Posted on November 15 2018
COPD, or Chronic Obstructive Pulmonary Disease is a progressive disease that makes it hard to breathe and gets worse over time. COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25% of people with COPD never smoked. Long term exposure to other lung irritants - such as air pollution, chemical fumes, or dusts - may also contribute to COPD. A rare genetic condition called alpha 1 antitrypsin (AAT) deficiency can also cause the disease.
Overview of COPD
To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes, or airways. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli.
Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood of the capillaries. At the same time, a waste product called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process is called gas exchange, and brings in oxygen for the body to use for vital functions and removes C02.
The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways due to:
- The airways and air sacs losing their elastic quality.
- The walls between many of the air sacs being destroyed.
- The walls of the airways becoming thick and inflamed.
- The airways making more mucus than usual and becoming clogged.
In the US, the term COPD includes 2 main conditions: emphysema and chronic bronchitis.
In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage can destroy the walls of the air sacs, leading to fewer and larger air sacs, instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.
In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, causing the lining to swell. A large amount of thick mucus forms in the airways, making it difficult to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person.
COPD is a major cause of disability, and it is the 4th leading cause of death in the US. Currently, 16 million people are diagnosed with COPD, and many more have the disease and don't even know it. COPD develops slowly, with symptoms worsening over time and limiting your ability to do routine activities. Severe COPD may prevent you from doing basic tasks such as, walking, cooking, or taking care of yourself.
Majority of the time, COPD is diagnosed in middle aged or older adults. The disease is not contagious and cannot be spread from person to person. COPD has no cure yet, and doctors are unsure of how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progression of the disease.
Causes of COPD
Long term exposure to lung irritants that damage the lungs and the airways is usually the cause of COPD. In the US, the most common irritant that causes the disease is cigarette smoke. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, air pollution, chemical fumes, or dusts from the environment or workplace can also contribute to COPD.
Rarely, a genetic condition called alpha 1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT) - a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have AAT deficiency and also smoke, COPD can worsen very quickly.
Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment, such as nebulizers, inhalers, and acapella products usually can reverse the inflammation and narrowing that occurs in asthma.
Risk Factors for COPD
The main risk factor for COPD is smoking. Up to 75% of people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. As mentioned above, long term exposure to lung irritants is also a risk factor for COPD.
Most people who have COPD are at least 40 years of age when symptoms begin. Although uncommon, people younger than 40 can have COPD. This may occur if the individual has a predisposing health issue, such as AAT deficiency.
Screening & Preventing COPD
There are steps to prevent COPD before it starts. Even if you already have COPD, you can take steps to prevent complications and slow the progression of the disease.
The best way to prevent COPD is to not start smoking or to quit smoking. Since smoking is the leading cause of COPD, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer services to help people learn how to quit smoking. Ask for support in your efforts to quit.
In addition, try to avoid lung irritants that can contribute to COPD. If possible, avoid air pollution, chemical fumes, dusts, and secondhand smoke.
If you have COPD, follow your treatments exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should receive the flu and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.
Symptoms & Complications from COPD
At first, COPD may cause no symptoms, or only mild symptoms. As the disease progresses, symptoms usually become more severe. Common symptoms of COPD include:
- An ongoing cough or a cough that produces a lot of mucus, also known as a smoker's cough.
- Shortness of breath, especially with physical activity.
- Wheezing, whistling, or squeaky sound when you breathe.
- Chest tightness.
If you have COPD, you may often have colds or other respiratory infections, such as the flu. Not everyone who has the symptoms above has COPD. Likewise, not everyone who has COPD has those symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD.
If you symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you can take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, becoming short of breath during a physical activity. The severity of your symptoms will depend on how much lung damage you have. If you continue smoking, the damage will occur faster than if you quit smoking.
Severe COPD can cause other symptoms, such as swelling your ankles, feet, or legs; weight loss, and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You, or those around you should seek emergency care if you experience the following:
- Unable to catch your breath or talk
- Your lips or fingernails turn blue or gray - a sign of low oxygen levels in your blood
- Lack of mental alertness
- Fast heartbeat
- The recommended treatment for symptoms that are getting worse is not working
Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. You doctor may ask whether you smoke or have had contact with lung irritants. If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. You should also let your doctor know whether you have a family history of COPD.
Your doctor will examine you and use a stethoscope to listen for wheezing in your lungs or other abnormal chest sounds. They may also recommend one or more tests - such as pulmonary function tests - to accurately diagnose COPD.
Pulmonary Function Tests: measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used.
Spirometry: is a painless test where you will take a deep breath in, then blow as hard as you can into a tube connected to a small machine, called a spirometer. The machine measures how much air you breathe out and how fast you can blow air out. Your doctor may have you inhale medicine that helps open your airways, then blow into the tube again. They can then compare the test results before and after taking the medicine.
Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms.
Your doctor may also recommend other tests, such as a chest x-ray or CT scan. These tests create pictures of the structures inside of your chest and can show signs of COPD. They may also show whether another condition is causing your symptoms. They may recommend an arterial blood gas test, which measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.
COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progression of the disease. The goals of COPD treatment include:
- Relieving your symptoms
- Slowing the progress of the disease
- Improving your exercise tolerance or the ability to stay active
- Preventing and treating complications
- Improving your overall health
To assist with your treatment, your family doctor may advise you to see a pulmonologist - a doctor who specializes in treating lung disorders.
Aside from quitting smoking and avoiding lung irritants, you can also make more lifestyle changes that will better help you cope with your disease. For instance, if you have COPD, especially more severe forms, you may have trouble eating enough because of shortness of breath and fatigue. As a result, you may not receive all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections.
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. Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms, but physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
Bronchodilators: relax the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short acting or long acting bronchodilators. Short acting bronchodilators last about 4-6 hours and should be used only when needed. Long acting bronchodilators last about 12 hours or more, and are used every day. If your COPD is mild, your doctor may only prescribe a short acting inhaled bronchodilator, and may only be used when the symptoms occur. If your COPD is moderate or severe, your doctor may prescribe regular treatment with short and long acting bronchodilators.
Most bronchodilators are taken using an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way, so be sure to ask your health care provider to show you the correct way to use your inhaler.
Combination Bronchodilators Plus Inhaled Glucocorticosteroids: In general using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that include a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation. Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see if that helps relieve your breathing problems.
Flu and Pneumococcal Vaccination: Influenza and pneumonia can cause serious health problems for those with COPD. These vaccines can reduce your risk of getting these diseases. Talk to your doctor about the yearly flu vaccination and the pneumococcal vaccination.
Pulmonary Rehab: This is a broad program that helps improve the well-being of people who have chronic breathing problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities.
Oxygen Therapy: If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask. You may need extra oxygen all of the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them do tasks or activities while experiencing fewer symptoms, protect their hearts and other organs from damage, sleep more during the night and improve alertness during the day, and live longer.
Surgery: Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medications. Surgeries for people who have COPD that is mainly related to emphysema include a bullectomy and lung volume reduction surgery. A lung transplant might be an option for people who have very severe COPD.
Managing Life with COPD
While COPD doesn't currently have a cure, there are steps you can take to manage your symptoms, slow the progression of the disease, and live your best life.
Avoid Lung Irritants: If you smoke, quit. There are many programs available at your disposal to help you quit smoking. Also, try to avoid lung irritants that can contribute to COPD, and keep these irritants out of your home. If your home is getting painted, or sprayed for insects, have it done when you can stay away for a while. If possible, keep your windows closed and stay at home when there is a lot of air pollution or dusts outside.
Get Ongoing Care: If you have COPD, it's important to receive ongoing medical care. Take all your medicines as your doctor prescribes and make sure to refill your prescriptions before they run out. Bring a list of all of the medicines you are taking when you have medical checkups. Talk with your doctor about whether and when you should get the flu and pneumonia vaccines. Also, as your doctor about other diseases for which COPD may increase your risk.
Manage COPD and Its Symptoms: Do activities slowly. Put items you use often in one easy to reach place. Find simple ways to cook, clean, and do other chores. Ask for help in making things more accessible in your house, so that you won't need to climb stairs as often. Keep your clothes loose, and wear 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.
Prepare for Emergencies: 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 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 also should have hand directions to the doctor's office and hospital, as well as a list of all medications you are taking.
Emotional Issues and Support: Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your healthcare team. Talking to a professional counselor also might help. If you are 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 who have the same symptoms have coped with them. 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.