Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.

COPD is a progressive and (currently) incurable disease, but with the right diagnosis and treatment, there are many things you can do to manage your COPD and breathe better. People can live for many years with COPD and enjoy life.

 In Emphysema the tiny, delicate air sacs (alveoli) in your lungs are damaged. The walls of the damaged air sacs become stretched out and your lungs actually get bigger, making it harder to move your air in and out. Old air gets trapped inside the alveoli so there is little or no room for new air to go. In emphysema it is harder to get oxygen in and carbon dioxide (the waste product of your breathing) out.

Chronic bronchitis is an inflammation of the breathing tubes (bronchial airways) inside your lungs. Tiny hair-like structures (cilia) line your airways and sweep mucus up, keeping your airways clean. When cilia are damaged, they can’t do this, and it becomes harder for you to cough up mucus. This can make your airways swollen and clogged. These changes limit airflow in and out of your lungs, making it hard to breathe.

Refractory (non-reversible) asthma is a type of asthma that does not respond to usual asthma medications. In an asthma attack, bronchial airways tighten up and swell. Medications can usually reverse this, opening up the airways and returning them to how they were before the asthma attack. In refractory asthma, medications cannot reverse the tightening and swelling of the airways.

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In developed countries like the United States, the single biggest cause of COPD is cigarette smoking. About 90 percent of people who have COPD are smokers or former smokers. Among smokers, 20 to 30 percent develop COPD. Many others develop lung conditions or have reduced lung function.

Most people with COPD are over 40 years old and have at least some history of smoking. The longer you smoke, the greater your risk of COPD is. In addition to cigarette smoke, cigar smoke, pipe smoke, and secondhand smoke can cause COPD.

Your risk of COPD is even greater if you have asthma and smoke.

You can also develop COPD if you’re exposed to chemicals and fumes in the workplace. Long-term exposure to air pollution and inhaling dust can also cause COPD.

In developing countries, along with tobacco smoke, homes are often poorly ventilated, forcing families to breathe fumes from cooking and heating fuel.

There may be a genetic predisposition to developing COPD. Up to 5 percent of people with COPD have a deficiency in a protein called alpha-1-antitrypsin. This deficiency causes the lungs to deteriorate and also can affect the liver. There may be other genetic factors at play as well.

According to the Centers of Disease Control and Prevention (CDC), chronic lower respiratory disease, mainly chronic obstructive pulmonary disease (COPD), is the third leading cause of death in the United States. This disease kills about 3 million people worldwide each year. Nearly 16 million people in the United States are hospitalized each year because of COPD.

COPD develops slowly and usually worsens over time. In the early stages, someone with COPD may not experience any symptoms. Early prevention and treatment can help prevent serious lung damage, respiratory problems, and even heart failure.

The first step is to recognize your personal risk factors for developing this disease.

At first, symptoms of COPD can be quite mild. You might be inclined to dismiss them as a cold.

Early symptoms include:

  • occasional shortness of breath, especially after exercise
  • mild but recurrent cough
  • needing to clear your throat often, especially first thing in the morning

You might start making subtle changes, such as avoiding stairs and skipping physical activities.

Symptoms can get progressively worse and harder to ignore. As the lungs become more damaged, you may experience:

  • shortness of breath, after even mild exercise such as walking up a flight of stairs
  • wheezing, or noisy breathing
  • chest tightness
  • chronic cough, with or without mucus
  • need to clear mucus from your lungs every day
  • frequent colds, flu, or other respiratory infections
  • lack of energy

In later stages of COPD, symptoms may also include:

  • fatigue
  • swelling of the feet, ankles, or legs
  • weight loss

Immediate medical care is needed if:

  • you have bluish or gray fingernails or lips, as this indicates low oxygen levels in your blood
  • you have trouble catching your breath or cannot talk
  • you feel confused, muddled, or faint
  • your heart is racing

Symptoms are likely to be much worse if you currently smoke or are regularly exposed to smoke.

There’s no single test for COPD. Diagnosis is based on symptoms, a physical exam, and test results.

When you visit the doctor, be sure to mention all of your symptoms. Tell your doctor if:

  • you’re a smoker, or have smoked in the past
  • you’re exposed to lung irritants on the job
  • you’re exposed to a lot of secondhand smoke
  • there’s a family history of COPD
  • you have asthma or other respiratory conditions
  • you take over-the-counter or prescription medications

During the physical exam, your doctor will use a stethoscope to listen to your lungs as you breathe. Based on all this information, your doctor may order some of these tests to get a more complete picture:

  • A spirometry is a noninvasive test to assess lung function. During the test, you’ll take a deep breath and then blow into a tube connected to the spirometer.
  • Imaging tests include a chest X-ray or CT scan. These images can provide a detailed look at your lungs, blood vessels, and heart.
  • An arterial blood gas test involves taking a blood sample from an artery to measure your blood oxygen levels.

These tests can determine if you have COPD, or perhaps some other condition, such as asthma or heart failure.

Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.

Medication

Bronchodilators are medications that help relax the muscles of the airways so you can breathe easier. They’re usually taken through an inhaler. Glucocorticosteroids can be added to reduce inflammation in the airways.

To lower risk of other respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, and a tetanus booster that includes protection from pertussis or whooping cough.

Oxygen therapy

If your blood oxygen levels are low, you can receive oxygen through a mask or nasal prongs to help you breathe better. A portable unit can make it easier to get around.

Surgery

Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have emphysema. One type of surgery is called bullectomy. That’s when surgeons remove large air sacs (bullae) from the lungs. Another is lung volume reduction surgery, which removes damaged lung tissue.

Lung transplant is an option in some cases.

Lifestyle changes

Certain lifestyle changes may also help alleviate your symptoms or provide relief.

These include:

  • If you smoke, quit. Your doctor can recommend appropriate products or support services.
  • Whenever possible, avoid secondhand smoke and chemical fumes.
  • Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
  • Talk to your doctor about how much exercise is safe for you.

The most common cause of COPD is cigarette smoking. Smoking accounts for eight out of 10 COPD-related deaths, according to the Centers for Disease Control and Prevention (CDC).  One of the best ways to prevent getting COPD is to never start smoking, or to quit smoking if you already do.

If you have trouble quitting smoking, there are numerous options to help you, including gums, patches, and prescription medication.

Additionally, support groups and classes to help you quit smoking can often be found through hospitals, workplaces, and community associations.

Enlisting the support of family and friends may also help you in your smoking cessation efforts.

Heavy and long-term exposure to various lung irritants, including air pollution, dust and chemical fumes in the workplace, and secondhand smoke, can also cause COPD.

Here are some tips to reduce your exposure to COPD-causing irritants:

  • If you have a wood-burning stove or fireplace, make sure it's well ventilated.
  • Stay indoors if there's noticeable air pollution outside, such as smog or a nearby wildfire.
  • Make your home an environment free from secondhand smoke.
  • If you work in an environment where you are exposed to chemical fumes and dust, speak with your supervisor about respiratory protective equipment and other ways to protect yourself.

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