COPD Complications: Presenting Symptoms and Prognosis

Almost every disease has its complications and COPD, too, has its share of serious ones. The respiratory and the cardiac or cardiovascular COPD complications are particularly serious and can cause death.

Having said that, it becomes necessary for the patient to take proper care of the disease by religiously taking his medication and in general, following the care tips to prevent the complications from setting in.

Secondly, recognizing the COPD complications in the early stages and taking prompt treatment will help improve the prognosis.

A complication is a secondary disease that develops in the course of a primary disease.

You can define these complications as COPD side effects or as COPD secondary problems or the consequences of COPD. Here is the list of them.

COPD complications, how they present and prognosis

COPD symptoms start appearing after the age of about 40 years and by then lung damage is already significant. You are, therefore, likely to develop complications as an older adult. Elderly people with complications have a poor prognosis due to the weakening of the immune system because of aging. The lung capacity, too, weakens with age.

GOLD has divided COPD into four progressive stages according to its spirometry results and the severity of its symptoms. Each stage has its own share of complications.

Patients with mild-to-moderate COPD tend to die from cardiovascular disease or lung cancer. The reason for this is likely to be chronic low-grade inflammation associated with COPD.

Respiratory failure, the leading cause of COPD-related death is a complication of the end stage of COPD.

The most common COPD complications include

  • Pulmonary hypertension
  • Cor pulmonale
  • An acute exacerbation
  • Pneumothorax
  • Respiratory failure

Many of these complications can be worrisome to your health advisor. To improve the long-term outlook, you must learn to recognize them early and seek prompt treatment.

Pulmonary hypertension or high blood pressure in the lungs

COPD causes pathophysiological changes in the lungs and considerable lung damage.

  • The walls of the alveoli (air sacs) become thick, inflamed and damaged
  • Due to inflammation of the walls of the bronchi (airways), too much mucus is secreted, which blocks them.
  • The elastic property of the bronchi and the alveoli is lost.

All these changes impair the gas exchange process in the lungs, which results in lower oxygen levels (hypoxia) and higher carbon dioxide levels (hypercapnia) in the blood.

Low oxygen levels (hypoxia), inflammation and loss of alveolar capillaries due to severe emphysema cause the narrowing of the blood vessels in the lungs (pulmonary arteries), which raises the blood pressure in the pulmonary arteries. This is called pulmonary arterial hypertension (PAH) or just pulmonary hypertension.

Symptoms of PAH include shortness of breath, fatigue, dizziness, chest pain, pedal edema, rapid heart beat. They worsen during exercise, sleep, and an exacerbation.

Prognosis.

According to the American Lung Association, about 50 percent of people will die from pulmonary arterial hypertension within five years. Without treatment, the patients live for an average of three years.

Cor pulmonale

Because of pulmonary hypertension, the right ventricle of the heart that pumps blood through the pulmonary arteries to the lungs is under a high back pressure of the blood.

Due to this constant strain, it becomes enlarged over time and eventually fails. This is called right-sided heart failure or cor pulmonale.

Symptoms include shortness of breath, fatigue, increased heart rate, lightheadedness, leg or feet swelling, coughing and wheezing

Prognosis. According to Medscape, the five-year survival rate for cor pulmonale complicating COPD is approximately 50%. Without treatment, the patient with COPD induced cor pulmonale will not live beyond three years.

Coronary artery disease

Coronary artery disease (CAD) develops when the major blood vessels that supply blood, oxygen and nutrients to the heart become hardened, narrowed or blocked.

Cholesterol-containing deposits (plaques) on the inner walls of the coronary arteries and inflammation are usually to blame for coronary artery disease.

Chronic bronchitis is associated with a 50% higher risk of death from CAD. This risk is independent of the risks associated with smoking.

It takes decades for CAD to develop and significant blockage for symptoms to develop. When the artery is completely blocked, you get a heart attack.

Symptoms include chest pain called angina pectoris on the left side of the chest and, breathlessness.

This presents as  a crushing pressure in your chest and the pain may radiate to your left shoulder or arm At times, there may be shortness of breath and sweating.

Prognosis

The incidence of heart attack is very high and at present, it is rated as the number one killer in the United States and worldwide.

According to the American Heart Association, 63% of women and 48% of men who died suddenly of coronary artery disease had no previous symptoms.

1.5 million cases of heart attacks are reported every year in the United States of which more than  half a million die.

Respiratory failure

Respiratory failure is an advanced complication of the end stage of COPD (stage 4). It is the leading cause of death from COPD and is associated with frequent exacerbations with a fast deterioration of the disease.

Long-term severe hypoxia and hypercapnia can cause acute respiratory failure, which may result in life-threatening arrhythmias (irregular heart beats.

Signs and symptoms of respiratory failure may include shortness of breath and very rapid and shallow breathing, In severe cases, signs and symptoms may include a bluish coloring of the skin, lips, and fingernails, confusion; and sleepiness (hypersomnolence).

Prognosis

According to the American College of Physicians, even by treating acute respiratory failure patients having COPD with mechanical ventilation, the long-term prognosis is poor.

For patients who have developed acute respiratory failure with COPD, the overall mortality has declined from approximately 26% to 10%. Acute exacerbations of COPD carry a mortality of approximately 30%.

Lung cancer

Patients with a 30-year history of smoking and COPD association (airflow limitation) are at high risk of developing lung cancer.

The other probable causes associated with smoking include chronic inflammation in the lungs and a genetic link.

Symptoms include a persistent cough at times with blood, chest pain, shortness of breath, hoarseness, loss of appetite and weight, and fatigue.

Prognosis  

Lung cancer has four stages. Prognosis of each stage varies. Cancer research UK gives the differing mortality rate of each stage.

COPD complication pneumonia

Patients with COPD who use inhaled corticosteroids are more likely than nonusers to contract pneumonia. The prognosis, however, does not change and remains the same for users and nonusers of inhaled steroids.

Having developed the pneumonia complication when you are already suffering from COPD, is a two-fold blow to the patient. The major symptoms of both these conditions overlap making the diagnosis of pneumonia difficult.

The doctor could easily mistake the symptoms for a COPD exacerbation. Both, pneumonia and a COPD flare-up show symptoms of sputum with mucus, chest tightness or pain, wheezing, shortness of breath and fever.

In pneumonia, the fever will be high (101 to 105 degrees Fahrenheit) with rigors (shaking) in addition to chest pain when coughing. The chest X-ray, however, will help to clinch the diagnosis.

Pneumonia can come on as a complication of an influenza infection in the COPD patient in which case pneumonia will be viral. Or, pneumonia can be of bacterial origin. The bacterial disease is more serious and so is the severity of its symptoms.

Patients with COPD who develop pneumonia are at a higher risk of developing respiratory failure.

Pneumothorax

Pneumothorax occurs when air collects in the cavity between the lungs and the chest wall. It happens due to the escape of air through a tiny opening in the lung causing the lung to collapse.

A secondary spontaneous pneumothorax (SSP) is defined as one that occurs as a complication of an underlying lung disease, in this case, COPD.

This opening could occur because of a bout of intense coughing or a chest wound. It is seen more in COPD patients because the lungs are substantially weakened increasing the risk of recurrences.

Symptoms include a sudden and sharp chest pain, chest tightness, rapid heart rate and a fall in blood pressure.

50 to 70 percent of secondary spontaneous pneumothorax cases are attributed to COPD.

Osteoporosis

As the name suggests, osteoporosis means porous bones; in other words loss of bone density. People with osteoporosis tend to have bone fractures very easily because their bones are considerably weakened.

Older age and chronic smoking are risk factors that are common for osteoporosis and COPD. Another risk factor for osteoporosis is long-term use of oral steroids, which is frequent among COPD patients.

Other factors that put COPD patients at an osteoporosis risk are

  • vitamin D deficiency
  • low weight
  • a sedentary lifestyle
  • Hypogonadism (reduced levels of sex hormones), which can be due to long-term steroid use.

Hypercapnia and hypoxia have significant impacts on bone metabolism and may predispose COPD patients to osteoporosis

The prevalence of osteoporosis is high among the moderate to severe COPD patients and the prevalence increases as the degree and stage of COPD progresses.

According to science direct, the prevalence of osteoporosis in COPD patients has increased dramatically  from 47% to 61% in 3 years. The possible cause is an increase in vitamin D deficiency among the population.  http://www.sciencedirect.com/science/article/pii/S0954611112000406

Sleep disturbances

Sleep disturbance is a very common complication seen by the fact that about half the patients with severe COPD experience sleeping disorders.

There are a number of reasons seen in COPD patients, which cause sleeping disorders such as insomnia.

  • Depression and anxiety
  • Sleep apnea — disturbed breathing during sleep
  • Nocturnal hypoxia is a lack of oxygen during sleep and which could be due to inhibition of the cough reflex and build-up of mucus.
  • Certain medications given for COPD can cause sleeplessness. Nighttime oxygen and a change in COPD treatment from beta-agonists to anticholinergics can sometimes help restore sleep.
  • Heartburn: GERD is a common condition associated with COPD that can prevent sleep.

COPD patients should not use sleep medications because they can have harmful respiratory side effects and other complications such as memory loss, decreased alertness, falls and an increased risk of accidents.

Depression

Depression signifies a feeling of fatigue, sadness, or hopelessness. In the patient suffering from COPD complication of depression, these symptoms can overlap with those of COPD. According to a one study, 40% of COPD patients suffer from depression.

  • Depression symptoms include
  • Being irritable and angry with others
  • A feeling of sadness lingering for weeks at a time
  • Feeling of hopelessness leading to suicidal tendencies
  • Unable to tolerate criticism
  • Feeling guilty or worthless

The cause of the prevalence of depression in COPD patients is thought to be chronic breathlessness and fatigue, which does not allow the patient to do much and makes him feel hopeless.

An estimated 6-12% of the US population will experience depression at some time. The annual suicide rate in the United States is 12.93 per 100,000 individuals. Suicide is the tenth leading of cause of mortality.

Overall prognosis of COPD 

There are two major factors that determine the prognosis of the COPD patient.

Firstly, how severe is the lung disease and secondly, whether the person continues to smoke. If the person quits smoking, prognosis improves.

FEV1 value (forced expiratory volume in one second) as determined through the spirometry test will tell you how severe is the disease.

Patients of FEV1 more than 50% have a good prognosis and equal to that of patients without COPD.

Patients with FEV1 of 30% or less, as in stage 4, have a 1-year mortality rate of 30 percent and a 10-year mortality rate of 95 percent.

Factors responsible for an increased mortality rate of a patient admitted to a hospital for a COPD exacerbation are:

  •  Age: The mortality risk increases with age.
  • Carbon dioxide levels in the blood: Chronically higher CO2 levels significantly increase mortality chances.
  • Long-term use of oral steroids weakens the immune system and it then becomes very difficult to control the disease exacerbation.

 

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