What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.
COPD is a progressive and (currently) incurable disease, but with the right diagnosis and treatment, there are many things you can do to manage your COPD and breathe better. People can live for many years with COPD and enjoy life.
What are the symptoms of COPD?
COPD makes it harder to breathe. Symptoms may be mild at first, beginning with intermittent coughing and shortness of breath. As it progresses, symptoms can become more constant to where it can become increasingly difficult to breathe.
You may experience wheezing and tightness in the chest or have excess sputum production. Some people with COPD have acute exacerbations, which are flare-ups of severe symptoms.
At first, symptoms of COPD can be quite mild. You might mistake them for a cold.
Early symptoms include:
- occasional shortness of breath, especially after exercise
- mild but recurrent cough
- needing to clear your throat often, especially first thing in the morning
You might start making subtle changes, such as avoiding stairs and skipping physical activities.
Symptoms can get progressively worse and harder to ignore. As the lungs become more damaged, you may experience:
- shortness of breath, after even mild exercise such as walking up a flight of stairs
- wheezing, which is a type of higher pitched noisy breathing, especially during exhalations
- chest tightness
- chronic cough, with or without mucus
- need to clear mucus from your lungs every day
- frequent colds, flu, or other respiratory infections
- lack of energy
In later stages of COPD, symptoms may also include:
- swelling of the feet, ankles, or legs
- weight loss
Immediate medical care is needed if:
- you have bluish or gray fingernails or lips, as this indicates low oxygen levels in your blood
- you have trouble catching your breath or cannot talk
- you feel confused, muddled, or faint
- your heart is racing
Symptoms are likely to be much worse if you currently smoke or are regularly exposed to second hand smoke.
What causes COPD?
The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.
Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.
How your lungs are affected
Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).
The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.
Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale.
Causes of airway obstruction
Causes of airway obstruction include:
- Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.
- Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.
Cigarette smoke and other irritants
In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD.
Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes.
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. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
People with asthma who smoke. The combination of asthma, a chronic inflammatory 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.
Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.
Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
Genetics. 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.
COPD can cause many complications, including:
Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.
Heart problems. For reasons that aren’t fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk.
Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk.
High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).
Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.
Treatment for COPD
Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.
Bronchodilators are medications that help relax the muscles of the airways, widening the airways so you can breathe easier. They’re usually taken through an inhaler or a nebulizer. Glucocorticosteroids can be added to reduce inflammation in the airways.
To lower risk of other respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, and a tetanus booster that includes protection from pertussis (whooping cough).
If your blood oxygen level is too low, you can receive supplemental oxygen through a mask or nasal cannula to help you breathe better. A portable unit can make it easier to get around.
Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have a form of severe emphysema.
One type of surgery is called bullectomy. During this procedure, surgeons remove large, abnormal air spaces (bullae) from the lungs.
Another is lung volume reduction surgery, which removes damaged upper lung tissue.
Lung transplantation is an option in some cases.
Certain lifestyle changes may also help alleviate your symptoms or provide relief.
- If you smoke, quit. Your doctor can recommend appropriate products or support services.
- Whenever possible, avoid secondhand smoke and chemical fumes.
- Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
- Talk to your doctor about how much exercise is safe for you.
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