What is COPD?

COPD stands for chronic obstructive pulmonary disease. People who cough up a lot of mucus or have trouble breathing out used air may have COPD. If it is hard for you to breathe out used air, it is also hard for fresh, healthy air to come in to your lungs.

To understand COPD, you need to know how your lungs work. When you breathe in air through your nose or mouth, the air travels down your windpipe (also called trachea) into your lungs. In your lungs, airways (called the bronchial tubes) branch out like an upside-down tree. At the end of each branch are many little air sacs (called alveoli). The air you breathe travels down these airways into the air sacs. The air sacs have very thin walls full of tiny blood vessels (called capillaries). From these blood vessels, oxygen moves into your bloodstream while carbon monoxide (used air) goes out of your blood.

What happens to the lungs when you have COPD?

In healthy lungs, the airways are clear and open and the air sacs are small, elastic and springy. When you breathe in, each air sac fills up with air like a small balloon, and when you breathe out, the balloon deflates and air goes out. When you have COPD, changes occur in the airways and the air sacs. These changes happen because of two related kinds of lung disease that are part of COPD.

Chronic bronchitis makes your airways red and swollen (inflamed). Mucus collects in your airways and clogs them up.This is why it is hard for people with chronic bronchitis to breathe.

Emphysema injures your air sacs, leaving scar tissue that makes them stiff. Because of this, people with emphysema have trouble getting oxygen into their blood and carbon monoxide out of their blood.

Some people have chronic bronchitis that leads to COPD. Others get COPD as a result of emphysema. What happens to your lungs when you have chronic bronchitis may be different from what happens when you have emphysema. But either way the treatment for COPD is the same.

How does my doctor know I have COPD?

The symptoms of COPD are: 

•   A chronic, persistent cough

•   Increased mucus

•   Shortness of breath, especially during physical activity

•   Wheezing

•   A tight feeling in the chest

If you have these symptoms, your doctor will want to test for COPD. Your doctor will probably refer you for pulmonary function tests to see how well your lungs are working. In this test, you take deep breaths and then blow into a machine. The machine measures how deeply you can breathe and how fast you can move air in and out of your lungs. In most cases, this test (called a spirometry test) is all the doctor needs to make a diagnosis. In some cases, the doctor might also suggest a chest x-ray. The x-ray cannot tell that you have COPD but it can show signs of COPD.

What causes COPD?

Most people get COPD because they smoke cigarettes. Sometimes, people can get it even if they do not smoke. It is not yet known whether second-hand smoke can lead to COPD but people who live with or work with smokers are more likely to have respiratory diseases in general. People who breathe in large amounts of chemical fumes or dust at work or at home may also be at risk for COPD. COPD runs in some families, making people in those families more likely to get COPD, especially if they smoke.

What can I do if I have COPD?

What is a bronchoscopy?

A bronchoscopy is a procedure where a tube is inserted into the lower respiratory tract via the nose or mouth. This allows your physician to clearly visualize lesions in the trachea and bronchi. The bronchoscope is equipped to take samples of tissue directly observed by your physician for biopsy, to take smears by brushing, and to perform bronchial lavage. The equipment involved allows your physician to make an accurate diagnosis and to perform treatment more easily.

The bronchoscope is a soft and flexible tube with a small diameter, enabling a clear field of vision with a high degree of safety. The patient experiences minimal discomfort and only requires a local anesthetic. Most importantly, a bronchoscopy is the best method for diagnosing bronchial lesions. It can be used to discover lesions deep within the trachea, bronchi, and lungs that are difficult to detect that would not be found using chest CT. Diagnosis and treatment can be performed without the need to perform surgery.

When does a bronchoscopy need to be performed?

A bronchoscopy is needed to diagnose disease in the following circumstances:

• Causes of chronic cough，hemoptysis or blood-stained sputum，localized wheezing or hoarseness are unknown

• Chest X-ray and/or CT suggests abnormal changes

• Evaluation before thoracic operation

• Diagnosis for laceration or rupture of the trachea or bronchi in chest trauma

• Etiological diagnosis of infectious disease of the lung or bronchi

• Management of the airways during mechanical ventilation

• Diagnosis and treatment for fistulas of the trachea or bronchi

A bronchoscopy is needed for disease treatment in the following circumstance:

• Remove foreign objects from the bronchi, clearing abnormal secretions from the trachea, such as sputum, pus, and blood clots

• Remove emboli from the bronchi and pulmonary reexpansion in the event of pulmonary atelectasis caused by embolism involving pus, sputum, or blood

• Confirm the location of bleeding for patients with hemoptysis, then attempting to stop bleeding locally.

• Perform local radiation or local injection with chemotherapy drugs for patients with lung cancer

• Guided intubation of the airways and guided bronchial intubation where there are difficulties with intubation

• Laser, microwave, frozen, or high-frequency electrosurgical treatment for patients with benign or malignant tumors of the airways

When should a bronchoscopy not be performed?

• Active massive hemoptysis

• Severe arrhythmia

• Recent myocardial infarction or history of unstable angina pectoris

• Severe heart or pulmonary dysfunction

• Thrombocytopenia, coagulation dysfunction or the other bleeding disorder.

• Newly onset cerebral infarction or hemorrhage

• Aortic aneurysm

• Incompatibility or intolerable to bronchoscopy exam

What should I pay special attention to before my bronchoscopy?

• Before the bronchoscopy do not eat or drink for 4–6 hours，sign the consent form and a family member should accompany you on the day of the procedure

• Before the bronchoscopy give an accurate account of your health condition and past medical history to your physician. Remember to also let your physician know about any drug allergies, anticoagulants orantiplatelet drugs still used, hypertrophic rhinosinusitis, snoring, throat surgery you have had done, or serious cervical vertebrae diseases you may have

• Before the bronchoscopy take medications for illnesses strictly following the schedule provided by your physician. For example, medications for hypertension or heart disease can be taken orally two hours before the bronchoscopy and will not affect the procedure

• Before the bronchoscopy complete your preoperative examination: This includes chest CT, ECG, FBC, check for infections pre-surgery, and blood coagulation studies. Before leaving home, be sure to bring any chest X-ray or CT images, ECG, FBC, and blood coagulation reports for your physician to look at

• After the bronchoscopy wait outside the examination room after your procedure for at least 30 minutes to ensure that you are not experiencing any dizziness or other symptoms before you leave the hospital

• After the bronchoscopy appearance of blood-stained sputum following bronchoscopy is normal. See your doctor immediately if there is a significant amount of hemoptysis, bloody sputum, intense chest pain, difficulty breathing, recurring fevers, or arrhythmia

• After the bronchoscopy rest well and avoid talking to reduce hoarseness and a painful throat or chest

• After the bronchoscopy do not eat or drink for 2–3 hours following the procedure. Try drinking some warm water 3 or more hours after the procedure. If you are not choking or coughing, you can eat some cool, mild food

Is a bronchoscopy dangerous?

A bronchoscopy is a relatively safe procedure. Complications may occur (such as allergies to anesthetics, laryngeal edema, cramps in the airways, hypoxia, infections, bleeding, pneumothorax, and cardiocerebral events), however the chance of them occurring is low, and your physician will actively respond if such events occur. Your physician will perform strict checks, especially before the procedure, for indications and contraindications, to ensure that you are prepared. During the procedure, your physician will perform close monitoring, and respond immediately to any symptoms, reducing the risk of complications, and ensuring that the procedure is safe and effective.  

Why is fluorescence bronchoscopy necessary?

Autofluorescence bronchoscopy (AFB) is a new type of bronchoscopy procedure combining regular white light bronchoscopy (WLB) with cell autofluorescence and information technology. This equipment stimulates cell fluorescence, to determine differences in cell fluorescence. The principle behind it is that dysplasia and microinvasive carcinoma of the bronchial epithelium occurs during blue laser exposure creates a weaker red fluorescence and weaker green fluorescence compared with normal tissue. This makes lesions appear in a reddish brown color whereas normal tissue appears green. Computer-aided imaging techniques enable such lesions and their extent to be identified. AFB is unique compared with other microscopic techniques, as it allows discovery of extremely minute lesions, therefore increasing the sensitivity and accuracy of biopsies carried out via bronchoscopy.

As with regular bronchoscopies, AFB is suitable for screening and diagnosis for patients at high risk of developing lung cancer and central type lung cancer in its early stages: AFB is also suitable as a preoperative examination or follow-up examination for lung cancer, useful in determining the scope of surgery prior to a procedure, avoiding resection line involvement, and in the early discovery of relapse and local metastasis following surgery.

Reference

中华医学会呼吸病学分会：诊断性可弯曲支气管镜应用指南（2008年版）