Chronic obstructive pulmonary disease (COPD)

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COPD is primarily an umbrella term for two conditions: emphysema and chronic bronchitis. Someone with COPD may have one or both of these issues, and the severity of each varies from person to person.

Emphysema damages the air sacs of the lungs. The lungs lose their elasticity and are no longer able to exchange oxygen and carbon dioxide efficiently, as a result.

Chronic bronchitis involves inflammation of the lining of the airways. This results in increased production and thickening of mucus. Bronchitis becomes chronic when it persists and resists treatment.

Asthma symptoms may be part of COPD, and a history of asthma can increase the risk of developing the condition. Asthma causes inflammation of the airways, which spasm and overreact to inhaled substances.

COPD is a lifelong issue involving irreversible damage to the lungs and worsening difficulty breathing and airway obstruction. A person with advanced COPD may be unable to climb the stairs or cook. They may need medications and supplementary oxygen.

In 2014, COPD was the third leading cause of death in the United States.

COPD causes some or all of the following:

• breathlessness, especially after exertion
• a persistent cough
• excess production of sputum
• fatigue
• wheezing
• difficulty breathing that worsens over time

A person with severe symptoms may also have:

• a bluish tint to the lips or fingernail beds
• shortness of breath while talking
• reduced mental alertness
• a rapid heartbeat

Anyone with any severe symptoms should receive immediate medical care.

If symptoms are mild, a person may not realize that they have COPD. Almost 6.4% of the U.S. population have diagnosed COPD, but its actual prevalence may be far more extensive.

Here, find tips to stop wheezing.

Visual model of COPD

Below is an interactive 3D model of COPD. Explore it with the mouse pad or touchscreen.

In the U.S., as many as 75% of people with COPD smoke or once did. Beyond smoking, COPD risk factors include:

• exposure to secondhand smoke
• exposure to other air pollutants and toxins, at home or in the workplace, for example
• asthma
• rarely, genetic factors, which may lead to a deficiency of the protective protein alpha-1 antitrypsin
• a family history of COPD

If COPD develops before the age of 40, there is usually an underlying health issue, such as an alpha-1 antitrypsin deficiency.

Asthma can increase the risk of COPD because it inflames and narrows the airways. However, treatment can usually reverse any damage resulting from asthma.

Various conditions can cause coughing and breathing problems. If a person has COPD, these symptoms persist and worsen over time.

To identify COPD, a doctor:

• considers the personal and family medical histories
• asks about the history of smoking and exposure to other pollutants
• performs a physical examination, using a stethoscope to listen to the person’s breathing
• performs or requests:
  • a lung function test
  • an arterial blood test to measure the oxygen levels in the blood
  • imaging tests, such as an X-ray or CT scan

One lung function test, spirometry, measures the amount and speed of airflow during a short breath. The person blows hard into a tube attached to a device called spirometer, which gives the reading.

This and similar tests can help rule out other conditions or indicate COPD.

The doctor will also use the Global Initiative for Chronic Obstructive Lung Disease guidelines to assess COPD symptoms and the risk of them worsening.

There is no cure for COPD. Treatment involves managing the symptoms to improve the quality of life, reduce the risk of complications, and slow the progression of the health issues involved.

Smoking cessation

Quitting smoking can help improve COPD symptoms and slow its progression. Doing so can also prevent COPD.

Here, learn about managing nicotine withdrawal.

Air pollutant avoidance

Whenever possible, people should reduce their exposure to air pollutants.

This may involve:

• avoiding open fires
• asking others not to smoke nearby
• avoiding places where people are spraying paint or insect repellant
• staying home with the windows closed when air pollution levels are high
• wearing protective gear, such as a mask, when working in a dusty environment

Drug treatments

Medications can help manage COPD symptoms and prevent complications.

To help ease breathing, a doctor may prescribe an inhaler that contains a number of drugs. For example, to relax the muscles around the airways and make breathing easier, an inhaler may contain a medication called a bronchodilator.

An inhaler may also contain a glucocorticoid, a type of corticosteroid that can reduce inflammation in the airways.

Some inhalers are for short-term use. They act quickly and are effective for a few hours. They can make breathing easier during a COPD flare-up. Others are for long-term, daily use.

During follow-up visits, the doctor may adjust the medication regimen to help control worsening symptoms and flare-ups.

They may also recommend antibiotics to manage any acute bacterial infection that develops, as well as vaccination to ward off the flu and pneumonia.

A person with COPD who has effective inhaled treatment may still experience reoccurring flare-ups that require hospital care.

In this case, the doctor may recommend the oral anti-inflammatory medication roflumilast (Daliresp) or the oral antibiotic azithromycin (Zithromax) to reduce the frequency of flare-ups.

Doctors largely base their choice on anticipated side effects, as researchers have yet to directly compare the efficacy of the two medications.

Learn more about how to manage a COPD flare-up.

Oxygen therapy

If blood oxygen levels are low, a doctor may recommend this treatment, which involves breathing oxygen through a device — a mask or nasal prongs — attached to a tank.

People can use this at home, either continuously or only at certain times of the day.

Surgery

Some procedures that may be an option for certain people with COPD include:

• a single or double lung transplant
• a bullectomy to remove the larger air sacs that affect breathing
• the removal of damaged lung tissue, known as lung volume reduction surgery
• the placement of endobronchial valves in the part of the lung with the most damage

A surgeon needs special training and equipment to place endobronchial valves.

Various measures can help reduce the impact and progression of COPD.

Breathing exercises

These can counter breathlessness, and some examples include pursed-lip breathing and diaphragmatic breathing, or “belly breathing.”

Here, learn other techniques to relieve shortness of breath.

Pulmonary rehabilitation

Pulmonary rehabilitation aims to help people maximize their activity levels and quality of life.

A healthcare professional draws up a plan, which may involve:

• boosting exercise tolerance
• doing breathing exercises
• making dietary changes
• learning about the lungs
• learning to use medication most effectively
• learning ways to conserve energy and reduce breathlessness
• attending counseling to help manage any depression or anxiety

Here, find other natural ways to manage COPD symptoms.

People with COPD are more likely to experience:

• mobility problems, due to shortness of breath
• mental health conditions, such as depression
• fair or poor overall health
• other chronic diseases, such as heart disease, diabetes, or asthma
• confusion and memory loss
• a loss of work and income
• social isolation

Following up with the healthcare team and attending all medical appointments can help prevent or manage complications.

COPD can be life-threatening, and a person’s life expectancy largely depends on whether they smoke and the severity of existing lung damage.

People who smoke and have advanced COPD may lose around 6 years of their life expectancies, apart from the 4 years that smoking itself takes away, according to a study published in 2009.

COPD is irreversible, and people who smoke can reduce their risk by quitting as soon as possible.

COPD is an irreversible lung condition that causes difficulty breathing. Someone with COPD may have chronic bronchitis, emphysema or both.

There is no cure, but treatment can help manage the symptoms and enhance the quality of life.

Anyone who receives a COPD diagnosis should take action to protect their lungs. For those who smoke, quitting is essential.

Find more tips for preserving lung health here.