|
Chronic Obstructive Pulmonary Disease is a slowly progressive
serious disease of the airways that is characterized by a
gradual loss of lung function. It's has strong similarities
to the lung damage done by chronic emphysema. The disease is
also known by its acronym which is COPD, and includes chronic
bronchitis, chronic obstructive bronchitis, or emphysema,
or combinations of these life-threatening medical conditions.
It represents the 4th leading cause of death in the U.S.
In some people, the start of a chronic cough and its related
sputum production are the first signs they are at risk for
developing the airflow obstruction and shortness of breath
characteristic of "Chronic Obstructive Pulmonary Disease"
In other people, shortness of breath may be the first evidence
they have developed chronic obstructive pulmonary disease.
In the United States the most important risk factor for COPD
by far is cigarette smoking. Pipe, cigar, other types of tobacco
smoking, and passive exposure to cigarette smoke are also
risk factors. Other documented causes of COPD include occupational
dusts and chemicals. Outdoor air pollution adds to the total
burden of inhaled particles in the lungs, but its role in
causing Chronic Obstructive Pulmonary Disease is not certain.
The most important measure for preventing chronic obstructive
pulmonary disease – and for stopping disease progression
– is avoidance of smoking. Also visit the
emphysema organization for more information on how to
stop smoking and potentially save your life, including slowing-down
lung disease progression.
The diagnosis of "chronic obstructive pulmonary disease"
is confirmed by the presence of air-way obstruction on testing
with spirometry. Unfortunately, there is no known cure for
COPD at this time. Chronic-obstructive-pulmonary-disease
treatment is usually supportive and designed
to relieve chronic obstructive pulmonary disease symptoms and
also improve quality of life.
With continued exposure to cigarettes or noxious particles,
the disease progresses and individuals with COPD increasingly
lose their ability to breathe. Acute infections or certain
weather conditions may temporarily worsen symptoms (exacerbations),
occasionally where hospitalization may be required.
COPD develops slowly, and it may be many years before you
notice symptoms like feeling short of breath. Most of the
time, COPD is diagnosed in middle-aged or older people.
Chronic obstructive pulmonary disease is a major cause of
death and illness, and it's the 4th leading cause of death
in the USA and throughout the world.
There is no cure for COPD. The damage to your airways and
lung disease damage cannot be reversed, however there are
things you can do to feel better and slow the damage caused by
chronic obstructive pulmonary disease and progression of
lung disease.
COPD is not contagious and you cannot catch it from someone
who already you has the lung disease.
Who Is At Risk for COPD?
Most people with chronic-obstructive-pulmonary-disease (COPD)
are smokers or former smokers. People with a family history
of COPD are more likely to get the disease if they smoke.
The chance of developing COPD is also greater in people who
have spent many years in contact with lung irritants, such
as: Air pollution - Chemical fumes, vapors, and dusts usually
linked to certain jobs
A person who has had frequent and severe lung infections,
especially during childhood, may have a greater chance of
developing lung damage that can lead to
chronic-obstructive-pulmonary-disease. Fortunately,
this is much less common today with anti-biotic treatments.
Most people with COPD are at least 40-years old or middle
age when symptoms start. It is unusual, but possible for people
younger than 40-years old to have COPD.
What Are the Signs and Symptoms of COPD?
The signs and symptoms of chronic obstructive pulmonary disease
include the following listed below:
- Cough
- Sputum (mucus) production
- Shortness of breath, especially with exercise
- Wheezing - which is a whistling or squeaky sound when
you breathe
- Chest tightness
A cough that doesn't go away and coughing up lots of mucus
are common signs of COPD. These often occur years before the
flow of air in and out of the lungs is reduced. However, not
everyone with a cough and sputum production goes on to develop
COPD, and not everyone with COPD has a cough.
The severity of the symptoms depends on how much of the lung
has been destroyed. If you continue to smoke, the lung destruction
is faster than if you stop smoking.
How the Lungs Work
The lungs provide a very large surface area (the size of
a football field) for the exchange of oxygen and carbon dioxide
between the body and the environment.
 A slice
of normal lung looks like a pink sponge filled with tiny bubbles
or holes. These bubbles, surrounded by a fine network of tiny
blood vessels, give the lungs a large surface to exchange
oxygen into the blood where it is carried throughout the body
by veins and arteries
and removes carbon dioxide (out of the blood). This process
is called gas exchange, which healthy lungs do well.
Here is how normal breathing works:
You breathe in air through your nose and mouth. The air travels
down through your windpipe (trachea) then through large and
small tubes in your lungs called bronchial tubes.
The larger tubes are bronchi, and the smaller
tubes are bronchioles. Sometimes the word
"airways" is used to refer to the various tubes
or passages that air must travel through from the nose and
mouth into the lungs. The airways in your lungs look something
like an upside-down tree with many branches.
At the ends of the small bronchial tubes, there are groups
of tiny air sacs called alveoli. The air
sacs have very thin walls, and small blood vessels called
capillaries run in the walls. Oxygen passes from the air sacs
into the blood in these small blood vessels. At the same time,
carbon dioxide passes from the blood into the air sacs. Carbon
dioxide, a normal byproduct of the body's metabolism, must
be removed.
The airways and air sacs in the lung are normally elastic—that
is, they try to spring back to their original shape after
being stretched or filled with air, just the way a new rubber
band or balloon would. This elastic quality helps retain the
normal structure of the lung and helps to move the air quickly
in and out. In COPD, much of the elastic quality is gone,
and the airways and air sacs no longer bounce back to their
original shape.
This means the airways collapse, like a floppy garden hose,
and air sacs tend to stay inflated. The floppy airways obstruct
the airflow out of the lungs, leading to an abnormal increase
in the lungs' size. In addition, the airways may become inflamed
and thickened, and mucus-producing cells produce more mucus,
further contributing to the difficulty of getting air out
of the lungs.
Causes of "chronic obstructive pulmonary disease"
Smoking Is the Most Common Cause of COPD
Most cases of chronic obstructive pulmonary disease (COPD)
develop after repeatedly breathing in fumes and other things
that irritate and damage the lungs and airways. Cigarette
smoking is the most common irritant that causes COPD. Pipe,
cigar, and other types of tobacco smoke can also cause COPD,
especially if the smoke is inhaled. Breathing in other fumes
and dusts over a long period of time may also cause COPD.
The lungs and airways are highly sensitive to these irritants.
They cause the airways to become inflamed and narrowed, and
they destroy the elastic fibers that allow the lung to stretch
and then return to its resting shape. This makes breathing
air in and out of the lungs more difficult.
Other things that may irritate the lungs and contribute to
COPD include:
- Working around certain chemicals and breathing in the
fumes for many years, including asbestos fibres, which may
also cause mesothelioma
lung cancer
- Working in a dusty area over many years
- Heavy exposure to air pollution
- Being around secondhand smoke (smoke in the air from
other people smoking cigarettes) also plays a role in an
individual developing COPD.
Genes—tiny bits of information in your body cells passed
on by your parents—may play a role in developing COPD.
In rare cases, COPD is caused by a gene-related disorder called
alpha 1 antitrypsin deficiency. Alpha 1 antitrypsin
is a protein in your blood that inactivates destructive proteins.
People with antitrypsin deficiency have low levels of alpha
1 antitrypsin; the imbalance of proteins leads to the destruction
of the lungs and COPD. If people with this condition smoke,
the disease progresses more rapidly.
How Is COPD Diagnosed?
Doctors consider a diagnosis of chronic obstructive pulmonary
disease (COPD) if you have the typical symptoms and a history
of exposure to lung irritants, especially cigarette smoking.
A medical history, physical exam, and breathing tests are
the most important tests to determine if you have COPD.
Your doctor will examine you and listen to your lungs. Your
doctor will also ask you questions about your family and medical
history and what lung irritants you may have been around for
long periods of time.
Breathing Tests
Your doctor will use a breathing test called spirometry to confirm a diagnosis of COPD. This test is easy and painless
and shows how well your lungs work. You breathe hard into
a large hose connected to a machine called a spirometer.
When you breathe out, the spirometer measures how much air
your lungs can hold and how fast you can blow air out of your
lungs after taking a deep breath.
Spirometry is the most sensitive and commonly used test of
lung functions. It can detect chronic obstructive pulmonary disease
long before you have significant lung disease symptoms.
Based on this test, your doctor can determine if you have
COPD and how severe it is. Doctors classify the severity of
COPD as:
- At risk (for developing COPD). Breathing test is normal.
Mild signs that include a chronic cough and sputum production.
- Mild COPD. Breathing test shows mild airflow limitation.
Signs may include a chronic cough and sputum production.
At this stage, you may not be aware that airflow in your
lungs is reduced.
- Moderate COPD. Breathing test shows a worsening airflow
limitation. Usually the signs have increased. Shortness
of breath usually develops when working hard, walking fast,
or doing other brisk activities. At this stage, a person
usually seeks medical attention.
- Severe COPD. Breathing test shows severe airflow limitation.
A person is short of breath after just a little activity.
In very severe COPD, complications like respiratory failure
or signs of heart failure may develop. At this stage, the
quality of life is greatly impaired and the worsening symptoms
may be life threatening.
Your doctor may also recommend tests to rule out other causes
of your signs and symptoms. These tests include:
- Bronchodilator reversibility testing.
This test uses the spirometer and medicines called bronchodilators.
Bronchodilators work by relaxing tightened muscles around
the airways and opening up airways quickly to ease breathing.
Your doctor will use the results of this test to see if
your lung problems are being caused by another lung condition
such as asthma. However, since airways in copd may also
be constricted, your doctor can use the results of this
test to help set your treatment goals.
- Other pulmonary function testing. For instance, your
doctor could test diffusion capacity.
- Chest x-ray. A chest X-ray is a picture of your lungs.
A chest X-ray may be done to see if another disease, including
arteriosclerotic heart disease, may be causing chronic-obstructive-
pulmonary-disease health symptoms.
- Arterial blood gas. This is a blood test showing the
oxygen level in your blood. It is measured in people with
severe COPD to see if oxygen treatment is recommended.
How Is COPD Treated?
Quitting smoking is the single most important thing you can
do to reduce your risk of developing chronic obstructive pulmonary
disease (COPD) and slow the progress of the pulmonary disease.
Your doctor will recommend treatments to help relieve your
symptoms and help you breathe easier. However, COPD cannot
be cured.
The goals of chronic-obstructive-pulmonary-disease treatment are to:
- Relieve your symptoms with no or minimal side effects
of treatment
- Slow the progress of the lung disease
- Improve exercise tolerance (your ability to stay active)
- Prevent and treat complications and sudden onset of problems
- Improve your overall health
The treatment for COPD is different for each person. Your
family doctor may recommend that you see a lung specialist
called a pulmonologist.
Treatment is based on whether your symptoms are mild, moderate,
or severe.
Medicines and pulmonary rehabilitation (rehab) are often
used to help relieve your symptoms and to help you breathe
more easily and stay active.
Chronic Obstructive Pulmonary Disease Medicine & Drugs
Bronchodilators - Your doctor
may recommend medicines called bronchodilators that work by
relaxing the muscles around your airways. This type of medicine
helps to open your airways rapidly and make breathing easier.
Bronchodilators can be either short acting or long acting.
- Short-acting bronchodilators last about 4 to 6 hours and
are used only when needed.
- Long-acting bronchodilators last about 12 hours or more
and are used every day.
- Most bronchodilator medicines are inhaled, so they go
directly into your lungs where they are needed. There are
many kinds of inhalers, and it is important to know how
to use your inhaler correctly.
If you have mild COPD, your doctor may recommend that you
use a short-acting bronchodilator. You then will use the inhaler
only when needed.
If you have moderate or severe COPD, your doctor may recommend
regular treatment with one or more inhaled bronchodilators.
You may be told to use one long-acting bronchodilator. Some
people may need to use a long-acting bronchodilator and a
short-acting bronchodilator. This is called combination therapy.
Inhaled glucocorticosteroids (steroids)
- Inhaled steroids are used for some people with moderate
or severe COPD. Inhaled steroids work to reduce airway inflammation.
Your doctor may recommend that you try inhaled steroids for
a trial period of 6 weeks to 3 months to see if the medicine
is helping with your breathing problems.
Flu shots - The flu (influenza)
can cause serious problems in people with COPD. Flu shots
can reduce the chance of getting the flu. You should get a
flu shot every year.
Pneumococcal vaccine - This
vaccine should be administered to those with COPD to prevent
a common cause of pneumonia. Revaccination may be necessary
after 5 years in those older than 65 years of age.
Pulmonary Rehabilitation - Pulmonary
rehabilitation (rehab) is a coordinated program of exercise,
disease management training, and counseling that can help
you stay more active and carry out your day-to-day activities.
What is included in your pulmonary rehab program will depend
on what you and your doctor think you need.
It may include exercise training, nutrition advice, education
about your disease and how to manage it, and counseling. The
different parts of the rehab program are managed by different
types of health care professionals (doctors, nurses, physical
therapists, respiratory therapists, exercise specialists,
dietitians) who work together to develop a program just for
you. Pulmonary rehab programs can include some or all of the
following aspects.
Medical evaluation and management -
To decide what you need in your pulmonary rehab program,
a medical evaluation will be done. This may include getting
information on your health history and what medicines you
take, doing a physical exam, and learning about your symptoms.
A spirometry measurement may also be done before and after
you take a bronchodilator medicine.
Setting goals - You will work
with your pulmonary rehab team to set goals for your program.
These goals will look at the types of activities that you
want to do. For example, you may want to take walks every
day, do chores around the house, and visit with friends. These
things will be worked on in your pulmonary rehab program.
Exercise training - Your program
may include exercise training. This training includes showing
you exercises to help your arms and legs get stronger. You
may also learn breathing exercises that strengthen the muscles
needed for breathing.
Education - Many pulmonary rehab
programs have an educational component that helps you learn
about your disease and symptoms, commonly used treatments,
different techniques used to manage symptoms, and what you
should expect from the program. The education may include
meeting with (1) a dietitian to learn about your diet and
healthy eating; (2) an occupational therapist to learn ways
that are easier on your breathing to carry out your everyday
activities; or (3) a respiratory therapist to learn about
breathing techniques and how to do respiratory treatments.
Program results (outcomes) - You
will talk with your pulmonary rehab team at different times
during your program to go over the goals that you set and
see if you are meeting them. For example, if your goal is
to walk every day for 30 minutes, you will talk to members
of your pulmonary team and tell them how often you are walking
and for how long. The team is interested in helping you reach
your goals.
Oxygen Treatment - If you have
severe COPD and low levels of oxygen in your blood, you are
not getting enough oxygen on you own. Your doctor may recommend
oxygen therapy to help with your shortness of breath. You
may need extra oxygen all the time or some of the time. For
some people with severe COPD, using extra oxygen for more
than 15 hours a day can help them:
- Do tasks or activities with less shortness of breath
- Protect the heart and other organs from damage
- Sleep more during the night and improve alertness during
the day
- Live longer
- Surgery
For some people with severe chronic obstructive pulmonary disease,
surgery may be recommended. Surgery is usually done for people who have:
- Severe lung disease symptoms
- Not had improvement from taking medicines
- A very hard time breathing most of the time
The two types of surgeries considered in the treatment of
severe COPD are:
- Bullectomy. In this procedure, doctors remove one or more
very large bullae from the lungs of people who have emphysema.
Bullae are air spaces that are formed when the walls of
the air sacs break. The air spaces can become so large that
they interfere with breathing.
- Lung volume reduction surgery (LVRS). In this procedure,
surgeons remove sections of damaged tissue from the lungs
of patients with emphysema. A major NHLBI study of LVRS
recently showed that patients whose emphysema was mostly
in the upper lobes of the lung and who had this surgery,
along with medical treatment and pulmonary rehabilitation,
were more likely to function better after 2 years than patients
who received medical therapy only. They also did not have
a greater chance of dying than the other patients.
A small group of these patients who also had low exercise
capacity after pulmonary rehabilitation but before surgery
were also more likely to function better after LVRS than similar
patients who received medical treatment only. A lung transplant
may be done for some people with very severe COPD. A transplant
involves removing the lung of a person with COPD and replacing
it with a healthy lung from a donor.
How Can COPD Be Prevented From Progressing?
If you smoke, the most important thing you can do to stop
more damage to your lungs is to quit smoking. For information
on how to quit smoking, visit the Web site of the U.S. Office
of the Surgeon General. Many hospitals have smoking cessation
programs or can refer you to one.
It is also important to stay away from people who are smoking
and places where you know there will be smokers.
Staying away from other lung irritants such as pollution,
dust, and certain cooking or heating fumes is also important.
For example, you should stay in your house when the outside
air quality is poor.
Managing Complications and Preventing Sudden Onset of Problems
People with chronic obstructive pulmonary disease (COPD)
often have symptoms that suddenly get worse. When this happens,
you have a much harder time catching your breath. You may
also have chest tightness, more coughing, change in your sputum,
and a fever. It is important to call your doctor if you have
any of these signs or symptoms.
Your doctor will look at things that might be causing these
signs and symptoms to suddenly worsen. Sometimes the signs
and symptoms are caused by a lung infection. Your doctor may
want you to take an antibiotic medicine that helps fight off
the infection.
Your doctor may also recommend additional medicines to help
with your breathing. These medicines include bronchodilators
and glucocorticosteroids.
Your doctor may recommend that you spend time in the hospital
if:
- You have a lot of difficulty catching your breath
- You have a hard time talking
- Your lips or fingernails turn blue or gray
- You are not mentally alert
- Your heartbeat is very fast
- Home treatment of worsening symptoms doesn't help
Living With COPD
Although there is no cure for chronic obstructive pulmonary
disease (COPD), your symptoms can be managed, and damage to
your lungs can be slowed. If you smoke, to quickly
stop-smoking is the most important thing you can do to
help your lungs. Here is some online-information on ways to
help you quit-smoking. You also need to try to stay away from
people who are smoking or public places where smoking is allowed:
It is important to keep the air in your home clean. Here
are some things that may help your breathing in your home:
- Keep smoke, fumes, and strong smells out of your home
- If your home is painted or sprayed for insects, have
it done when you can stay away from your home
- Cook near an open door or window
- If you heat with wood or kerosene, keep a door or window
open
- Keep your windows closed and stay at home when there
is a lot of air pollution, smog or dust outside
- If you are taking medicines, take them as ordered and
make sure you refill them so you do not run-out
See your doctor at least 2-times a year, even if you are
feeling good. Make sure you bring a list of medicines you
are taking to your doctor visit.
Ask your doctor or nurse about getting a flu shot and pneumonia
vaccination.
Keep your body strong by learning breathing exercises and
walking and exercising regularly.
Eat healthy foods. Ask your family to help you buy and fix
healthy foods. Eat lots of fruits and vegetables. Eat protein
food like meat, fish, eggs, milk, and soy.
If your doctor has told you that you have severe COPD, there
are some things that you can do to get the most out of each
breath. Make your life as easy as possible at home by:
- Asking your friends and family for help
- Doing things slowly
- Doing things sitting down
- Putting things you need in one place that is easy to
reach
- Finding very simple ways to cook, clean, and do other
chores. Some people use a small table or cart with wheels
to move things around. Using a pole or tongs with long handles
can help you reach things
- Keeping your clothes loose
- Wearing clothes and shoes that are easy to put on and
take off
- Asking for help moving your things around in your house
so that you will not need to climb stairs as often
- Picking a place to sit which location you can enjoy and visit with
others
If you are finding that it is becoming more difficult to
catch your breath, your coughing has gotten worse, you are
coughing up more mucus, or you have signs of infection (such
as a fever and feeling poorly), you need to call your doctor
right away. Your doctor may do a spirometry test, blood work,
and a chest x ray. Your doctor may also:
- Order antibiotics, which are medicines that help fight
off infection
- Change the type and dosage of the bronchodilator and
glucocorticosteroids medicines you have been taking
- Order oxygen or increase the amount of oxygen you are
currently using
It is helpful to have certain information on hand in case
you need to go to the hospital or doctor right away. You should
plan now to make sure you have:
- The phone numbers for the doctor, hospital, and people
who can take you to the hospital or doctor
- Directions to the hospital and doctor's office
- A list of the drugs and medicines you are taking
When To Get Emergency Help?
You should get emergency help if:
- You find that is hard to talk or walk
- Your heart is beating very fast or irregularly
- Your lips or fingernails are gray or blue
- Your breathing is fast and hard, even when you are using
your medicines
Key Points
Smoking is the most common cause of chronic obstructive pulmonary
disease (COPD).
COPD is a disease that slowly worsens over time, especially
if you continue to smoke.
Breathing in other kinds of lung irritants, like pollution,
dust, or chemicals, over a long period of time may also cause
or contribute to COPD. Secondhand smoke and genetic disorders
can also play a role in chronic-obstructive-pulmonary-disease.
There is no cure for "chronic obstructive pulmonary
disease" (which includes emphysema and chronic bronchitis),
and is a major cause of illness, and the 4th most common cause
of death.
In COPD, much of the lung's elastic quality of the airways
and lung air-sacs are gone. The airways collapse and obstruct
the normal airflow. Airways may also become inflamed and thickened.
The signs and symptoms of COPD are different for each person.
Common signs are cough, sputum production, shortness of breath,
wheezing, and chest tightness.
COPD usually occurs in people who are over 40-years
old. Chronic obstructive pulmonary disease is not contagious.
If you have COPD, you are more likely to have lung infections,
which can be fatal.
Your doctor can use a medical history, physical exam, and
breathing tests, such as spirometry, to diagnose—or
rule out—COPD even before you have significant symptoms.
If the lungs are severely damaged, the heart may be affected.
A person with COPD dies when the lungs and heart are unable
to function and get oxygen to the body's organs and tissues,
or when a complication such as a severe infection occurs.
Treatment for COPD may help prevent complications, prolong
life, and improve a person's quality of life. Quitting smoking,
staying away from people who are smoking, and avoiding exposure
to other lung irritants are the most important ways to reduce
your risk of developing COPD or to slow the progress of the
lung disease.
Treatment may include medicines such as bronchodilators,
steroids, flu shots, and pneumococcal vaccine to avoid or
reduce further complications.
As the symptoms of chronicobstructivepulmonarydisease worsen
over time, a person may have more difficulty walking and exercising.
You should talk to your doctor about exercising and if
you could benefit from a pulmonary rehab program — a coordinated
program of exercise, physical therapy, disease management
training, advice on diet, plus diet and health counseling.
Oxygen treatment and surgery to remove part of a lung or
even to transplant a lung may be recommended for persons with
severe chronic obstructive pulmonary disease.
If you have a sudden worsening of chronic obstructive
pulmonary-disease symptoms and lung disease indications,
it's important to contact your doctor and seek emergency treatment.
Be prepared and have information on hand that you or others
would need in a medical emergency, such as information on
medicines you are taking, directions to the hospital or your
doctor’s office, and people to contact if you are unable
to speak or call them.
|
