Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe.

There are two main forms of COPD:

Chronic bronchitis, which involves a long-term cough with mucus
Emphysema, which involves damage to the lungs over time

Most people with COPD have a combination of both conditions.

Alternative Names

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

Causes

Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD.

In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

Emphysema is a lung disease involving damage to the air sacs (alveoli). There is progressive destruction of alveoli and the surrounding tissue that supports the alveoli. With more advanced disease, large air cysts develop where normal lung tissue used to be. Air is trapped in the lungs due to lack of supportive tissue which decreases oxygenation.

Other risk factors for COPD are:

Exposure to certain gases or fumes in the workplace
Exposure to heavy amounts of secondhand smoke and pollution
Frequent use of a cooking fire without proper ventilation

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Symptoms

Symptoms may include any of the following:

Cough, with or without mucus
Fatigue
Many respiratory infections
Shortness of breath (dyspnea) that gets worse with mild activity
Trouble catching one's breath
Wheezing

Because the symptoms develop slowly, some people may not know that they have COPD.

Exams and Tests

The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away.

Spirometry is a painless study of air volume and flow rate within the lungs. Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma or cystic fibrosis.

Using a stethoscope to listen to the lungs can also be helpful. But sometimes, the lungs sound normal, even when a person has COPD.

Imaging tests of the lungs, such as x-rays and CT scans may be ordered. With an x-ray, the lungs may look normal, even when a person has COPD. A CT scan will usually show signs of COPD.

Sometimes, a blood test called arterial blood gas may be done to measure the amounts of oxygen and carbon dioxide in the blood.

Treatment

There is no cure for COPD. But there are many things you can do to relieve symptoms and keep the disease from getting worse.

If you smoke, now is the time to quit. This is the best way to slow lung damage.

Medicines used to treat COPD include:

Quick-relief drugs to help open the airways
Control drugs to reduce lung inflammation
Anti-inflammatory drugs to reduce swelling in the airways
Certain long-term antibiotics

In severe cases or during flare-ups, you may need to receive:

Steroids by mouth or through a vein (intravenously)
Bronchodilators through a nebulizer
Oxygen therapy
Assistance from a machine to help breathing by using a mask or through the use of an endotracheal tube

Your health care provider may prescribe antibiotics during symptom flare-ups, because an infection can make COPD worse.

You may need oxygen therapy at home if you have a low level of oxygen in your blood.

Pulmonary rehabilitation does not cure COPD. But it can teach you more about the disease, train you to breathe in a different way so you can stay active and feel better, and keeps you functioning at the highest level possible.

LIVING WITH COPD

You can do things every day to keep COPD from getting worse, protect your lungs, and stay healthy.

Walk to build up strength:

Ask the provider or therapist how far to walk.
Slowly increase how far you walk.
Avoid talking if you get short of breath when you walk.
Use pursed lip breathing when you breathe out, to empty your lungs before the next breath.

Things you can do to make it easier for yourself around the home include:

Avoid very cold air or very hot weather
Make sure no one smokes in your home
Reduce air pollution by not using the fireplace and getting rid of other irritants
Manage stress and your mood
Use oxygen if prescribed for you

Eat healthy foods, including fish, poultry, and lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a provider or dietitian about eating foods with more calories.

Surgery may be used to treat COPD. Only a few people benefit from these surgical treatments:

Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some people with emphysema.
Lung transplant for a small number of very severe cases.

Support Groups

You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking.

If you have severe COPD, you will be short of breath with most activities. You may be admitted to the hospital more often.

Talk with your provider about breathing machines and end-of-life care as the disease progresses.

Possible Complications

With COPD, you may have other health problems such as:

Irregular heartbeat (arrhythmia)
Need for breathing machine and oxygen therapy
Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
Pneumonia
Collapsed lung (pneumothorax)
Severe weight loss and malnutrition
Thinning of the bones (osteoporosis)
Debilitation
Increased anxiety

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath.

Prevention

Not smoking prevents most COPD. Ask your provider about quit-smoking programs. Medicines are also available to help you stop smoking.

References

Celli BR, Zuwallack RL. Pulmonary rehabilitation. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 105.

Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society guideline. Chest. 2015;147(4):894-942. PMID: 25321320 www.ncbi.nlm.nih.gov/pubmed/25321320.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2018 report. goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf. Accessed June 25, 2018.

Han MK, Lazarus SC. COPD: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

National Institutes of Health, National Heart, Lung, and Blood Institute website. COPD National Action Plan. Bethesda, MD: National Institutes of Health; 2017. NIH publication 17-HL-8031. www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan.