COPD Diagnosis, Treatment and Therapy Techniques: A Medical View

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COPD Diagnosis and Treatment from the Medical View
COPD (Chronic Obstructive Pulmonary Disease) the diagnosis is based on spirometry intervention
that effectively evaluates the level of airflow obstruction. The ratio of forced expiratory volume in
one second and forced vital capacity (i.e. FEV1/FVC) assists in diagnosing COPD severity. FER (forced
expiratory ratio) value of less than 0.7 (following bronchodilator administration) is regarded as a cut-
off point for COPD (Johns, Walters and Walters, 2014). Similarly, the FEV1 value greater than 80% is
indicative of mild COPD. Similarly, 50-80%, 30-49%, and less than 30% FEV1 values predict moderate,
severe, and very severe forms of COPD. However, the ancillary diagnostic testing for COPD is based
on the identification of clinical symptoms (including a chronic cough, dyspnea, and expectoration),
history, physical examination, chest X-ray, bronchodilator reversibility testing and FEV1
normalization assessment (Burkhardt and Pankow, 2014). The assessment of transdiaphragmatic
pressure through EMG (electromyographic) analysis substantially assists in evaluating the respiratory
incapacity of the COPD patients (Sarlabous et al., 2017). Similarly, mechanomyographic assessment
helps in mechanical muscle potential of the COPD suspects. Pharmacotherapeutic treatment of
COPD is based on the administration of bronchodilators, glucocorticoids, vasodilators, antitussives,
immunoregulators, antioxidants, mucolytic agents, α1-antitrypsin augmentation therapy, antibiotics,
and vaccines. The symptomatic treatment of COPD is based on the administration of long and short-
acting drugs including theophylline, anticholinergics, and selective β2-adrenergic agonists
(Montuschi, 2006). The treatment of COPD exacerbations warrants the administration of
glucocorticoids along with other combination drugs.
COPD Therapy Techniques from the Medical View
COPD therapy techniques for treating the patients affected with severe airflow obstruction include
the breathing intervention, biofeedback, distraction therapy, guided imagery, progressive muscle
relaxation, acupuncture, and other relaxation techniques (Volpato et al., 2015). Furthermore,
pulmonary rehabilitation includes significant techniques attributing to respiratory muscle training,
breathing therapy, smoking cessation, support, psychosocial support, nutrition counseling,
behavioral training, patient education, exercise training, and pharmacological treatment
optimization. These techniques enhance the survival rate, muscle functioning, health-related quality
of life, and exercise capacity of COPD patients (Leupoldt et al., 2012). These interventions also assist
in controlling depression, anxiety, and breathlessness perception of the target population to a
considerable extent. The progressive muscle relaxation technique requires the enhancement of
tension at the targeted body part followed by relaxation after an interval of five seconds. This
process requires repetition for different muscle groups with a gap of 15 seconds. However,

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conventional pharmacotherapy inhaler techniques are based on the recommended use of inhaler
devices to administer the appropriate dose of the selected drug across the respiratory system
(Nguyen and Nguyen, 2018). Treatment of severe COPD is also based on oxygen therapy that assists
in enhancing the quality of life and survival rate of the affected patients. Oxygen therapy
substantially assists in minimizing exertional dyspnoea in COPD patients (Barnes and Stockley, 2005).
Antibiotic administration to the COPD patients is required to control bacteria associated virus-based
COPD exacerbations. The administration of oral antibiotics impacts bacterial colonization across the
lower respiratory passage. The long-term antibiotic use by COPD patients effectively stabilizes the
respiratory system and controls exacerbation episodes for an extended duration. Smoking cessation
intervention includes the nicotine addiction therapy that attempts to improve the long-term quit
rate of the COPD patients (Barnes and Stockley, 2005).
Study – 1
Methodology
The study by (Sarlabous et al., 2017) utilized capacitive accelerometers to record the respiratory
muscle mechanomyogram (MMG) signal. The placement of accelerometers over right anterior
axillary lines, 7-8 intercostal space, and chest surface assisted in recording the mechanical vibrations
of the diaphragm muscle. A 12-bit analog-to-digital converter was used to register the respiratory
muscle MMG signal as well as inspiratory mouth pressure. A zero-phase fourth-order Butterworth
filter was utilized to filter the MMG recordings of the frequency of 5-25Hz in the context of
surpassing the respiration-based chest wall’s reduced frequency movement.
Experiment Protocol
The selected subjects were asked to sit in an upright manner while acquiring a comfortable posture.
T tube was connected to the mouthpiece for breathing facilitation. The inspiratory mechanical
activation was recorded during the effortless breathing for the 1-minute duration. The IVE
(incremental ventilatory effort) protocol was initiated with the objective of progressively enhancing
the intensity and rhythm of the breathing pattern of the study subjects. Subsequently, the subjects
were instructed to resume the shallow breathing pattern while reducing the breathing intensity and
rhythm. This technique assisted in recording the inspiratory pressure of subjects in accordance with
their total airflow pattern. The protocol lasted for 2-6 minutes while three-times replicating the
technique for every study subject.

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Sampling
The study engaged seven healthy subjects and thirteen patients affected by COPD. Healthy subjects
included four males and three female individuals. However, diseased subjects included eleven male
and two female patients.
Data Analysis
MLZ (Multistate Lempel-Ziv) index was utilized to record the inspiratory muscles’ mechanical
strength. The assessment of non-occluded tidal volume-based peak inspiratory mouth pressure
helped in tracking the inspiratory muscles’ mechanical outcome during a complete respiratory cycle.
This assisted in evaluating the overall distensibility and activity of the respiratory muscle. The MMG
indices/peak inspiratory mouth pressure’s median value recording assisted in evaluating the
mechanical activation pattern and inspiratory muscle effort of the selected subjects. The MMG-
based inspiratory muscle activity was eventually compared with the inspiratory muscle potential
obtained through the conventional RMS (root mean square) method. Pearson correlation coefficient
and Wilcoxon signed-rank test were used to comparatively analyze the inspiratory muscle capacity
of healthy groups and COPD patients.
Results
The study outcomes revealed the elevated value of mean respiratory frequency in COPD patients as
compared to the healthy subjects. Ventilation level enhancement significantly increased the MMG-
RMS, MMG-MLZ, and peak inspiratory mouth pressures in COPD groups as compared to the healthy
subjects. The mean and peak tidal volume and inspiratory mouth pressure assisted in identifying the
inspiration-based muscle effort, respiratory components, and respiratory system compliance of the
study groups. The assessment of synergistic respiratory muscle action was undertaken through the
evaluation of inspiratory mouth pressure of the study candidates. The study revealed an inverse
relationship between respiratory muscle activation and COPD severity.
Study – 2
Methodology
The study by (Torres et al., 2010) instrumented the subjects with the objective of acquiring the right
and left hemidiaphragm mechanomyometric signals (MMGr and MMGl) along with the (IP)
inspiratory pressure. The pressure transducer was utilized and placed across the subjects’ breathing
tube for the IP assessment. The thoracic cage was used to place Kistler 8312B2 capacitive
accelerometers in the context of retrieving MMGr and MMGl levels. Bilateral hemidiaphragm MMG