Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease, or COPD, causes long-lasting obstruction of the respiratory airways, resulting in damaged lungs and making it hard to breathe. Emphysema and chronic bronchitis are forms of COPD.

Daughter Knows Best

Chrissy's father had been smoking cigarettes since he was a teen. In the past few years, though, her father had developed a nasty cough that never seemed to go away. Her father said it was just a “smoker's cough” and nothing to worry about, but Chrissy was concerned. Finally, she convinced her father to see a doctor. The doctor said that her father had an early stage of chronic obstructive pulmonary disease, or COPD, an illness that affects a large number of smokers. The doctor pointed out that too many smokers do not take this condition seriously until their lungs have been badly damaged. At that point, smokers can develop life-threatening breathing problems or heart failure. Surprised by what he had learned, Chrissy's father thanked his daughter for urging him to get help before it was too late. The next day, he joined a group for smokers who want to stop smoking.

How Does the Respiratory System Work?

The thousands of tiny alveoli provide a surface about the size of a football field for the exchange of oxygen and carbon dioxide. It is here that the body takes in oxygen to nourish the body cells and gives off carbon dioxide, which is exhaled. Normally, the airways and air sacs are elastic and spring back to their original shape after filling with air, acting like a new rubber band or balloon. This flexibility allows the oxygen and carbon dioxide exchange to take place efficiently. A slice of a normal lung looks like a pink sponge filled with tiny bubbles or holes.

Did You Know?

What Happens in COPD?

In COPD, less oxygen-laden air gets in and less air gets out for the following reasons:

In the emphysema type of COPD, the bronchi and bronchioles are inflamed and continually swollen and clogged. This condition causes the alveoli to swell, burst, and merge. Instead of healthy pink tissue with small holes, the lungs look like a dirty sponge with many large bubbles or holes in it. Deposits of tar from smoking make the tissue dark and spotted. Because there is less surface area, the damage to the alveoli makes it more difficult for the transfer of oxygen and carbon dioxide to take place and for the person to breathe.

There are three types of emphysema depending on the location of the inflammation. Panlobular or panacinar emphysema is characteristic of weakening and inflammation of alveoli at the end of the bronchioles. When destruction is severe, the lungs appear like a spiderweb in x-rays. A mild version of this type of emphysema occurs in aging; in younger people, it is caused by the body's inability to produce sufficient amounts of the protein Alpha-1 antrypsin (ATT). The second type, centrilobular or centriacinar emphysema, affects single alveoli, destroying them and causing the airway walls to enlarge. This type is commonly associated with chronic bronchitis. A third type, distal acinar emphysema or paraseptal, is rare.




The respiratory system with cross sections of healthy alveoli and alveoli with Chronic Obstructive Pulmonary Disease (COPD).





The respiratory system with cross sections of healthy alveoli and alveoli with Chronic Obstructive Pulmonary Disease (COPD).
SOURCE: Diseases and Conditions Index (DCI), National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. Illustration by GGS Information Services. © 2016 Cengage Learning®.

What Are the Causes of COPD?

COPD, including emphysema, is very rare in young people, but the incidence * steadily increases as people grow older, particularly during or after middle age. The repeated breathing of cigarette smoke 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. Secondhand smoke that is in the air from other people smoking can also play a part in developing COPD, due to the cumulative effect on the lungs of breathing tobacco smoke. One person cannot catch COPD from another.

Emphysema used to be more common in men than in women, but this is no longer the case. More women are also diagnosed with chronic bronchitis and are dying from COPD than men.

The lungs and airways are very sensitive, and other irritants can inflame them and destroy the elasticity of the sensitive structures. Such activities as working around certain kinds of chemicals and breathing those fumes for many years, working in dusty areas over the years, and heavy exposure to air pollution can cause COPD. Environmental air pollution contributes to the development of chronic bronchitis and emphysema. With on-the-job exposure to mineral dusts, such as coal dust in a mine, emphysema may occur as part of a disease known as pneumoconiosis (noo-mo-ko-nee-O-sis).

Emphysema may accompany diseases such as asthma and tuberculosis that can obstruct the airways in the lungs. A less serious form of emphysema sometimes develops in elderly people whose lungs have lost elasticity as a part of the aging process. Another usually mild form, called compensatory emphysema, results when a lung over-expands to occupy the space of another lung that has collapsed or has been removed surgically.

The great majority of emphysema cases are associated with cigarette smoking. It has been found that people who are heavy smokers of cigarettes are 10 to 15 times more likely to develop emphysema than are nonsmokers.

300 YEARS AGO: NO SMOKING PLEASE

Sir John Floyer (1649–1735), an English physician who had asthma, first described emphysema in the 17th century. Floyer was studying pulmonary (lung) disorders and described the characteristic prolonged expiration and progressive nature of emphysema.

Floyer warned his patients to avoid tobacco smoke, metallic fumes, and other potential irritants because he believed that they caused pulmonary disorders. He was right.

What Are the Signs and Symptoms of COPD?

COPD is usually not diagnosed until about the sixth decade (between the ages of 50 and 59 years) in a person's life. Most of these people have smoked at least 10 to 20 cigarettes per day for 20 or more years before experiencing any symptoms. The signs of COPD are as follows:

With any of these symptoms, the person is encouraged to seek medical attention.

How Is COPD Diagnosed?

The healthcare provider asks about symptoms and whether the person has smoked, currently smokes, or is exposed to secondhand smoke or air pollutants. The physician takes a medical history, completes a physical exam, and then listens to the lungs. A sample of sputum may be collected and sent to a laboratory for analysis.

Tests for the chest and breathing

A chest x-ray or a high-resolution computed tomography (CT) scan may be taken. The CT scan provides more detail than a chest x-ray and is useful especially in diagnosing emphysema.

Spirometry (speh-ROM-eh-tree) is an easy and painless breathing test to help determine how well the lungs are working. This pulmonary function test detects and assesses the severity of the disease. In this test, the person breathes hard into a large hose connected to a machine called a spirometer. When the person breathes out, the machine measures how much air the lungs can hold and how fast the person can blow air out of the lungs after taking a deep breath. Spirometry measures the amount of air that the person can exhale—the forced expiratory volume or FEV in one second (FEV1). The test, which shows the narrowing of airways, bases the normal value at 70 to 80 percent of the forced volume capacity (FVD). The device is quite sensitive and can detect COPD before serious symptoms appear. Based on the result of tests, doctors divide COPD into three categories according to severity:

  1. Mild COPD or Stage 1 is FEV1 in which breathing is equal or more than 50 percent of the predicted normal value of 70 to 80 percent. The breathing test shows mild airflow limitation. Signs may include a chronic cough and sputum production.
  2. Moderate COPD or Stage 2 is FEV1 in which breathing is 35 to 49 percent of the predicted value. The breathing test shows a worsening airflow limitation. Usually, the symptoms have increased, including shortness of breath that develops when the person is working hard, walking fast, or doing strenuous activities. The person begins to realize that it is time to seek medical attention.
  3. Severe COPD or Stage 3 is FEV1 in which breathing is less than 35 percent of the predicted value. Breathing test shows severe airflow limitation. The person is very short of breath after little activity. Other complications such as signs of heart or respiratory failure may develop. Now the person has a greatly impaired quality of life. The worsening symptoms become life threatening.

The doctor may recommend other tests to rule out conditions that may have similar signs and symptoms. The tests may include an arterial blood gas test that measures how well lungs are transferring oxygen into the blood and how efficient the lungs are removing carbon dioxide. Another test uses a pulse oximeter, which is attached to a finger, to measure the percentage of oxygen saturation in the blood.

How Is COPD Treated?

The goals of COPD treatment are to improve the quality of life of the person by preventing symptoms of the condition, to slow the progress of the disease, to prevent complications and sudden onset of problems, and to improve overall health. COPD treatment is different for each person, and the general practitioner may recommend a pulmonologist (pull-mon-OL-o-gist), a specialist who works with diseases and disorders of the respiratory system. Three types of treatment are self-help at home, medications, and surgery, and treatment may depend on whether the symptoms are mild, moderate, or severe.

Self-care at home

The most important step that a person with COPD can take is to stop smoking in order to try to reduce the progress of the disease. A plan to stop smoking is essential, and help from outside sources may be necessary. Most patients have trouble stopping their habit of smoking. The addictive power of nicotine, the conditioned response to smoking-associated stimuli, psychological problems, and poor education about the nature of nicotine make it difficult for individuals to stop smoking. A smoking cessation program may involve the following techniques and tools:

Several nicotine-replacement therapies are available. Nicotine chewing gum is available in a variety of strengths, depending on how much the individual typically smokes in a day. The person may chew hourly and as needed for any initial cravings within the first two weeks and then gradually reduce the amount of use over the next three months. Transdermal nicotine patches are available and generally well tolerated; these products are scheduled for decreased use over 6 to 10 weeks. The antidepressant bupropion is a non-nicotine aid for stopping smoking and may also be effective for those people who have not been able to stop with other nicotine replacement therapies. Some people have had success with hypnotherapy.

Withdrawal from nicotine may cause unpleasant side effects, such as anxiety, irritability, difficulty concentrating, weight gain, anger, fatigue, drowsiness, depression, and sleep disruption. Smoking the first cigarette within 30 minutes of waking up is a sign that a person is highly addicted and likely would benefit from nicotine-replacement therapy. A nicotine-replacement program is an important part of smoking cessation but must be used only under the supervision of a physician.

Medications for COPD

Several types of medication are used to treat COPD. Following are medications that may be recommended depending on the nature and progress of the disease:

* to deliver the medication in tiny droplets and open breathing passages with minimal side effects. A group of long-acting bronchodilators use methylxanthines, chemicals related to the caffeine family. Caution is recommended with this group due to unwanted side effects.

New medications used to treat COPD include the combination of an anticholinergic medication (umeclidinium) and a long-acting beta 2- adrenergic agonist medicine (vilanterol). This medication is inhaled and is used to relax the lung tissue and improve the exchange of oxygen.

One additional new medication, tiotropium, is a bronchodilator that relaxes muscles in the airways and increases airflow to the lungs. This medication is used to prevent bronchospasm (narrowing of the airways in the lungs) in people with COPD, including bronchitis and emphysema.

Surgery for COPD

Surgical approaches are typically the last measure to consider in treating COPD. Three major surgical approaches available include bullectomy, lung volume reduction surgery (LIRS), and lung transplantation:

How Can COPD Be Prevented?

Because the damage of COPD, emphysema, and bronchitis is irreversible, it is especially important to prevent this disease from developing in the first place. Adopting healthy habits early in life—especially not smoking—is very important. Avoiding exposure to secondhand smoke and staying clear of wood and cooking smoke are also wise. Trying to limit air pollutants in the home is prudent as well. It is very important to avoid respiratory infections during cold and flu seasons. Vaccines for flu and pneumonia are recommended for those who are prone to chest disorders and for those older than 65 years. People can take an active role in fighting for clean air laws to prevent air pollution.

See also Asthma • Bronchiolitis and Infectious Bronchitis • Pneumoconiosis • Tobacco-Related Diseases: Overview • Tuberculosis

Resources

Books and Articles

Abramovitz, Melissa. COPD. Farmington Hills, MI: Lucent Books, 2015.

King, Jared, ed. Chronic Obstructive Pulmonary Disease (COPD): Clinical Symptoms, Emerging Treatment Strategies, and Impact on Quality of Life. Hauppauge, NY: Nova Science Publishers, 2016.

Sutton, Amy, ed. Respiratory Disorders Sourcebook, 3rd Edition. Detroit, MI: Omnigraphics, 2014.

Vlies, B.H., and P.P. Walker. “Improving the Diagnosis and Management of COPD.” Practitioner 259 no. 1787 (November 2015): 15–19.

Wong, J.S., and M. Gottwald. “Advance Care Planning Discussions in Chronic Obstructive Pulmonary Disease: A Critical Review.” Journal of Palliative Care 31 no. 4 (2015): 258–264.

Websites

Centers for Disease Control and Prevention. “Chronic Obstructive Pulmonary Disease (COPD).” http://www.cdc.gov/copd/index.html (accessed April 30, 2016).

Organizations

American Lung Association. 55 W. Wacker Drive, Suite 1150 Chicago, IL 60601. Toll-free: 800-LUNG-USA (800-548-8252). Website: http://www.lung.org (accessed March 6, 2016).

COPD Foundation. 20 F Street NW, Suite 200-A Washington, DC 20001. Toll-free: 866-731-COPD (866-731-2673). Website: http://www.copdfoundation.org (accessed March 6, 2016).

National Heart, Lung, and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. Telephone: 301-592-8573. http://www.nhlbi.nih.gov (accessed April 30, 2016).

* incidence means rate of occurrence.

* aerosolize (AIR-o-suh-lize) is to put something, such as a medication, in the form of small particles or droplets that can be sprayed or released into the air.

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)