Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a term for many respiratory diseases, where the respiratory tract’s airways become constricted, limiting normal breathing capacity. Globally, COPD is prevalent, and rates of the disease keep increasing as the years progress.⁶

Patients diagnosed with chronic bronchitis and/or emphysema constitute the majority of patients with COPD.¹ Inhaled irritants cause airway inflammation and mucus buildup due to immune activation. Normal function of the lungs becomes compromised, and can present in symptoms such as shortness of breath, a persistent mucus cough or sometimes blue skin.¹

Laryngitis is a respiratory disease affecting the larynx, also known as the voice box. It sits just above the windpipe and can become inflamed or infected, depending on the reason behind its dysfunction. Laryngitis is commonly caused by either injury to the larynx or infection, causing inflammation in the area. This can cause patients to have a hoarse voice, pain in the front part of their neck, or sometimes fevers.⁴

COPD and laryngitis both affect lung functioning and breathing. As with most respiratory diseases, they are both heavily affected by lifestyle choices such as smoking or drinking heavily.^2,4 Laryngitis can worsen COPD symptoms and is linked to bronchitis progression, a key part of COPD.³ Therefore, understanding the interactions between these two diseases may help manage the progression of both diseases.

Understanding chronic obstructive pulmonary disorder

COPD is a worldwide health problem, creating a significant burden on healthcare systems globally.² The risk of COPD increases significantly over the age of 65, and for people assigned female at birth, or with alpha-1 antitrypsin deficiency. COPD develops as the lungs become exposed to noxious gases or chemicals that the lungs respond to immunologically. Examples of irritants include toxins from smoking cigarettes or abnormal levels of pollution, which irritate the internal structures of the lungs. The immune system remodels the tissue within the respiratory tract, which damages internal structures. As COPD progresses, symptoms such as coughing and mucus production worsen, and some may also experience weight loss as more energy is being put into breathing.⁶ Furthermore, other disorders alongside COPD could develop, such as gastroesophageal reflux, coronary heart disease, or even depression. Understanding how long a person has smoked, or a comprehensive family history of chronic respiratory disorders, can help doctors in diagnosis and treatment.

Chronic bronchitis is an example of how the immune response changes the structure of the bronchi within the respiratory tract. Mucus glands within the lung, in normal function, secrete mucus to trap pathogens or irritants to prevent build-up further down the respiratory tract, and are moved out by coughing or sneezing. In bronchitis, these mucus glands can swell and change the diameter of the bronchi, affecting airflow in and out of the lungs.² There are two types of bronchitis, acute and chronic. Acute bronchitis occurs most commonly, such as in viral infections, and usually clears out within a week or two for healthy individuals,⁵ through coughing and sputum (mucus) buildup. Chronic bronchitis is more serious in comparison. The coughing and sputum production can persist for over 3 months, and when coupled with restricted airways, is diagnosed as COPD.⁵ 

Emphysema is a respiratory disease which targets the alveoli after the terminal bronchioles,⁶ the small air sacs where oxygen is delivered to the blood and carbon dioxide is removed as a waste product. This disease is more likely to affect those assigned male at birth and the older population.¹ Normally, alveoli have elastic walls that are able to expand and recoil, with an adjacent capillary optimised for gas exchange efficiency. However, as emphysema progresses, the alveoli become indefinitely larger, and the elasticity of the alveolar walls is severely damaged.⁶ There are three different types of emphysema, categorised by the area which is affected in the alveolar sacs after the terminal bronchioles. 

Understanding laryngitis

Laryngitis is the inflammation or infection of the larynx, which sits above the trachea in the respiratory tract. The larynx maintains pressure within the lungs and is involved in processes such as coughing or sneezing.⁴ There are two types of laryngitis: acute or chronic. Acute laryngitis is most common, lasting only a few weeks, typically due to a short-term infection. Most often, acute laryngitis is caused by a pathogenic infection or overstraining your voice for a prolonged period.⁴ Chronic laryngitis, on the other hand, affects patients for longer than three weeks. The onset of chronic laryngitis can initially be caused by acute laryngitis, but can also be caused by heavy smoking, acid reflux or chronic sinusitis.^1,4 If acid reflux reaches the throat, it is known as laryngopharyngeal reflux, and can strain the larynx further.⁷

Symptoms of laryngitis will vary depending on whether it is acute or chronic, if the onset is inflammatory or due to an infection, and many other reasons. Common symptoms for laryngitis include:⁴

• Dysphonia (hoarseness in your voice)
• Air wastage
• Pain in the neck (where your larynx is located)
• Coughing
• Globus pharyngeus (feeling a lump in your throat)
• Fever
• Myalgia (pain in your muscles)
• Dysphagia (problems swallowing)

When assessing a patient for laryngitis, the first point of call is to check the airway, whilst considering the symptoms being presented and any family history of chronic respiratory disorders. Doctors may take a swab of the throat to assess infection, or a biopsy to get a closer look at what might be wrong.³

How are laryngitis and COPD linked?

Laryngitis is not directly correlated with the onset of COPD, such as chronic bronchitis or emphysema. That being said, there is an important link between the two. They both are heavily impacted by similar risk factors, such as smoking or drinking heavily. Furthermore, laryngitis is a risk factor for developing bronchitis,³ which is one of the key conditions under the COPD definition. Patients with laryngopharyngeal reflux, a key symptom which worsens the onset of laryngitis, were found to be more prevalent in patients with COPD in comparison to those without COPD.⁷ Their symptoms, such as hoarseness and excessive mucus production, worsened, indicating that the comorbidity of COPD and laryngitis negatively affects patients. 

Furthermore, there is a risk of misdiagnosis with such respiratory conditions. As the symptoms, risk factors and onset of COPD and laryngitis are very similar, one condition may be mistaken for another. This is problematic because when it comes to treating the disease, what should be targeted may be left to worsen or progress further. Therefore, it is very important to consult a doctor as these symptoms progress to ensure the correct treatment and diagnosis.

Clinical diagnosis and management

COPD is diagnosed when radiological findings present chronic bronchitis or emphysema, with a partially reversible or completely irreversible obstruction in the airways.⁵ In emphysema, spirometry is primarily used to diagnose what stage of emphysema the patient has.⁶ This is based on a person’s FEV¹ value (the amount of air a person is able to forcefully exhale in one breath), and a table is shown below for the definition of each stage:¹

If diagnosis is proving difficult, doctors may refer to radiography techniques such as CT scans or X-rays, particularly if the progression of emphysema is severe.⁶ Testing for alpha-1 antitrypsin deficiency or early detection if you have a family history of COPD is crucial to prevent further lung damage. Diagnosis of chronic bronchitis is given when a cough is persistent for three months or over, and postmortem biopsies have confirmed the restriction of bronchi by excess mucus production.²

Managing COPD and laryngitis is done through lifestyle changes and medical interventions if the onset is severe. The biggest change that should be implemented is to stop smoking. Its irritants are most harmful, especially in the progression of chronic bronchitis and emphysema onset. In emphysema, if the blood oxygen saturation of the blood drops below 92%, the patient is at risk of hypercapnia, and arterial blood gases are suggested as treatment.⁶ For bronchitis, a bronchodilator may be suggested as a way to open airways, and rehabilitation where exercise can slowly increase lung health are options to explore.¹

When treating laryngitis, it is important to establish its nature first. If acute, a simple antibiotic treatment or vocal rest may help recovery,⁴ However, in cases of chronic laryngitis, treatment focuses on underlying issues such as laryngopharyngeal reflux or lifestyle habits. Doctors may prescribe steroids to be used in severe cases to help with the inflammation and pain, especially during flare-ups (exacerbations).¹

Summary

COPD is a respiratory disorder which encompasses chronic bronchitis and emphysema primarily. This condition primarily affects those assigned female at birth and people aged over 65. COPD limits lung functioning by restructuring tissue as a result of damage, causing restricted airflow. Consequently, patients can experience shortness of breath, wheezing and a persistent mucus cough. Laryngitis is the inflammation of the larynx or voice box, causing hoarseness of the voice, coughing or pain in the throat area. Laryngitis is most likely to affect those assigned male at birth and within the age category of 50-70.³

Both laryngitis and COPD affect the respiratory system and affect the efficiency of gas exchange, which is needed to keep our blood saturated with oxygen. Smoking is the most significant risk factor for both diseases, and patients are advised to quit to prevent further progression. Infections and toxins are also common risk factors. Symptoms of one condition can impact the severity of symptoms in the other, worsening the quality of life for patients with both, affecting their daily activities. Therefore, managing laryngitis and COPD should come with a lifestyle change of stopping smoking and exposure to toxins where possible, as well as doctor-prescribed medical treatments to live better with these diseases.