COPD

Definition
Chronic obstructive pulmonary disease (COPD) is the overall term for a group of
chronic lung conditions that obstruct the airways in your lungs. COPD usually refers
to obstruction caused by chronic bronchitis and emphysema, but it can also refer to
damage caused by asthmatic bronchitis. In all forms of COPD, there's a blockage
within the tubes and air sacs that make up your lungs, which hinders your ability to
exhale. And, when you can't properly exhale, air gets trapped in your lungs and makes
it difficult for you to breathe in normally.

COPD is very common. It's a major cause of death and illness worldwide, and it's the
fourth-leading cause of death in the United States. In the majority of cases, COPD is
caused by long-term smoking and could be prevented by not smoking or quitting
smoking. However, once symptoms begin, the damage to your lungs can't be
reversed, and there's no cure. Treatments for COPD focus primarily on controlling
symptoms and preventing further damage.

Symptoms
Initially, COPD is often silent. Signs and symptoms may not appear until there's
significant lung damage, but once symptoms begin, they typically worsen over time.
COPD symptoms may include:

 Persistent cough
 Increased mucus production
 Shortness of breath, especially during physical activities
 Wheezing
 Chest tightness
 Frequent respiratory infections

Causes
To understand COPD, it helps to understand how your lungs work and how they can
become obstructed.

How your lungs work

When you inhale, air travels down your windpipe (trachea) and into your lungs
through two large tubes (bronchi). Inside your lungs, these tubes divide many times
— like the branches of a tree — into many smaller tubes (bronchioles) that end in
clusters of tiny air sacs (alveoli). The air sacs have very thin walls full of tiny blood
vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels
and enters your bloodstream, where it will be distributed throughout your body. At the
same time, carbon dioxide — a waste product of metabolism — is removed and
exhaled.

When you breathe in, most of the work is done by the muscles in your diaphragm and
rib cage. These muscles contract as you inhale, which expands your chest cavity and
draws air into your lungs. However, these muscles don't expel the air back out again.
To force air out of your body, your lungs rely on the natural elasticity of the bronchial
tubes and air sacs. When your tubes or air sacs are damaged, they lose their elasticity.
This can slow down air movement when you exhale and trap stale air in your lungs,
leaving you to work harder to get adequate oxygen in and carbon dioxide out.

Causes of airway obstruction

COPD primarily refers to obstruction in the lungs from two chronic lung conditions.
Many people with COPD have both:

 Emphysema. This lung disease causes inflammation within the fragile walls of the alveoli.
This can destroy some of the walls and some of the elastic fibers, which allows small
airways to collapse when you breathe out. This impairs airflow out of your lungs.
  Chronic bronchitis. This condition, which is characterized by an ongoing cough, causes
inflammation and narrowing of the major and smaller bronchial tubes. Chronic bronchitis
also causes increased mucus production, which can block the narrowed tubes.

Asthmatic bronchitis also is sometimes classified as COPD, because it obstructs

airways and makes it difficult to inhale. Asthmatic bronchitis — also known as
bronchial asthma — is a term used to describe chronic bronchitis accompanied by
contractions of the muscle fibers in the lining of the airways (bronchospasm).

Cigarette smoke and other irritants

In the vast majority of cases, the damage in the lungs that leads to COPD is caused by
long-term cigarette smoking. But other irritants can cause COPD, including cigar
smoke, secondhand smoke, pipe smoke, air pollution and certain occupational fumes.

In rare cases, COPD results from low levels of a protein called alpha-1-antitrypsin.
This is a rare genetic disorder known as alpha-1-antitrypsin deficiency.

Risk factors
Risk factors for COPD include:

 Exposure to tobacco smoke. The most significant risk factor for COPD is
long-term cigarette smoking. The more years you smoke and the more packs
you smoke, the greater your risk. Pipe smokers, cigar smokers and people
exposed to large amounts of secondhand smoke also are at risk.
 Occupational exposure to dusts and chemicals. Long-term exposure to
chemical fumes, vapors and dusts can irritate and inflame your lungs.
 Age. COPD develops slowly over years, so most people are at least 40 years
old when symptoms begin.
 Genetics. A rare genetic disorder known as alpha-1-antitrypsin deficiency is
the source of a few cases of COPD. Researchers suspect that some genetic
factors may also make certain smokers more susceptible to the disease.

When to seek medical advice

If you're a smoker with signs and symptoms of COPD — such as cough, mucus
production or shortness of breath — talk to your doctor. If you've been told that you
have chronic bronchitis, emphysema or asthmatic bronchitis and you start
experiencing symptoms of COPD, talk to your doctor. It's important to act quickly to
preserve your lungs.

Tests and diagnosis

If you have symptoms of COPD and a history of exposure to lung irritants —
especially cigarette smoke — your doctor may recommend these tests:

 Pulmonary function tests. Spirometry is the most common lung function test. During this
test, you'll be asked to blow into a large tube connected to a spirometer. This machine
measures how much air your lungs can hold and how fast you can blow the air out of your
lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can
also be used to track the progression of disease and to monitor how well treatment is
working.
 Chest X-ray. A chest X-ray can show emphysema — one of the main causes of COPD. An
X-ray can also rule out other lung problems or heart failure.
 Arterial blood gas analysis. This blood test measures how well your lungs are bringing
oxygen into your blood and removing carbon dioxide.
 Sputum examination. Analysis of the cells in your sputum can help identify the cause of your
lung problems and help rule out some lung cancers.
 Computerized tomography (CT) scan. A CT scan is an X-ray technique that produces more-
detailed images of your internal organs than those produced by conventional X-rays. A CT
scan of your lungs can help detect emphysema and help determine if you might benefit from
surgery for COPD.

Complications
Complications of COPD include:

 Respiratory infections. When you have COPD, you're more likely to get
frequent colds, the flu or even pneumonia. Plus, any respiratory infection can
make it much more difficult to breathe and produce further irreversible
damage to the lung tissue. An annual flu shot and regular pneumococcal
vaccines can help.
 High blood pressure. COPD may cause high blood pressure in the arteries
that bring blood to your lungs.
 Heart problems. For reasons that aren't fully understood, COPD increases
your risk of heart disease, including heart attack.
  Lung cancer. Smokers with chronic bronchitis are at a higher risk of
developing lung cancer than are smokers who don't have chronic bronchitis.
 Depression. Difficulty breathing can keep you from doing activities that you
enjoy. And it can be very difficult to deal with a disease that is progressive and
incurable. Talk to your doctor if you feel sad or helpless or think that you may
be experiencing depression.

Treatments and drugs

There's no cure for COPD. And it's impossible to undo damage to your lungs. But
COPD treatments can control symptoms, reduce the risk of complications and
improve your ability to lead an active life.

Smoking cessation
The most essential step in any treatment plan for smokers with COPD is to stop all
smoking. It's the only way to keep COPD from getting worse — which can eventually
result in losing your ability to breathe. But quitting smoking is never easy. And this
task may seem particularly daunting if you've tried to quit before. Talk to your doctor
about nicotine replacement products and medications that might help, as well as how
you might handle relapses. It's not easy to kick the habit, but a smoke-free future is
critical to preserving your breath.

Medications
Doctors use three basic groups of medications to treat the symptoms and
complications of COPD. You may take some medications on a regular basis and
others as needed:

 Bronchodilators. These medications — which usually come in an inhaler — relax the

muscles around your airways. This can help relieve coughing and shortness of breath and
make breathing easier. Depending on the severity of your disease, you may need a short-
 acting bronchodilator before activities, a long-acting bronchodilator that you use every day,
or both.
 Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and
help you breathe better. But prolonged use of these medications can weaken your bones and
increase your risk of high blood pressure, cataracts and diabetes. They're usually reserved
for people with moderate or severe COPD.
 Antibiotics. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can
aggravate COPD symptoms. Antibiotics can help fight bacterial infections.
 Emerging medications. A number of promising COPD medications are in the testing stages
of development. Doctors and researchers hope these new medications will provide longer or
more effective relief of COPD symptoms.

Surgery
Surgery is an option for some people with some forms of severe emphysema who
aren't helped sufficiently by medications alone:

 Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of
damaged lung tissue. This creates extra space in your chest cavity so that the remaining
lung tissue and the diaphragm work more efficiently.
 Lung transplant. Single-lung transplantation may be an option for certain people with
severe emphysema who meet specific criteria. Transplantation can improve your ability to
breathe and be active, but it doesn't appear to prolong life and you may have to wait for a
long time to receive a donated organ. So, the decision to undergo lung transplantation is
complicated.

Other therapies
Doctors often use these additional therapies for people with moderate or severe
COPD:

 Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental
oxygen. There are several devices to deliver oxygen to your lungs, including lightweight,
portable units that you can take with you to run errands and get around town. Some people
with COPD use oxygen only during activities or while sleeping. Others use oxygen all the
time. Talk to your doctor about your needs and options.
 Pulmonary rehabilitation program. Comprehensive pulmonary rehabilitation may be able to
decrease the length of any hospitalizations you require, increase your ability to participate
in everyday activities and improve your quality of life. These programs typically combine
education, exercise training, nutrition advice and counseling. If you are referred to a
program, you'll probably work with a range of health care professionals, including physical
therapists, respiratory therapists, exercise specialists and dietitians. These specialists can
tailor your rehabilitation program to meet your needs.

Managing exacerbations
Even with ongoing treatment, you may experience times when symptoms suddenly
get worse. This is called an acute exacerbation, and it may cause lung failure if you
don't receive prompt treatment. Exacerbations may be caused by a respiratory
infection or a change in temperature or air pollution. Whatever the cause, it's
important to seek prompt medical help if you notice more coughing, a change in your
mucus or if you have a harder time breathing.

When exacerbations occur, you may need additional medications, supplemental

oxygen or treatment in the hospital. Once symptoms improve, you'll want to take
measures to prevent future exacerbations. This may include quitting smoking,
exercise or a change in your medications.
Prevention
Unlike some diseases, COPD has a clear cause and a near-surefire path to prevention.
The vast majority of cases are directly related to cigarette smoking, and the best way
to prevent COPD is to never smoke — or to quit smoking.

If you're a longtime smoker, these simple statements may not seem so simple,
especially if you've tried quitting — once, twice or many times before. But it's critical
to find a tobacco cessation program that can help you kick the habit for good. It's your
best chance for preventing damage to your lungs.

Occupational exposure to chemical fumes and dust is another risk factor for COPD. If
you work with this type of lung irritant, talk to your supervisor about the best ways to
protect yourself, such as wearing a mask.

Lifestyle and home remedies

If you have COPD, you can take steps to feel better and slow the damage to your
lungs:

 Control your breathing. Talk to your doctor or respiratory therapist about

techniques for breathing more efficiently throughout the day. Also be sure to
discuss breathing positions and relaxation techniques that you can use when
you're short of breath.
 Clear your airways. In COPD, mucus tends to collect in your air passages
and can be difficult to clear. Controlled coughing, drinking plenty of water and
using a humidifier may help.
 Exercise regularly. It may seem difficult to exercise when you have trouble
breathing, but regular exercise can improve your overall strength and
endurance and strengthen your respiratory muscles.
 Eat healthy foods. A healthy diet can help you maintain your strength. If
you're underweight, your doctor may recommend nutritional supplements. If
you're overweight, losing weight can significantly help your breathing,
especially during times of exertion.
 Avoid smoke. In addition to quitting smoking, it's important to avoid places
where others smoke. Secondhand smoke can contribute to further lung
damage.
 Pay attention to frequent heartburn. Constant heartburn can indicate
gastroesophageal reflux disease (GERD), a condition in which stomach acid
or, occasionally, bile flows back (refluxes) into your food pipe (esophagus).
This constant backwash of acid can aggravate COPD, but treatments for
GERD can help. Talk to your doctor if you have frequent heartburn.
 See your doctor regularly. Stick to your appointment schedule, even if you're
feeling fine. It's important to steadily monitor your lung function.

Coping and support

Living with COPD can be difficult — especially as it becomes more and more
difficult to catch your breath. You may have to give up activities you previously
enjoyed. And your family and friends may face significant changes and challenges in
an effort to help you. You may also find yourself facing some tough questions, such
as how long you have to live and what you will do if you no longer can take care of
yourself.

Share your fears and feelings with your family, friends and doctor. You may also
want to consider joining a support group for people with COPD. And you may benefit
from counseling if you feel depressed or overwhelmed.