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What is JJ
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COPD includes emphysema, an anatomically defined condition characterized by
destruction and enlargement of the lung alveoli; chronic bronchitis, a
clinically defined condition with chronic cough and phlegm; and small airways
disease, a condition in which small bronchioles are narrowed.
Epidemiology:

COPD is the fourth leading cause of death and affects more than 16 million
persons in the United States. COPD is also a disease of increasing public health
importance around the world.

Risk Factors

Cigarette Smoking

The causal relationship between cigarette smoking and the development of COPD
has been absolutely proved, there is considerable variability in the response to
smoking.

Respiratory Infections

These have been studied as potential risk factors for the development and
progression of COPD in adults; childhood respiratory infections have also been
assessed as potential predisposing factors for the eventual development of COPD.

Occupational Exposures

Increased respiratory symptoms and airflow obstruction have been suggested as
resulting from general exposure to dust at work. Several specific occupational
exposures, including coal mining, gold mining, and cotton textile dust, have
been suggested as risk factors for chronic airflow obstruction. However,
although nonsmokers in these occupations developed some reductions in FEV1, the
importance of dust exposure as a risk factor for COPD, independent of cigarette
smoking, is not certain.

Passive, or Second-Hand Jeff
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Exposure of children to maternal smoking results in significantly reduced
lung growth. In utero tobacco smoke exposure also contributes to significant
reductions in postnatal pulmonary function. Although passive smoke exposure has
been associated with reductions in pulmonary function, the importance of this
risk factor in the development of the severe pulmonary function reductions in
COPD remains uncertain.

Genetic Considerations

Severe antitrypsin deficiency is a proven genetic risk factor for COPD; there
is increasing evidence that other genetic determinants also exist.

Pathophysiology

Persistent reduction in forced expiratory flow rates is the most typical
finding in COPD. Increases in the residual volume and the residual volume or
total lung capacity ratio, non uniform distribution of ventilation, and
ventilation-perfusion mismatching also occur.

Pathology

Cigarette smoke exposure may affect the large airways, small airways and
alveolar space. Changes in large airways cause cough and sputum, while changes
in small airways and alveoli are responsible for physiologic alterations.
Emphysema and small airway pathology are both present in most persons with COPD,
and their relative contributions to obstruction vary from one person to another.

Pathogenesis

Airflow limitation, the major physiologic change in COPD, can result from
both small airway obstruction and emphysema, as discussed above. Pathologic
findings that can contribute to small airway obstruction are described above,
but their relative importance is unknown. Fibrosis surrounding the small airways
appears to be a significant contributor.

Clinical features:

The three most common symptoms in COPD are cough, sputum production, and
exertional dyspnea.

Many patients have such symptoms for months or years before seeking medical
attention.

Although the development of airflow obstruction is a gradual process, many
patients date the onset of their disease to an acute illness or exacerbation.

A careful history Jamal
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of symptoms prior to the acute exacerbation.

The development of exertional dyspnea, often described as increased effort to
breathe, heaviness, air hunger, or gasping, can be insidious.

Homoeopathic approach:

Senega:

It is indicated where the cough is irritating and the phlegm is especially
adhesive and the patient complains of a pressing pain in the chest, when
respiring, moving or coughing.

Scilla:

It suits obstinate chronic coughs with stitches in the chest, expectoration
transparent or muco-purulent, easy at times, hard at others.

Dulcamara:

It is a valuable remedy for bronchial catarrhs of old people with a very free
greenish expectoration, worse from change of weather to cold and wet.

Bacillinum:

It is a remedy highly spoken of by some competent observers; it seems to suit
especially individuals who are constantly catching cold, one is hardly gotten
rid of before another is contracted.

The irritation locates itself in the bronchial mucous membrane

leaving troublesome cough.

Mercurius :

The remedy in inflammatory bronchial catarrh; there is roughness and soreness
from the fauces down through the middle of the chest Glen
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exhausting ;sputum watery, saliva-like,or yellow and muco-purulent.

There is fever and alternation of hills and heat, desire for cold drinks,
which aggravate the cough. and pasty sweat without relief.

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