1. Definition: What does it mean? (6/2016)
COPD means “chronic obstructive lung disease”. In past decades this term was used in this way. Towards the end of the eighties in the past century the meaning of this term changed. From then on it was understood as “chronic bronchitis with bronchial obstruction” in contrast to “asthma”. Due to the fact that it has been impossible to describe several distinctive diseases of chronic bronchitis this change in definition occurred. This term is nowadays also used like a name of a disease.
Until now we have not been able to clearly distinguish between different types of chronic bronchitis but we should do so. That is why they were thought to be as one and the same disease. It is true that these conditions are similar, sometimes not to be distinguished from asthma. But we have do differentiate all these conditions. Experts are more and more becoming aware of these facts. There are different conditions of chronic bronchitis and at some point in the future we will be able to differentiate them. In the professional terminology nowadays the word “phenotyping” is used. I think even this term is not quiet right. Later on I will discuss this.
It is expected that we use the term “chronic obstructive lung disease” in some years as it was years ago. It would then be a category of obstructive lung diseases. Asthma would then be one of the diseases referred to by COPD. We try to differentiate the several diseases as well as we can. More time and effort are needed to understand these diseases.
Recent research has brought more different data to light. The word “asthma” is even used for several different conditions. Soon we will know more types of asthma. Probably we can then treat these conditions more individually.
2. How does COPD (Asthma) start?
There are many facts supporting the interpretation that chronic obstructive lung diseases are passed on by our parents. We see it clearly in asthma which is combined with Neurodermitis and hayfever. We call it “Atopy”. There are families with many members suffering from it and other families who do not know such suffering members. Heredity is hardly doubted. The combination of asthma and allergies is often passed on by parents too. Seldom we see people suffering from asthma without other members in their family who do so. Less certain is heredity of chronic bronchitis. But often we find several members in one family suffering from such symptoms. In the past such diseases were not looked at and not treated. Tuberculosis was in the focus. A physician was seldom consulted. But if we take time and if we ask more precisely then suddenly the patient will remember sick members among his relatives and ancestors.
I think we may have to face that there are several genes or epigenes causing various symptoms. In consequence several combinations exist with various forms of the illness. More variations may be caused by different alleles of several genes. So the variability becomes enormous.
The fact of heredity would alter our understanding of chronic bronchitis as caused by smoking. At birth we had not been smoking. Heredity and smoking are different facts.
Often cough and breathlessness are seen to be caused by psychic disorders. Hereditability is somatical medicine, not psychiatry. Asthma and chronic bronchitis would not been caused by psychic conditions.
In addition people and physicians often think breathlessness in people suffering from chronic bronchitis would be caused by adipositas or lack of training. In part that may be true, but often we can differentiate these causes.
We could also consider these diseases not as sickness but as constitution. We are born with lungs of various constitution or quality.
3. Co-factors – What else does influence our lungs? (6/2016)
We are born with a lung with certain qualities. It grows some years and it performs a big part of the gas exchange between our body and the environment. It is exposed to many different influences like gases, dust, humidity, changes of temperature of the air, bugs and others.
Some lungs can not cope with dust and gases as well as others. Obviously they lack some defenders or have not enough of them. So they suffer damage even from low concentration of such substances. Other people are lucky. They have got resistant and strong lungs.
Other lungs react with inflammation of the airway´s mucoid skin. This makes bronchi easily react to their environment. Changes in humidity and temperature of the air are followed by cough, phlegm and constriction of bronchi.
In other people a “weak” lung leads to more frequent infections by viruses, bacteria and sometimes even fungi.
The most important and widest spread co-factor is actively smoking. Passively smoking does it to a lesser extent. Working with asbestfibers for some time, working as a coal-miner for long time, extensive inhalation of gasoline and particularly exhaust fumes from diesel engines on roads with much traffic and some inhalation of dust in industries and other places are also potentially harmful for our lungs (in this order).
Some observations can be made looking at smoking: Everybody knows smoking causes cancer of the lung. That is correct but we want to look at another fact. More often smoking causes other damages to our lung than cancer. The effects may differ widely. Some people grow old without damage to their lung by smoking. Their lungs are resistant against damage through smoking. Others are smoking only for a short time, but their lungs are even so damaged seriously. So the damage suffered varies much from person to person. We are not able to foresee the future of the lung of each smoker. We can only see it looking back, when it is too late. The effects are rarely or hardly reversible.
Even in asthmatics the tolerability for smoking varies widely. We find some patients who in spite of suffering from asthma smoke for 40 years and afterwards show no signs of smoke-induced chronic bronchitis. Other asthmatics tolerate smoking very badly and we soon find damage of the lung caused by smoking. In these individuals we find many gradations between the extremes. Generally smoking is less tolerated by asthmatics.
4. Why does one get symptoms? Under which conditions do the symptoms become worse?(3/2016)
Let us suppose one is suffering from Asthma or Chronic Bronchitis. Does he ever feel it? Which conditions will lead to more or to fewer symptoms?
Asthma is known as a disease with varying symptoms. We find certain developments of asthma. The symptoms vary due to external influences. We may feel well at times or suffer from an asthma attack. At other times you can ask: Am I suffering from asthma? Or can we rule out asthma? Am I well or sick? I can answer these questions depending on my point of view. Do I say, “I am well, when I do not feel any symptom?” If asthma is a varying disease, my genes always will be the same. I may not feel anything, at certain times, but I am not healthy. For the moment it may be not important but it might change my attitude to therapy. Treatment even during “good” periods might make sense.
For example: If there is somebody suffering from an allergy against cats and that is the only trigger for this disease, he is likely to be free of symptoms if he avoids contact to cats. He does not need any therapy. But he needs to avoid contact to cats. This is the condition. If he is lucky, he may be well for the rest of his life. Other people get symptoms again, because of contact to cats or by developing an allergy to housedustmites or by other causes.
We may ask again: Has this person been healthy or has he only not felt any symptoms for some time?
Factors that strengthen or weaken symptoms in asthma:
Contact to substances one is allergic to.
Inhaled irritant agents like : Odors, dusts (also smoking active and passive) Gases, even humid air (warm or cold).
Extreme physical excertion (sports or works),
Infections of the airways and more.
This dependence on external irritating factors leads to more or fewer symptoms for most people suffering from asthma (and to a lesser extent people suffering from chronic bronchitis) if they move from a humid flat to a dry flat and vice versa. It does not need even take mould. Some people have an additionally problem with mould. The extent of humidity in the rooms is important. Similar to this fact we see the changes when moving from a dry to a wet region or the other way round. Sometime two weeks of holidays are enough to show us the changes. Some rare cases (<5 %) feel the symptoms in the opposite conditions.
Living with AC in more than 50 % increases symptoms for people suffering from asthma.
5. Complaints and symptoms of asthma and chronic bronchitis (6/2016)
Asthma and chronic bronchitis are often thought to be linked with breathlessness. That is correct. But it is only one way of looking at it. Breathlessness is a frequent symptom that affects us seriously. Breathlessness is harmful and we cannot easily overlook it. And we easily understand the connection.
The underlying reason for breathlessness in asthma is an inflammation of the mucoid skin in the bronchi, in chronic bronchitis is an inflammation and dysfunction of mucoid skin and tissue of the lung. Primary we feel it as foreign body or as phlegm in the throat and larynx. Some become hoarse. If it becomes worse the patient might clear his throat, get dry hacking cough and later on cough with phlegm.
Children suffering from asthma often are predisposed to infection. This might be one or even the only sign of asthma. Also in adults infection may play a role, but we also find other patients suffering from asthma without infections. They are fairly resistant against bugs. Frequent infections followed by cough for a long time might indicate a chronic obstructive lung disease.
Cough and phlegm often are dependent on inhalation of irritants. Fast changes in humidity and temperature of the air cause cough. Some people even cough when they laugh. Dusty air, for example when many pollen are flying, fumes, gases and steam can cause cough and even shortness of breath.
Many patients suffering from asthma and chronic bronchitis easily sweat. Even the smallest exertion causes them to sweat. Sweating often occurs before breathlessness. People suffering from overweight also easily sweat. If a patient is overweight and suffering from asthma or chronic bronchitis, which is frequently the case, the affects add up. Some patients complain about extreme sweating at night, so they need to change clothes during the night several times. It is well-known that tuberculosis patients sweat at night, however, this disease has become rare. We must not confound this sweating with hyperthyreoidism or changes in hormon levels in the second half of life.