Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum production, and wheezing. It is caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer, and a variety of other conditions.

Emphysema and chronic bronchitis are the 2 types of COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It is characterized by daily cough and sputum production. Emphysema is a condition in which the air sacs (alveoli) at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure.

COPD develops slowly and gets worse over time. COPD makes it hard to breathe. It is a major cause of disability and is the third leading cause of death in the United States. Currently, millions of people are diagnosed with COPD.

Symptoms of COPD get progressively worse and eventually limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults.

COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.

COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Symptoms of COPD often do not appear until significant lung damage has occurred, and they usually worsen over time, particularly if you continue to smoke cigarettes.

Signs and symptoms of COPD include:

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Having to clear your throat first thing in the morning, due to excess mucus in your lungs
• A chronic cough that produces sputum that may be clear, white, yellow or greenish
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections such as colds or the flu
• Lack of energy
• Unintended weight loss (in later stages)

People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.

Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.

In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)

Rarely, a genetic condition may play a role in causing COPD. People who have this condition have low levels of a protein made in the liver, which can lead to lung damage and COPD if they are exposed to smoke or other lung irritants.

Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop.

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.
• People with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.
• Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
• Age. COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin.
• Genetics. As noted above, the uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.

Your doctor will diagnose COPD on the basis of your signs and symptoms, your medical and family histories, and test results. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD.

Tell your doctor if 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 have had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.

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. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.
• 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.
• CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer, which is more common among people with COPD than it is among those who smoked but didn't develop COPD.
• Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.

Living with COPD can be a challenge, especially as it becomes harder to catch your breath. You may have to give up some activities you previously enjoyed. Your family and friends may have difficulty adjusting to some of the changes.

It can help to 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 or medication if you feel depressed or overwhelmed.

COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:

• Avoid lung irritants by quitting smoking or avoiding exposure to other irritants.
• Get ongoing care by regularly visiting your physician, taking your medications as prescribed, and receiving flu and pneumonia vaccines.
• Manage the disease and its symptoms by doing activities slowly, modify your daily activities, and ask for help when you need it.
• Prepare for emergencies by knowing what symptoms to look for and when to call for help.

The goals of COPD treatment are to control symptoms, reduce the risk of complications and exacerbations, and improve the ability to lead an active life.

The first step in any treatment plan for COPD is to stop all smoking. It is the only way to keep COPD from getting worse. Talk to your doctor about products, medications, and support systems that might help you stop smoking, as well as how to handle relapses. Avoid secondhand smoke exposure whenever possible.

Several kinds of medications are available to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others only on an as-needed basis.

• Bronchodilators. Brochnodilators usually come in an inhaler. They relax the muscles around your airways, which helps relieve coughing and shortness of breath and makes 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.
• Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex), and ipratropium (Atrovent). Long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza).
• Inhaled steroids. Inhaled corticosteroid medications reduce airway inflammation and help prevent exacerbations. Inhaled steroids are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent) and budesonide (Pulmicort) are examples of inhaled steroids.
• Combination inhalers. Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers.
• Oral steroids. For people who have a moderate or severe acute exacerbation, short courses (for example, 5 days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection as well as increased mortality associated with COPD.
• Phosphodiesterase-4 inhibitors A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways.
• Theophylline. Theophylline helps improve breathing and prevents exacerbations.

Additional therapies may be helpful for people with moderate or severe COPD:

• Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life.
• Pulmonary rehabilitation program. These programs typically combine education, exercise training, nutrition advice, and counseling. Specialists tailor a rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities, and improve your quality of life.

Surgery is an option for some people with some forms of severe emphysema who are not helped sufficiently by medications alone. Surgical options include lung volume reduction surgery and lung transplantation.