (difficulty breathing) accentuated by exertion.
According to WHO estimates, COPD will become the third cause of death by the year 20301.
The primary risk factor for developing COPD is cigarette, pipe, cigar and other types of tobacco smoke; second-hand smoke also triggers the respiratory symptoms of COPD. There are other documented causes of COPD, including exposure to dusts and chemical agents (vapours, irritants and fumes) and domestic causes such as pollution due to fuel (biomass) used for cooking and heating in poorly ventilated spaces.
A COPD diagnosis should be considered when examining subjects who have been exposed to risk factors and who exhibit symptoms like cough, sputum and breathlessness on exertion. The diagnosis should be confirmed by respiratory function tests to determine the severity of the condition and monitor its course.
The most effective method, also in financial terms, to prevent COPD or slow down its progression is to stop smoking.
Treatment aims to control the evolution of the clinical condition over time, so as to reduce the risk of exacerbation and COPD-related hospitalization, as well as to improve respiratory symptoms. The primary therapy for the management of COPD symptoms is based on the use of bronchodilators. Non-pharmacological treatments include: respiratory rehabilitation programmes, oxygen therapy, and (in a limited number of cases) surgery.
Asthma is a chronic inflammatory disease of the air passages, whose symptoms are difficulty breathing, cough, wheezing and sense of chest constriction. It is also one of the most common chronic diseases: according to WHO estimates, it affects approximately 235 million people worldwide2.
Symptom intensity can vary over time, alternating with periods of well-being. In addition to a varying degree of intensity, some symptoms can be more prevalent in certain patients. Asthmatic crises can be triggered by allergies, respiratory infections, physical exercise or low temperatures. Treatment aims to correct the two elements that characterise the disease, i.e. inflammation and bronchial constriction, a narrowing of the bronchi that reduces the ability to breathe properly.
The inflammation of the nasal mucosa (rhinitis) is caused by infections or allergies. According to the ARIA classification (Allergic Rhinitis and its Impact on Asthma), rhinitis is classified as intermittent or persistent, and its severity as mild or moderate/severe. Based on clinical characteristics, 2 types can be identified: “sneezer and runner” or “blocker”. In the first case the symptoms are sneezing, itching and running nose, often associated with conjunctivitis and eye redness typical of allergic rhinitis. Conversely, in the blocker type the prevailing sensation is a blocked nose, with dense mucus running down the throat. Treatment is based on symptomatic medications that reduce inflammation and discomfort.
Cough is an important protection mechanism through which excess secretion and foreign materials (such as dust and irritating substances present in the environment) are expelled from the airways, in order to prevent damages and maintain airway patency. In itself, therefore, cough should be considered useful, although annoying, as its purpose is to remove foreign substances and excess mucus from the respiratory tree.
Numerous conditions, of varying nature and severity, may present cough as primary or secondary symptom, and it can be quite difficult to understand its exact meaning because its characteristics vary depending on the patient’s age, mode of onset and frequency. In managing patients with cough, it is important to determine the acute or chronic nature of the symptom; this, however, should be done using a systematic approach: once the cause is established and a correct etiological diagnosis is reached, therapeutic success can be achieved.
1 Source: http://www.who.int/respiratory/copd/enconsultated on 19 January 2014
2 Source: http://www.who.int/mediacentre/factsheets/fs307/en consultated on 19 January 2014