Chronic Obstructive Pulmonary Disease (COPD)

COPD, or chronic obstructive pulmonary disease, is term for a group of diseases including emphysema and chronic bronchitis that causes progressive difficulty breathing.

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. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may contribute to COPD. Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. For example, this may happen if a person has alpha-1 antitrypsin deficiency, a genetic condition.

There is no cure for COPD, but treatments and lifestyle changes treat symptoms and slow the progress of the disease. Quitting smoking is the most important step to treat COPD. Medications include short (albuterol, levalbuterol, ipratropium) and long acting bronchodilators (tiotropium, salmeterol, formoterol) which relax the muscles around the airways, opening them up to make breathing easier. Corticosteroids, phosphodiesterase-4 inhibitors, and methylxanthines help reduce airway inflammation.

The signs and symptoms of COPD include:

• an ongoing cough or a cough that produces large amounts of mucus (often called "smoker's cough")
• shortness of breath, especially with physical activity
• wheezing (a whistling or squeaky sound when you breathe)
• chest tightness

These symptoms often occur years before the flow of air into and out of the lungs declines. However, not everyone who has these symptoms has COPD. Likewise, not everyone who has COPD has these symptoms.

Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can find out whether you have COPD.

If you have COPD, you may have colds or the flu (influenza) frequently. If your COPD is severe, you may have swelling in your ankles, feet, or legs; a bluish color on your lips due to a low blood oxygen level; and shortness of breath.

COPD symptoms usually slowly worsen over time. At first, if symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.

Over time, symptoms may become severe enough to see a doctor. For example, you may get short of breath during physical exertion.

How severe your symptoms are depends on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. In severe COPD, you may have other symptoms, such as weight loss and lower muscle endurance.

Some severe symptoms may require treatment in a hospital. You—with the help of family members or friends, if you're unable—should seek emergency care if:

• you are having a hard time catching your breath or talking
• your lips or fingernails turn blue or gray (this is a sign of a low oxygen level in your blood)
• you are not mentally alert
• your heartbeat is very fast
• the recommended treatment for symptoms that are getting worse isn't working

Most cases of COPD occur as a result of long-term exposure to lung irritants that damage the lungs and the airways.

In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, air pollution, and chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)

In rare cases, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low 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're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.

Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.

He or she may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dust.

If you have an ongoing cough, your doctor may ask how long you've had it, how much you cough, and how much mucus comes up when you cough. He or she also may ask whether you have a family history of COPD.

Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds.

You also may need one or more tests to diagnose COPD.

It is always important to speak with your Doctor about COPD. Your Doctor will be able to discuss your treatment options and make recommendations on ways to deal with COPD.

To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating people who have lung disorders.

COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:

Avoid Lung Irritants

If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program.

Try to avoid other lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)

Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for a while.

Keep your windows closed and stay at home (if possible) when there's a lot of air pollution or dust outside.

Get Ongoing Care

If you have COPD, it's important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring all of the medicines you're taking when you have medical checkups.

Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.

Manage COPD and Its Symptoms

You can do things to help manage your disease and its symptoms. Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks. Do activities slowly. Put items that you need often in one place that's easy to reach.

Find very simple ways to cook, clean, and do other chores. Some people find it helpful to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help moving things around 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.

Prepare for Emergencies

If you have COPD, knowing when and where to seek help for your symptoms is important. You should seek 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 on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.

Emotional Issues and Support

Living with COPD may cause fear, anxiety, depression, and stress. It's important to talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're feeling very 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. Talk with your doctor about local support groups or check with an area medical center.

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.

COPD has no cure yet. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.

Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.

Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke. (Secondhand smoke is smoke in the air from other people smoking.)

Other treatments for COPD may include medicines (bronchodilators and inhaled steroids), vaccines, pulmonary rehabilitation, oxygen therapy, and surgery. Your doctor also may recommend tips for managing COPD complications.

Medications

• Bronchodilators. These medications 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.
• Inhaled glucocorticoid steroids. Doctors use inhaled steroids to treat people whose COPD symptoms flare up or worsen. These medicines help reduce airway inflammation. Your doctor may ask you to try inhaled steroids for a trial period of 6 weeks to 3 months to see whether the medicine helps relieve your breathing problems.

The goals of COPD treatment include:

• relieving your symptoms
• slowing the progress of the disease
• improving your exercise tolerance (your ability to stay active)
• preventing and treating complications
• improving your overall health