Chronic respiratory diseases are diseases of the airways and other structures of the lung. Some of the most common are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.
In addition to tobacco smoke, other risk factors include air pollution, occupational chemicals and dust, and frequent lower respiratory infections during childhood.
Here we present one very common respiratory disease, Chronic Obstructive Pulmonary Disease (COPD).
The case of Chronic Obstructive Pulmonary Disease (COPD)
age: 60 year old
Job: Delivery worker
The case of Steven with chronic obstructive pulmonary disease (COPD)
For some months, Steven has developed a persistent cough and when he needs to travel long distances on foot, climb stairs or carry the heaviest packages, he gets out of breath and is forced to stop and sit down for a few minutes to recover. His doctor told him that these are the first symptoms of chronic obstructive pulmonary disease and that he should avoid carrying heavy weights or do this type of tasks and that during a respiratory crisis he must use an oxygen inhaler. Steven would like to talk to his boss about the disease, hoping he can make his job less tiring and accept these conditions. He does not want to stop working but, at his age, he is afraid they may let him go and he thinks he might have real difficulties in finding other jobs.
Chronic Obstructive Pulmonary Diseases (COPD)
1 What is it
Chronic Obstructive Pulmonary Disease (COPD) is a set of respiratory diseases that affect the lungs and bronchi and cause difficulty in breathing. It is a chronic, long-lasting condition; therefore, the damage it causes is often irreversible and may only be slowed down.
COPD is an umbrella term used to describe progressive lung diseases including:
- Chronic bronchitis: a protracted inflammatory state of the bronchial mucosa.
- Emphysema: damage to the pulmonary alveoli, the structures of the lungs in which the exchange between air and blood actually takes place. Emphysema usually originates from chronic bronchitis
- Refractory (non-reversible) asthma: a type of asthma that does not respond to usual asthma medications.
There may be several causes of the disease:
- In the great majority of cases, COPD is caused by inhaling pollutants; that includes tobacco smoking.
- Exposure to toxic substances of industrial origin (i.e fumes) as well as dust and poor air quality.
- Genetics can also play a role in an individual’s development of COPD, for people who have a deficiency in a protein that protects the lungs.
The main symptoms of COPD are:
- Shortness of breath, especially during physical activities, after even mild exercise such as walking up a flight of stairs
- Wheezing (dyspnoea): it’s a type of higher pitched noisy breathing, especially during exhalations. Breathing is altered in rhythm or frequency, and occurs with difficulty or suffering of the patient.
- Chest tightness
- Excessive production of mucus, that may contain small losses of blood.
- Chronic and persistent cough, with or without mucus
- Temperature or chills of cold
- Weakness and lack of energy
- Pain when swallowing
- Swelling of the feet, ankles, or leg
- Unintended weight loss (particularly in the later stages)
Symptoms can also progress into complications and cause much more serious harm to the person, such as: frequent respiratory infections (e.g. pharyngitis, colds, flu, pneumonia), emphysema, lung cancer, pulmonary hypertension (high blood pressure in lung arteries), and other chronic comorbidities such as heart disease, depression and anxiety.
COPD is a progressive and currently incurable disease, but with the right diagnosis and treatment, there are many things people can do to manage their disease, breathe better and avoid flare-ups.
With some lifestyle and activity changes, people can take an active role in managing their disease and can improve their physical and emotional health, living for many years and enjoying life.
The first treatment of chronic obstructive pulmonary disease is quitting smoking in order to stop the progression of damage and avoid exacerbations.
Avoidance of passive smoke, chemical fumes, air pollution, and dust, whenever possible.
The pharmacological treatment of COPD must be carefully planned by the specialist.
- Bronchodilators, Corticosteroids, Theophyllin, and Antibiotics
- Oxygen therapy, that compensate the difficulty in obtaining the necessary amount of oxygen for the functioning of organs and tissues, especially muscles, in particular the heart.
- Pulmonary rehabilitation: a combination of exercises to strengthen the support muscles in breathing.
4 Psychosocial issues and impact of the disease on employment
The diagnosis of COPD may have important consequences on personal and social life. This is true in particular for people of working age, because the disease can have a great impact on their job.
Keeping people with COPD at work as long as possible may provide not only a daily routine but may improve their financial, social and psychological wellbeing as well as their physical health. If the job does not have direct impact on the progression of the disease, people may choose to continue working and should be encouraged to do so.
Even if employees with COPD may not always be able to perform to full capacity, it does not mean the disease definitely affects productivity.
To manage workers with COPD and help them continue working or returning to work, employers can promote some interventions.
- Aerate and humidify work environment, providing adequate ventilation.
- Promote quitting smoking policies and contact with passive smoke. Provide a smoke-free, dust-free, fume-free and fragrance-free environment.
- If the task exposes the worker to any of these lung irritants (fumes, chemicals, toxins and pollution), make sure they protect themselves, for instance by using protective respiratory equipment.
- Limit strenuous activities of the employee, especially when the type of work requires extensive physical demands. This also may include taking rests from talking, because using the voice can be tiring for people with breathing problems.
- Allow a flexible work schedule (e.g. work from home, provide the chance to come in later or leave earlier).
- Make mobility easier for the worker (e.g. providing an accessible parking space or a mobility scooter, a briefcase on wheels to transport work items).
- Make sure that the employee wears oxygen apparatus at work: this helps prevent breathlessness, improves mental alertness and enables them to get through the workday more effectively. Give them time to rest and take inhaled medications during the working day.
When it’s clear that the type of work will make the employee condition worse, he may want to consider long-term disability. Leave the job early for a person with COPD can have a negative impact on pension benefits and on financial condition, as well as on psychological and social well-being, thus it’s important to consider early retirement as the very last option.
For further information, see:
European Respiratory Society (ERS) – https://www.erswhitebook.org/chapters/chronic-obstructive-pulmonary-disease/
European Academy of Allergy and Clinical Immunology (EAACI) – https://www.eaaci.org/
European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) – http://www.efanet.org