Chronic Obstructive Pulmonary Disease (COPD)

What is chronic obstructive pulmonary disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a condition in which some of your airways are permanently blocked. COPD makes it harder for you to breathe. It causes strain on and enlargement of your heart (cor pulmonale) and increased blood pressure in your lungs (pulmonary hypertension).

How does it occur?

There are 2 main types of COPD: chronic bronchitis (inflamed airways) and emphysema (damage to the lung tissue). Chronic bronchitis and emphysema result from irritation of your airways over a long time, usually from smoking and sometimes from air pollution. Other causes are on-the-job exposure to irritants such as dust or chemicals, or frequent lung infections.

Chronic bronchitis and emphysema can occur separately but often they develop together. In chronic bronchitis, the insides of the airways thicken and swell. This makes the passageway for air inside the airways smaller. The damaged airways make more mucus, which can block the airways and make it hard to breathe. In emphysema, the tiny air sacs (alveoli) in the lungs may become badly damaged or destroyed and lose their ability to stretch (get bigger and smaller). This makes it harder for you to breathe out carbon dioxide after breathing in air. As the carbon dioxide collects in your lungs, there is less room for oxygen to be breathed in.

COPD is not contagious. You cannot give it to someone or get it from someone else.

What are the symptoms?

Symptoms of COPD are:

• deep, persistent cough that produces lots of mucus (sputum)
• thick sputum that is hard to cough up
• wheezing
• shortness of breath, trouble breathing
• rapid breathing
• blue-purple color of the skin (cyanosis), especially of the hands, feet, and lips
• weight loss
• frequent lung infections
• swelling in the legs, ankles, and feet.

In the early stages of the disease you may not have any symptoms.

How is it diagnosed?

Your healthcare provider will ask you about:

• your symptoms and if you are less active because of the symptoms
• your smoking habits
• exposure to other people's smoke (secondhand smoke) and other irritants such as aerosol sprays, industrial chemicals, and air pollution
• your medical history, for example, if you have had asthma.

Your healthcare provider will examine you. You may have the following tests:

• a pulmonary function test called spirometry (you breathe into a tube to measure airflow into and out of your lungs to see how well your lungs are working)
• chest X-ray
• blood tests
• lab tests of sputum.

How is it treated?

The damage to your lungs cannot be reversed, so treatment aims to:

• Relieve symptoms to help you breathe better and feel better.
• Help you be more physically active.
• Treat infections when they happen.
• Help prevent complications.
• Help prevent the condition from getting worse.

For smokers the most important part of treatment is to quit smoking. Talk to your healthcare provider about ways to stop smoking. You might find it helpful to join a quit-smoking program or to use nicotine patches or gum.

Your healthcare provider may prescribe:

• Medicine that relaxes and opens the airways (called a bronchodilator). This makes it easier to breathe. Some forms of this medicine are taken as pills or liquid. Some are inhaled. Some need to be used with a nebulizer. A nebulizer is a machine used to inhale moisturized medicine through a face mask or breathing tube.
• Steroid medicines to reduce inflammation.
• Antibiotics to treat bacterial infection.
• Medicine (called an expectorant) that loosens the mucus and helps you cough it up.

Ask your healthcare provider if you can help your symptoms with:

• regular exercise, such as walking or riding a stationary bicycle, according to your healthcare provider's recommendations
• breathing exercises
• oxygen therapy to make breathing easier
• a humidifier to increase air moisture
• changes in your work environment to reduce exposure to irritants.

Also ask your healthcare provider how much fluid you should drink every day.

A pulmonary rehab program can help you learn how to live with COPD. The program may offer supervised exercise and information about a healthy diet. It can help you learn about how your lungs work and how to care for your COPD. Ask your provider if there is such a program in your area.

In rare cases of severe COPD, surgery may be an option. Surgery can remove the most diseased part of the lungs, or a lung transplant might be considered.

How long will the effects last?

COPD cannot be cured. Once you have COPD, it does not get better, but taking good care of yourself is the best way to keep it from getting worse. The best way to take care of yourself is to avoid things that may have caused the COPD, such as tobacco smoke or exposure to dust, fumes, or chemicals at the workplace. This will give you the greatest chance of stopping the disease from getting worse.

How can I take care of myself?

Follow these guidelines to take care of yourself:

• If you smoke, quit.
• Follow your healthcare provider's advice for treating COPD. Take all of your medicine according to your provider's instructions.
• Avoid secondhand smoke, air pollution, and extreme changes in temperature and humidity.
• Ask about getting flu and pneumonia shots.
• Avoid close contact with people who have colds or the flu.
• Eat healthy foods.
• Eat high-calorie snacks between meals if you are underweight.
• Take vitamin and mineral supplements if recommended by your healthcare provider.
• Be as active as you comfortably can.
• Get plenty of rest and sleep.
• Consider lifestyle changes such as changing jobs or moving to a less polluted climate or lower altitude.
• If you plan to travel, discuss your plans with your healthcare provider. It's good to make sure there will be no problems with high altitude, humidity, temperature, pressurized airplane cabins, or smoggy cities, especially if you are using oxygen.

An exacerbation is a worsening of the usual symptoms of COPD. You, or sometimes a family member, are usually the first to know when your lung disease is getting worse. Watch for:

• shortness of breath that gets worse
• more coughing, often with chest tightness
• an increase in sputum (you notice you are coughing up more sputum)
• an change in how the sputum looks, such as a change in color or streaks of blood
• sputum that has gotten thicker and stickier and harder to cough up
• new or worsening wheezing
• fever.

Any one of these symptoms might be a warning sign. An exacerbation is when any 2 of these things are happening. If you can catch these changes really early, you may be able to prevent a trip to the hospital. Ask your healthcare provider for instructions on what to do when you have these symptoms.

Call your healthcare provider if you have:

• chest pain
• fever
• sputum that thickens or changes in color
• blood in the phlegm
• worsening shortness of breath
• shortness of breath when you are resting.

When should I get emergency help?

It is important to know the difference between earlier signs and symptoms of sickness and the signs of an emergency. You are in an emergency situation if:

• You cannot talk.
• It is hard to walk.
• Your lips or fingernails turn gray or blue.
• Your heart is beating very fast.
• Your medicine does not help for very long or does not help at all.
• You are breathing fast and hard.
• You feel like you are going to die.
• You are having bad chest pain that does not go away within about 5 minutes.

Call 911 to get emergency help right away. Do not turn up your oxygen unless your healthcare provider tells you to do this.

How can I help prevent COPD?

85% of COPD cases are caused by tobacco smoke. This includes the smokers themselves and people who are exposed to secondhand smoke. In most cases you can prevent COPD by never smoking and not being around others who are smoking.