Introduction
Chronic obstructive pulmonary disease (COPD) is a hypernym given to a class of persistent lung diseases, which increase the difficulty of breathing air out of the lungs.1 The harmful chemicals in smoke can damage the lining of the lungs and airways, which increases mucus production and causes a productive cough. This productive cough may last for 3 months in a year and 2 years. Exposure to irritants and chemicals can result in overgrowth of bronchial mucous glands and goblet cells in bronchioles. The two most prevalent diseases causing COPD are emphysema and chronic bronchitis. These two ailments frequently coexist and can vary in severity among people with COPD.2 Chronic bronchitis is an infection of the bronchial tubes, which transports air to and from the lungs’ air sacs (alveoli). Emphysema is a disease in which the alveoli at the end of the bronchioles in the lungs are damaged due to harmful exposure to cigarette smoke and other irritating gaseous and particulate materials. It is characterized by daily coughing and mucus (sputum) production.3 Most COPD patients can attain adequate symptom control, quality of life, and a decreased risk of other linked conditions, with the right care for their condition. The purpose of this exploration is to shed light on the complexities of COPD, ranging from its epidemiological significance to the intricacies of diagnosis, treatment, and traditional therapeutic approaches. The structure of this overview will follow a systematic progression, offering insights into the epidemiology of COPD, the diagnostic challenges, contemporary treatment modalities, the role of traditional therapies, and conclude with a reflection on the evolving landscape of COPD care.
Symptoms
Excessive mucus production during coughing affects the heart and lungs. Wheezing causes tightness in the chest, and coughing up clear, white, yellow, or greenish-colored mucus that often contains phlegm. Breathlessness, particularly during vigorous activity, and chest constriction are common symptoms that contribute to a lack of energy in patients suffering from unwelcome fatigue. Additionally, these symptoms may lead to weight loss in later phases.
Mechanism
A poorly controlled airflow restriction and an aberrant inflammatory response in the lungs cause COPD. The latter is an illustration of the innate and adaptive immunological reactions to repeated exposure to toxic gases and particles, particularly cigarette smoke. The natural course of the disease is indicated by the combination of structural and inflammatory alterations that characterize COPD both pathologically and mechanistically. The two classic prototypes are “the pink puffer” and “the blue bloater”. Clinical manifestations of COPD’s etiological characteristics and causes include a progressive decline in lung function and irreversible blockage of airflow. Small airway disease, a crucial component of COPD, is the primary cause of decreased lung function. Luminal blockage induced by mucus, peri-bronchial fibrosis, structural alterations in the airway epithelium, and immune system activation are characteristics of bronchiolar remodeling, serving as a structural synonym for small airway disease.
Epidemiology
Early death from COPD is associated with significant life costs for healthcare systems.4 According to projections for 2020, COPD ranks third among all causes of mortality globally and fifth among all causes of death. The prevalence of this disease varies depending on the nation, encompassing several phenotypes that are currently under discussion.5 COPD is also associated with consequential comorbidities. The main challenge in the upcoming years will be to mitigate the negative effects of smoking beyond early detection of sickness in the general population. A persistent breathing condition that consistently progresses, characterized by an obstructive ventilatory guide,6 is commonly associated with cigarette use and can lead to enduring respiratory problems. Chronic bronchitis refers to a condition with persistent airway obstruction (forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio: 70%). Chronic obstructive bronchitis with hypoxemia is also termed chronic respiratory failure. Breathlessness is a symptom of the lung disease known as emphysema.
In individuals with emphysema, the alveoli, and the lungs’ air sacs, suffer damage. The anatomical level of emphysema is explained by the destruction of alveolar sac/duct walls distant from the terminal bronchiole, which may result in abnormally large distal airways.7
COPD in India
Over 30 million persons are estimated to have this disease, with India accounting for a significant and increasing portion of cases. Morbidity is among the greatest globally, according to estimates.8 In India, for those aged older than 64.7 years, conventional estimates indicate that there are approximately 556,000 deaths per 100,000 persons, or 7.4% (95% confidence interval: 5.0–9.8%).9
The first global report by lung experts, titled “Burden of Obstructive Lung Disease” (BOLD), is the most reliable method for estimating the impact of COPD and recommends everyone to estimate the disease burden.10 The global burden of disease had access to the research data over the previous four to five years and used it to develop national estimates. Over 40 countries, including India, participated in BOLD when it first began in the United States approximately 10 to 15 years ago. Bangladesh had the highest estimated pooled prevalence of COPD (13.1%; 95% confidence interval: 12.1–14.0%),11 followed by India (11.1%; 95% confidence interval: 3.5–18.7) and Nepal (8.5; 95% confidence interval: 7.2–10.0%).12 In rural Srinagar in northern India, the overall prevalence of COPD was highest among people aged 40 or older (19.3% according to the fixed criteria; 16.1% according to the lower limit of normal standards),13 and the lowest prevalence there was observed at 4.1% according to the fixed criteria. Furthermore, the prevalence rates for the lower limit of normal criteria-based COPD were higher in Kamlapur compared to the country of Bangladesh (22.0% vs 16.2%), a neighborhood of Kamlapur.14,15 According to four investigations, men were more likely than women to have COPD,16 according to fixed criteria in Delhi and Srinagar, as well as both spirometry criteria in Nepal and rural Matlab, Bangladesh.17 The overall incidence of COPD was significantly higher in rural regions (17.0% by fixed criteria and 12.5% by lower limit of normal criteria) than in suburban areas (9.9% by fixed criteria and 8.0% by lower limit of normal criteria),18 according to a single study from Bangladesh that contrasted samples from countryside and non-rural areas. As of 2019, nearly 393 million people worldwide, or 10.3% of those aged 30 to 79 years, had COPD. A ratio of 7.6% corresponding to 292 million individuals was affected (10.3%; 95% confidence interval: 8.2% to 12.8%).19 The gender patterns of COPD passing rate among men decreased by 25%, from 57.4 per 100,000 individuals in 1999 to 42.9% in 2018, whereas the percentage among women has remained moderately comparable over this period.20
Allergies and COPD
COPD is a progressive condition that presents challenges in exhaling. Allergies and susceptibility to environmental pollutants can exacerbate the symptoms of COPD. Individuals with COPD should be aware that potential irritants and triggers are likely to aggravate the symptoms. Inhaled steroids, such as fluticasone and mometasone furnace, may help reduce inflammation and mucus production, thereby decreasing symptoms of an allergic reaction or asthma attack and preventing COPD exacerbation. Medications, like pseudoephedrine (Sudafed), may relieve allergy symptoms, but they may not be optimal for daily.21
Diagnosis
Based on clinical symptoms, a specific test is called the pulmonary function test (PFT).22 To identify the condition, doctors would evaluate people’s signs, symptoms, and PFT.23 PFT assesses the capacity for air inhalation and exhalation and determines whether the lungs can supply adequate oxygen to the blood.24 For a thorough physical examination, medical professionals use various techniques to assess the patient’s respiratory health. A physical examination might offer crucial tips, even though a final diagnosis of COPD usually requires a combination of clinical evaluation, medical history, pulmonary function testing, and imaging studies.
Physical examination
A medical professional performing a physical examination for COPD may make the following observations through sight, touch, and sound:
Sight
While observing a patient, a healthcare professional may watch for any indications of respiratory distress. These can include cyanosis, blue staining of the lips or nails indicating insufficient oxygenation, rapid or laborious breathing, and the employment of accessory muscles (chest or neck muscles). The healthcare professional will also count the patient’s respiratory rate, which can be elevated in COPD patients.
Touch
The medical professional may examine the patient’s chest and back with their hands to check for soreness or abnormalities. The presence of a barrel chest appearance, caused by long-term lung hyperinflation and commonly found in patients with severe COPD, can be observed. Additionally, COPD patients might also be screened for hyperinflated lungs. Light palpation can be used to check for masses, crepitus (a crackling feeling beneath the skin), and any localized discomfort.
Sound
The healthcare professional will listen to breath sounds in different lung fields using a stethoscope. Specific findings in COPD may comprise decreased airflow in affected areas, as indicated by diminished breath sounds. A high-pitched whistling sound typically produced during expiration may indicate airway blockage, known as wheezing. Rales or crackles, usually audible during inspiration, may indicate fluid accumulation or tissue damage.25
Analyzing breathing patterns
The pace, rhythm, and depth of the patient’s breathing will all be noted by medical professionals. Respiratory distress can be indicated by irregular or difficult breathing patterns.
Examining the shoulders and neck
Indications of increased usage of auxiliary muscles during breathing can be observed by checking the neck and shoulder regions. To aid with breathing, this may involve utilizing the scalene muscles in the neck and the trapezius muscles in the shoulders.
Auscultation of lung sounds
The healthcare professional will use a stethoscope to listen to lung sounds in various regions of the chest. Wheezing (high-pitched musical notes) and diminished breath sounds are two signs of COPD.
Assessment of general health
The medical professional will evaluate the patient’s general health, considering any signs of muscle wasting or weight loss that may be related to severe COPD.
Medication evaluation
The evaluation frequently involves a discussion of the patient’s current medications, including oral and inhalation treatments for COPD.
Functional assessment
The healthcare professional may assess the patient’s capacity for performing activities of daily living, gauge exercise tolerance, and discuss any restrictions on physical activity, depending on their symptoms and functional limits.26
The six-minute walk test involves strolling at a regular pace for six minutes. This test is used to monitor the effectiveness of therapies for lung, heart, and other health issues. Individuals with COPD, pulmonary hypertension, interstitial lung disease, or other lung conditions often undergo this test.27 Pulse oximetry, a non-invasive test, determines blood oxygen saturation by illuminating light at specific wavelengths into the tissue,28 most frequently through the fingernail bed. A normal level is about 95% or more oxygen, while about 90% of patients with breathing problems or chronic lung illness may have normal levels.29 The following techniques are also used to diagnose COPD.30
Spirometry
A painless test is used to identify and monitor specific lung problems by measuring the amount of air involved.31 The first stage involves determining the test’s validity. The next phase is categorized as either an obstructive or restrictive ventilatory pattern.32 Depending on the severity, if a ventilatory pattern is identified, certain individuals may require additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing.33
Spirometric measurements
The FVC or Forced Vital Capacity, is the greatest amount of air that can be forcibly expelled. FEV1 is an abbreviation for Forced Expiratory Volume in one second, signifying the amount of air forcibly evacuated in the first second after a maximal inhalation.34 The FEV1/FVC ratio indicates the proportion of FVC evacuated in one second.35 FEV6 is an acronym for Forced Expiratory Volume in six seconds. An FEF of 25–75% is a shorthand for forced expiratory flow throughout the middle half of the FVC, representing the average flow from the point where 25% of the FVC has been expelled to the point when 75% of the FVC will be exhaled. MVV represents Maximum Voluntary Ventilation, and it is better correlated with different outcomes from physical activity in daily life than FEV1 and inspiratory capacity.35
Chest X-ray
Identifying signs such as persistent cough or shortness of breath helps recognize COPD manifestations in lung images. Images may reveal enlarged lungs, air pockets (bullae), and a flattened diaphragm. This device is primarily utilized for chest X-rays and comprises wall-mounted, box-like equipment storing X-ray images or a specialized plate that digitally records images.36
Blood test
Anemia, characterized by too little iron in the body, and polycythemia, involving an excess of red blood cells in the blood, can both exhibit symptoms similar to COPD. When there is a deficiency of alpha-1-antitrypsin, this may be assessed. The levels of oxygen and carbon dioxide in the blood are determined through an arterial blood gas test, indicating how effectively the lungs are operating.37 The results of this test can assist in determining the severity of COPD and whether patients can benefit from oxygen therapy.
Computed tomography scan
It assesses an individual’s lungs to aid in detecting emphysema and determining whether surgery for COPD would be beneficial. In comparison to a chest X-ray, computed tomography imaging may have the ability to detect emphysema earlier and identify additional COPD changes, including enlarged arteries in the lungs. This test involves a minimal amount of emission, but if a contrast dye is used, there may be some discomfort from the needle, a slight tingling sensation after the injection, or a metallic taste in the mouth. Although quite uncommon, the contrasting dye may cause allergic reactions in one or two individuals.38
Echocardiogram
Echocardiography is a rapid, noninvasive, portable, and accurate method for evaluating heart changes.39 This is the least common echocardiographic finding in pulmonale, appearing in 62 % of the patients. Other echocardiographic outcomes include right atrium/right ventricle expansion, right ventricular hypertrophy, left ventricular diastolic dysfunction, right ventricular systolic dysfunction and left ventricular hypertrophy. The frequency of heart dysfunction also increases with the severity of COPD.40
Electrocardiogram
When used to diagnose individuals with COPD, the results of the electrocardiogram were shown to be 35.8% hypersensitive and 95.7% reliable, with most of the patients also experiencing respiratory issues.41 The electrocardiogram captures an image of the heart’s electrical functioning throughout the tracked period, including the pressure evaluation, holter monitor, event recording device, and loop recording. Suppose there are any indications that an electrocardiogram could be irregular. In that case, various conditions may be considered, such as a lack of blood flow, a larger heart, cardiac abnormalities, birth defects, irregular heartbeats, and difficulties with ions. Examples of conditions that may affect the electrocardiogram include blocked arteries, cardiovascular disease, chamber hypertrophy, chamber dilatation, and alterations in how power flows through the heart.42
Peak flow test
A peak airflow meter calculates the volume of quick air that leaves the lungs as we forcibly breathe. Measurements from the meter might indicate whether children have asthma that is beginning to worsen. A peak expiratory flow rate of less than 80% is considered to be a good maximum flow reading for COPD and can identify over 90% of the population with the condition. This includes people with mild to moderate symptoms who are likely to benefit from the use of bronchodilators.43
Grades or stages
The phrase “stages” was used in the original Global Initiative for Chronic Obstructive Lung Disease (GOLD) system to describe the various COPD severity levels. They are now referred to as “grades”. The initial stages only utilized FEV findings. The physician will grade the following four factors: the severity of the patient’s present symptoms and the outcomes of the patient’s spirometry.44
Grades of spirometry findings
The findings of spirometry are reviewed to determine how well the lungs are functioning. These outcomes are classified into four grades: GOLD-1 indicates mild, GOLD-2 indicates moderate, GOLD-3 indicates severe, and GOLD-4 indicates an extremely severe condition. The term “flare” is used if the spirometry result is GOLD-3 or GOLD-4, as individuals are more likely to experience these flare-ups.45
COPD Groups
Physicians categorize COPD into groups based on various factors, including symptoms, spirometry results, and exacerbation risk.
GOLD 1 or 2 in Group A: Relatively minor symptoms with FEV-1 is at least 80%. The symptoms didn’t lead to hospitalization.
GOLD 1 or 2 in Group B: FEV-1 ranges from 50% to 80%, with more symptoms compared to Group A. Patients often visit their doctor for symptoms like coughing, wheezing, and shortness of breath.
GOLD 3 or 4 in Group C: The lungs’ capacity to take in and expel air is significantly constrained. The FEV-1 ranges from 30% to 50%. The individuals have experienced at least one hospital admission or more than two flare-ups in the last year.
GOLD 3 or 4 in Group D: Breathing in and out is difficult. A minimum of two flare-ups or one hospitalization occurred within the last year. This condition is referred to as the “end-stage” of COPD.46
Comorbid diseases
The common conditions associated with COPD include the following:
Cardiovascular diseases
Coronary artery disease, heart failure, and hypertension are cardiovascular conditions associated with an elevated risk of COPD. Cardiovascular issues may be exacerbated by the systemic inflammation and decreased oxygenation from COPD.47
Osteoporosis
People with COPD are more likely to develop this disorder, which is characterized by weaker bones that are more likely to break. Reduced physical activity and corticosteroid use may contribute to this condition.
Type 2 diabetes
Type 2 diabetes is more prevalent in people with COPD, likely due to similar risk factors such as smoking and inflammation.48
Gastroesophageal reflux disease
People with COPD are more likely to have gastroesophageal reflux disease. It might be a factor in exacerbations and can worsen respiratory symptoms.
Muscle weakness and wasting (Cachexia)
COPD can cause muscle weakness and wasting, restricting physical activity, and impairing function.
Infections of the respiratory system
Infections that may cause pneumonia and bronchitis, are more common in people with COPD. Persistent infections can lead to exacerbations.49
Smoking
Smoking is a common risk factor for lung cancer and COPD. Lung cancer is more likely to develop in those with COPD.
Anemia
Some people with COPD may develop anemia, caused by chronic inflammation or other reasons.
Metabolic syndrome
People with COPD are more likely to suffer from this group of ailments, including obesity, high blood pressure, high blood sugar, and abnormal lipid profiles.
Obstructive sleep apnea
Linked to COPD, this disorder can lower quality of life, increase fatigue, and cause daytime sleepiness.50
Treatment of COPD
The current COPD management strategy focuses on a combination of symptom control and reducing exacerbation risk. The GOLD-ABCD (A, low risk, fewer symptoms; B, low risk, more symptoms; C, high risk, fewer symptoms, D, high risk, more symptoms) concept tool categorizes patients into “risk stratification” groups, guiding direct pharmacotherapy. This classification is based on symptom severity, determined by both the COPD Assessment Test score and the modified Medical Research Council scale, along with worsening risk identified by both spirometry-defined airflow restriction or past exacerbations.51 COPD treatment involves managing related illnesses and providing additional oxygen for breathing.52,53 The key for individuals with COPD is to utilize respiratory aids such as inhaler devices, and drugs including bronchodilators, aerosol steroids, and specific antibiotics.54 Lung rehabilitation, a specialized fitness and respiratory program, as well as surgery or a lung transplant, are available options for a very small percentage of patients.
Nebulizer medicine
If inhaler devices fail to alleviate a severe case of COPD, a nebulizer device can be used. It serves to transform liquid medication into a fine spray that patients can inhale using a mouthpiece or a face mask. This method allows for the administration of multiple drugs simultaneously.55 Typically, a nebulizer machine can be provided for home use.
Roflumilast
It is a novel drug that is effective in treating flare-ups. It is recommended for those who feel that they have experienced a sudden worsening at least twice over the past 12 months. The drug is available in tablet form, and it alleviates respiratory and lung irritation.56
Long-term oxygen therapy
COPD causes blood oxygen levels to drop, and hence individuals may be advised to use a mask or nasal tubes at home to receive oxygen. This may assist in preventing a decrease in blood oxygen levels. It is recommended to use oxygen for at least 16 hours a day. When using oxygen, it is crucial to avoid smoking. Due to the heightened flammability of increased oxygen levels, even a single cigarette could lead to an explosion or fire.57
Ambulatory oxygen therapy
Vascular air, which individuals with COPD use while walking or engaging in physical activity, can be beneficial for them. Instead of undergoing long-term oxygen therapy, individuals may be able to receive portable oxygen treatment if their blood oxygen levels are normal at rest but drop during exercise.58
Non-invasive ventilation
Non-invasive ventilation therapy is employed for individuals admitted to a hospital due to a severe flare-up. A portable machine is connected to a mask that covers the nose or face, supporting the pulmonary system and facilitating breathing through the nose.59
Colorful inhalers for COPD
A variety of anticholinergic inhalers are available, including aclidinium, glycopyrronium, ipratropium, tiotropium, and umeclidinium. It is recommended to use anticholinergic inhalers daily, even if asymptomatic.
Inhalation devices for beta-agonists include salmeterol, olodaterol, arformoterol, formoterol and indacaterol.
Gobbled corticosteroids include beclomethasone, fluticasone, ciclesonide, mometasone, budesonide, and flunisolide. While taking these medications, the patient must rinse the mouth, gargle and spit it out.
A combination of two drugs includes budesonide and formoterol, albuterol and ipratropium, fluticasone and salmeterol, fluticasone and vilanterol, formoterol and mometasone, and tiotropium and olodaterol. These combinations are swallowed.60
Exacerbation of COPD
Patients experiencing COPD exacerbation are sometimes referred to as having a flare-up, when they face a significant worsening of breathing problems due to the condition. Although reactions to flare-ups vary, there are potential warning signs, such as the sensation of being unable to exhale. Worsening may last for several weeks or even days, necessitating the use of oral corticosteroids and antibiotics. Exacerbations are more likely to occur as lung function declines in the later stages of COPD. These episodes are often caused by bacterial or viral lung infections, but they can also result from factors or situations that make breathing difficult. In addition to the typical COPD symptoms, there are other signs of exacerbation. Sometimes, people mistake them for other conditions, such as severe allergies, a severe cold, or a sinus infection. The most common warning signs of an imminent exacerbation include:
Coughing, wheezing, or shortness of breath that occurs more frequently than usual; changes in the tone, thickness, or amount of mucus; prolonged exhaustion lasting more than a day; swelling in the ankles or legs; increased difficulty with sleep; or the urge to take in more oxygen if the oxygen level drops.61
Prevalence and risk factors
COPD affects 300 million individuals worldwide, ranking as the third leading cause of mortality and affecting one in every ten persons globally. There are about 3.2 million annual deaths.62 Among older age groups, significantly higher rates and numbers of COPD fatalities are observed.63 About 86% of COPD fatalities occur in persons aged 65 years or older.64 The age group between 75 to 84 years accounts for the majority of deaths, although 85 and older people experience the highest death rates. Except for those aged 85 and older, whose mortality rates increased by 0.5% each year from 1999 to 2018, death rates among people aged 55 and older are declining for each age group every 10 years.65
Traditional medicines and healing therapies for COPD
When exploring natural remedies for COPD or other respiratory illnesses, one might encounter thyme, echinacea, ginger, and curcumin, etc. Although there is some medical support for many of these herbs.
Echinacea
In earlier times, people have taken echinacea to aid in preventing the spread of upper respiratory illnesses related to influenza and the typical cold and it is typically well-tolerated. When adverse effects do occur, they frequently involve common gastrointestinal symptoms like nausea or stomach pain. A rash, worsened asthma symptoms, and anaphylaxis are just a few of the allergic reactions that echinacea has been linked to.66
Thyme
Thymus vulgaris, an expectorant and antioxidant frequently used in respiratory problem treatment, is a common culinary herb. In a laboratory model of a person’s COPD airways, thyme essence was reported to increase the cilia beating frequency.67 The small filaments known as cilia, which line the respiratory system and aid in clearing mucus from the airway, are frequently harmed in COPD instances.68
Curcumin
The main active molecule in turmeric (Curcuma longa), is a highly effective anti-inflammatory compound that may reduce inflammation of the airways.69 Scientists discovered that people with COPD who included curcumin in their diet showed significantly fewer incidences of a particular colonizing bacteria, non-typeable Haemophilus influenzae.70
Ginger
It is believed that ginger contains potent antioxidants and natural antibiotics to aid the immune system in fighting off infection. Additionally, ginger may relieve sore throats and help clear congestion. A few minor adverse effects have been noted, such as flatulence, diarrhea, and stomach pain. The interaction of ginger with blood thinners is also a potential risk. Given that ginger might enhance bile flow, several specialists also advise against using it for those with gallstone disease.71
N-acetylcysteine (NAC)
A type of antioxidant that is derived from the amino acid L-cysteine, aids in thinning thickened mucus and may halt or stop the deterioration of COPD symptoms. Several researchers examined the effects of NAC at low and high doses on the incidence of exacerbations in thousands of COPD patients who received treatment for four to 36 months. The study’s findings revealed that people who took NAC experienced significantly fewer flare-ups of COPD or chronic bronchitis.72
Acupuncture
While COPD is incurable, the symptoms of COPD may be alleviated, and the disease progression may be slowed by medications and alternative treatments such as acupuncture. Originating from traditional Chinese medicine, acupuncture entails the placement of tiny needles inside certain body parts. It can occasionally be used to treat conditions such as migraines and persistent pain. Acupuncture is believed to regulate the production of cytokines, which are pro-inflammatory chemicals. Lowering cytokine levels could potentially reduce inflammation in the respiratory system, alleviating symptoms of COPD such as loss of breath. Several investigations have discovered that acupuncture may enhance exercise effectiveness, immune response, and lifestyle quality.73 Acupuncture needles are placed into the body at precise sites called acupoints during an acupuncture treatment.74 The acupoint has unique therapeutic effects and can be used to treat a range of health issues.75 Acupuncture points that are often used and their efficacy under various conditions are listed in Table 1.76–79
Table 1Location and efficacy of acupuncture points
| Acupuncture points | Location | Efficacy |
|---|
| (Lung 1): LU1 | On the upper chest, just below the collarbone. | Used to treat asthma, cough, and other respiratory symptoms, as well as to enhance lung function. |
| (Lung 5): LU5 | On the forearm, in the depression at the elbow crease when the arm is bent. | Used frequently to clear the lungs and relieve cough, sore throat, and respiratory discomfort. |
| (Lung 7): LU7 | On the wrist, in the crease of the inner wrist, in line with the thumb. | Used to be effective for problems including cough, asthma, and shortness of breath since it aids in promoting lung function and reducing inflammation.76 |
| (Lung 9): LU9 | On the wrist, between the tendon of the abductor pollicis longus muscle and the radial artery, in the depression at the lateral end of the transverse crease of the wrist. | Supports lung function, relieves respiratory symptoms, boosts the immune system, and promotes emotional well- being. |
| (Conception Vessel 17): CV17 | In the center of the chest, in line with the nipples. | Supports emotional well- being and relaxation, potentially reducing stress and anxiety that can affect lung health. |
| (Lung 20): LU20 | In the depression below the clavicle, approximately 6 inches lateral to the midline (away from the sternum). | Relieves cough, chest congestion, and respiratory discomfort; may also support emotional balance. |
| (Lung 10): LU10 | On the palm, between the first and second metacarpal bones, at the midpoint of the second metacarpal bone. | Addresses sore throat, throat discomfort, and local pain in the throat area.77 |
| (Lung 11): LU11 | On the thumb, at the corner of the nail on the radial (thumb) side. | Particularly useful for throat conditions such as sore throat and difficulty swallowing. |
| (Ren 22): RN22 | On the upper chest, between the collarbones | Opens the chest and promotes easier breathing, beneficial for cough, chest congestion, and throat discomfort.78,79 |
Yoga
Yoga can benefit those who have COPD in several ways, such as encouraging conscious breathing, reducing anxiety, maintaining muscles, and increasing mobility. Additionally, practicing meditation will teach a person how to control breathing. Asanas and pranayama are both part of yoga. The breathing exercise known as pranayama can strengthen the diaphragm. Muscles are lengthened and strengthened through yogic postures known as asanas, maintaining flexibility and mobility.80
Future treatments for COPD
Researchers and medical professionals are continually striving to develop novel COPD treatments that will help patients breathe more easily. Anti-interleukin-5 medications benralizumab, mepolizumab, and reslizumab are the newer biological drugs designed to reduce exacerbations.81,82 Benralizumab and mepolizumab are both licensed for patients aged 12 years and older, while reslizumab is only approved for those 18 years and older.83,84 These medications exhibit outstanding safety and effectiveness profiles, significantly reducing asthma exacerbations and related healthcare consumption.
When combined with standard therapy, azithromycin, taken daily for a year, was found to reduce the frequency of exacerbations and improve the quality of life but was associated with hearing loss in a small number of participants.85
The lung flute, an innovative respiratory tool, increases mucous evacuation by emitting a low-frequency acoustic wave during a moderately powerful exhalation.
To achieve lung denervation and facilitate ventilation, a revolutionary bronchoscope treatment is used for COPD. The most recent COPD medication Fluticasone/Umeclidinium/Vilanterol (TRELEGY ELLIPTA), was the first triple inhaled therapy authorized for the condition.
GOLD treatment guidelines for COPD
Reducing the adverse consequences of the present exacerbation and helping to avoid future episodes are preventive measures for managing a COPD exacerbation.86 Short-acting beta2-agonists, either with or without short-acting anticholinergics, are the first line of therapy for mild exacerbations.87 Based on the location of airflow constraint, the GOLD criteria categorize situations into four separate orders: GOLD-1 (mild), GOLD-2 (moderate), GOLD-3 (severe), or GOLD-4 (verifiably severe). This classification can be determined by evaluating the post-bronchodilator FEV1/FVC.
Non-pharmacologic and precautionary remedy of GOLD
Non-pharmacologic therapy for COPD includes smoking cessation, exercise, and immunization. According to the 2021 GOLD recommendations, discontinuation rates were much greater for this therapy compared to patient-initiated therapy. The most sophisticated method of quitting cigarettes is to take medicine for nicotine withdrawal, utilizing ingredients such as those found in nicotine chewing gum, inhalers, nasal spray, skin patches, lingual tablets, or pills. Numerous medications, such as varenicline, bupropion, and nortriptyline, have been shown to increase long-term cessation rates. Even though e-cigarettes have been available for over fifteen years, there is still debate over their safety and efficacy.88,89 One of the most significant changes to the GOLD recommendations for 2021 is the inclusion of the Tdap immunization. Providing information on inhaler use, medication adherence, and proper technique is one important function a pharmacist can perform in helping COPD patients.90 It may be helpful to have a well-supported written action plan that covers avoiding aggravating factors and treating or managing exacerbated symptoms.91 Screening should check for increasing symptoms of COPD along with smoking status, the quantity, and regularity of flare-ups.92
Tips to stop COPD
The injury that has already occurred to the lungs cannot be repaired. However, the damage can be slowed down or prevented from worsening with certain alterations.93 It is crucial to avoid lung irritates, such as dust, pollutants, secondhand smoke, and smog as much as possible. For individuals with COPD, even a simple cold could cause serious issues. Therefore, it is essential to clean their hands thoroughly and regularly, especially in cold weather. Breathing can be made easier with the help of medications, other treatments, and lifestyle modifications. To achieve worldwide goals aimed at reducing premature mortality by 25% by 2025, there must be a considerable increase in the number of smokers attempting to cease, as well as a significant improvement in the success rates of those attempts in low-, middle-, and higher-income countries.94
Conclusion
In India, the prevalence of COPD is relatively high, with notable regional variations. Smoking cigarettes and bidis, as well as non-smokers’ exposure to environmental tobacco smoke, are significant risk factors. COPD is not only caused by smoking but also by exposure to secondhand smoke. Additionally, prolonged exposure to air pollution may lead to COPD, as individuals inhale dust or fumes from fuel burned for cooking or heating. Severely ill patients may require more intensive treatment. Patients with severe disease may benefit from advanced care planning, palliative care, and non-invasive home ventilation. Hence it is crucial to establish a consistent technique for assessing the national burden of illness and implementing disease-surveillance programs. Medications may be administered or inhaled to alleviate symptoms and reduce flare-ups.
Perspectives on holistic care which include advancements in pharmacological and non-pharmacological treatments, have improved symptom management. Integrating mental health considerations, nutritional support, and patient education into COPD care could enhance overall well-being and resilience, providing a more comprehensive approach to managing this chronic condition. Empowering individuals with COPD through education, self-management strategies, and community support is an integral aspect of future directions. Promoting patient advocacy initiatives can not only enhance disease awareness but also foster a sense of community and resilience among those affected by COPD. In conclusion, by embracing a dynamic and inclusive approach to COPD care, we can strive towards a future where the burden of this respiratory condition is alleviated, and individuals affected by COPD experience enhanced quality of life and well-being.
Declarations
Acknowledgement
The authors would like to thank the Management of KMCH College of Pharmacy, for the continuous encouragement, support, and assumed facilities to carry out the study.
Funding
No funding was received for this study.
Conflict of interest
The authors declare that they have no competing interests.
Authors’ contributions
Study impression and outline (SS, SR, RA and TV); review of literature, perusal and clarification (SR, SS and TV); draft of manuscript (SS and SR); manuscript writing (SR and SS); critical revision (SS, RA and TV); administrative support (RA, SS and TV). All the authors reviewed the literature, compiled the data and approved the final version of the manuscript.