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COPD is a progressive life-threatening lung disease that initially presents as breathlessness with exertion, but if left untreated will develop into a serious illness. It is subdivided into chronic bronchitis and emphysema:
Smoking, air pollution and recurrent respiratory infections play a role in COPD causes. It is an extremely prevalent disease, being the fourth leading cause of death worldwide.1
Patients with COPD typically present with a combination of symptoms of chronic bronchitis, emphysema, and reactive airway disease. Symptoms include the following2:
Diagnosis is primarily based on clinical presentation and lung function tests. Arterial blood gas tests and pulse oximetry are useful for quickly assessing the patient's O2 status. All COPD patients are diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The GOLD system categorises airflow limitation in patients as follows:
The ability to detect mild to moderate COPD through physical examination can be quite poor, but physical signs are more specific and pronounced for severe disease. Severe COPD may present itself through the following symptoms:4,5
In severe cases, COPD patients require hospitalisation or an emergency visit. Symptoms of confusion, lethargy, respiratory muscle fatigue, worsening hypoxemia, respiratory acidosis (pH < 7.30) and concern of respiratory failure are cause for emergency care.6 In such cases ventilatory support and intensive care unit (ICU) admission are frequent7 , 8,9,10,11,12,13,14,15,16
COPD can result in hypercapnia – elevated levels of carbon dioxide in the body – necessitating oxygen therapy. But oxygen treatment can bring its own set of risk factors, with hyperoxia – elevated levels of oxygen in the body – reported in some cases.17Hypercapnia can result in impaired cognitive function.18 In addition, hypercapnia has been associated with a poorer prognosis in patients with COPD19, and both hypercapnia and hypoxia may result in deleterious effects on the lungs.20,21
Correctly administered, noninvasive ventilation (NIV) coupled with long term oxygen therapy (LTOT) is beneficial to COPD patients with hypercapnia. Furthermore, usage of NIV or noninvasive positive pressure ventilation (NPPV) can control oxygen toxicity in COPD patients with hypercapnia.22