Chronic Obstructive Pulmonary Disease (COPD)

What is COPD?

Chronic Obstructive Pulmonary Disease, more commonly known as COPD, is comprised of two main conditions—emphysema and chronic bronchitis.

  • Emphysema causes damage to the walls between the air sacs in the lungs. As a result, the air sacs lose their shape. This damage can also destroy the walls of the air sacs themselves, leading to fewer and larger air sacs instead of many tiny ones. When this happens, the amount of gas exchange in the lungs is reduced – meaning your blood stream gets less oxygen.
  • Chronic bronchitis occurs when the lining of the airways is constantly irritated and inflamed, causing the lining to thicken. A large amount of thick mucus then forms in the airways, making it hard to breathe.

Many people who have COPD have both emphysema and chronic bronchitis.

What causes COPD?

Generally, long-term exposure to lung irritants that damage the lungs and the airways causes COPD. In the United States, the most common cause of COPD is smoking cigarettes, pipes, cigars or other types of tobacco, especially if the smoke is inhaled. Breathing in secondhand smoke, air pollution, chemical fumes or dust from the environment or workplace can also contribute to COPD.

Rarely, a genetic condition called Alpha-1 antitrypsin (AAT) deficiency may play a role in causing COPD. People with this condition have low levels of Alpha-1 antitrypsin, a protein made in the liver. Having low levels of the AAT protein can lead to lung damage and COPD if exposed to smoke or other lung irritants. If you have Alpha-1 deficiency and you smoke, COPD can worsen very quickly.

Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. Treatment for asthma can usually help with the inflammation and narrowing. However, if it’s not treated properly, COPD can develop.

What Are the Signs and Symptoms of COPD?

At first, COPD may cause mild or no symptoms. As the disease progresses, symptoms usually become more severe. Common signs and symptoms of COPD include:

  • An ongoing cough or a cough that produces a lot of mucus – Often called smoker’s cough
  • Shortness of breath – Especially with physical activity
  • Wheezing – A whistling or squeaky sound when you breathe
  • Chest tightness

Not everyone who has these symptoms has COPD. Likewise, not everyone who has COPD has these symptoms. Some symptoms of COPD are similar to those of other diseases and conditions. Medical tests need to be performed to determine whether or not the symptoms are caused by COPD.

If your COPD symptoms are mild, they may go unnoticed or it may be simple to adjust your lifestyle to make breathing easier, such as taking the elevator instead of the stairs.

Over time, symptoms may become severe enough to require a doctor’s visit. The severity of COPD symptoms will depend on how much lung damage you have.

Severe COPD can cause other symptoms such as swelling in the ankles, feet, or legs; weight loss; and lower muscle endurance.

How is COPD Diagnosed?

A doctor will diagnose COPD based on signs and symptoms; medical and family histories; and test results. They may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes or dust. If you have an ongoing cough, let your doctor know how long you’ve had it, how often you cough, and how much mucus your cough is producing.

Your doctor may also recommend diagnostic tests if your symptoms are caused by COPD. The main test used to determine if COPD is present is called spirometry. During this test, a technician will ask you to take a deep breath in and then blow as hard as you can into a tube connected to a small machine, called a spirometer. The spirometer measures how much air you breathe out and how fast you blow air out.

Spirometry can also detect COPD before symptoms develop. Your doctor can also use the test results to find out how severe your COPD is and help set your treatment goals.

In addition, your doctor may have you inhale a bronchodilator, a medicine that helps open your airways, and then have you exhale into the tube again. They can then compare your test results before and after taking the medicine.

How Is COPD Treated?

COPD has no cure yet; however, lifestyle changes, medicine and treatments can help you feel better, stay active and slow the progression of the disease. The goals of COPD treatment are:

  • Relieving COPD symptoms
  • Slowing the progression of the disease
  • Improving your exercise tolerance and your ability to stay active
  • Preventing and treating complications of COPD
  • Improving your overall health

Some lifestyle changes, medicine and other treatment options that your doctor may recommend include:

Lifestyle Changes
Quitting smoking is the most important step you can take to treat COPD. Not quitting will cause lung damage to occur faster. Talk with your doctor about programs and products that can help you quit.

Also, try to avoid secondhand smoke and places with dust, fumes or other toxic substances that you may inhale.

If you have COPD, you may have trouble eating because of your symptoms, such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. This is generally more common in severe forms of COPD. Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements.

You may find it hard to be active with your symptoms. Talk with your doctor about what types of activities are safe for you, as physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Medication
Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Bronchodilators relax the muscles around your airways, helping to open your airways and make breathing easier. Short-acting bronchodilators last about four to six hours and should be used only when needed. Long-acting bronchodilators last about 12 or more hours and are used every day.

If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.

Vaccines
Flu Shot – The flu can cause serious problems for people who have COPD. Talk with your doctor about getting a yearly flu shot to reduce your risk of getting the flu.

Pneumococcal Vaccine – People who have COPD are at higher risk for pneumonia. Talk with your doctor about this vaccine to lower your risk of getting pneumococcal pneumonia and its complications.

Pulmonary Rehabilitation
Pulmonary rehabilitation for COPD includes a program of exercises that helps people build their physical fitness, and teaches breathing techniques and strategies for living better with COPD.

Oxygen Therapy
If you have severe COPD and low levels of oxygen in your blood, your doctor may recommend oxygen therapy to help you breathe better.

You may need extra oxygen most of the day or only at certain times. For people who have severe COPD, using extra oxygen can help them:

  • Do tasks or activities with fewer symptoms
  • Protect their hearts and other organs from damage
  • Sleep longer and improve alertness during the day
  • Live longer

How is COPD Managed? You can do things to help manage COPD and its symptoms, including:

  • Moving slowly
  • Putting items that you need often in an easy to reach place
  • Finding simpler ways to cook, clean and do other chores, such as using a cart with wheels to move things around or using tongs with long handles to reach things
  • Asking for help moving things around your house so you don’t need to climb the stairs as often
  • Wearing loose-fitting clothing, and wearing clothes and shoes that are easy to put on and take off

Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks. If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking.

Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may need to change or adjust your treatments to relieve and treat symptoms.

Keep phone numbers handy for your doctor, hospital and someone who can take you for medical care. You should also have a list of all medications you’re taking and directions to the doctor’s office and hospital on hand.

Living with COPD may cause fear, anxiety, depression and stress. Talk about how you feel with your health care team or a professional counselor. If you’re depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with COPD. You can see how other people with COPD have coped. Talk with your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.