Overview

COPD stands for chronic obstructive pulmonary disease. It is a chronic inflammatory lung disease. It causes obstructed airflow from the lungs. It is cause by long-term exposure to irritating gasses or particulate matter. People with COPD have an increased risk of developing lung cancer or heart disease. 


Chronic bronchitis and Emphysema are the two conditions that most largely contribute to COPD. COPD is treatable and with the right management, most people with COPD can achieve good symptom control and quality of life, as well as a reduced risk of other associated conditions. 

Symptoms

COPD symptoms often won’t appear until significant lung damage occurs, and they generally worsen over time, particularly if smoking exposure continues. 

Other signs and symptoms of COPD include: 

  • Wheezing
  • A chronic cough that produces mucus that can be clear, yellow, white, or greenish
  • Shortness of breath, especially during physical activities
  • Chest tightness
  • Having to clear your throat first thing in the morning due to excess mucus in the lungs. 
  • Lack of energy
  • Swelling in ankles, legs, or feet
  • Blueness of the lips or fingernail beds
  • Unintended weight loss. 

COPD patients will likely experience episodes called exacerbations, during which time their symptoms become worse than usual. That persists for several days. 

Causes

The main cause of COPD is exposure to airborne irritants. These can include: tobacco smoke, fumes, workplace exposure to particle matter or fumes. 

Only 20-30 percent of chronic smokers might develop clinically apparent COPD. Some smokers develop less common lung conditions which may be misdiagnosed as having COPD until a more thorough evaluation is performed. 

Causes of airway obstruction

Causes of airway obstruction include: 

  • Emphysema. This lung disease can cause the destruction of the walls and fibers of alveoli. Small airways collapse when you exhale, impairing the airflow out of your lungs. 
  • Chronic bronchitis. In this condition, the bronchial tubes become inflamed and narrowed and your lungs produce more mucus which further blocks the narrowed tubes. You develop a chronic cough in an attempt to clear the airways. 

Diagnosis

COPD is often misdiagnosed – former smokers may be told they have COPD, when in reality, they could have simple deconditioning or another less common lung condition. Likewise, many people with COPD might not be diagnosed until the disease is more advanced and interventions are less effective. 

In order to diagnose you, your doctor will review your symptoms, discuss your medical history, and discuss any exposure you’ve had to lung irritants. Your doctor might order several tests to diagnose your condition. 

Tests may include:

  • Lung function tests. Pulmonary function tests measure the amount of air you inhale and exhale and if your lungs deliver enough oxygen to your blood. The most common lung function test is spirometry. This test involves blowing into a large tube connected to a small machine called a spirometer. This machine measures the amount of air your lungs can hold, and how fast you can blow the air out of your lungs.
    Spirometry can detect COPD before you have symptoms of the disease. It can also be used to track the disease’s progression and to monitor how treatment is working. Spirometry usually includes measurement of the effect of the administration of bronchodilators. Other lung function tests include measuring lung volumes, pulse oximetry, and diffusing capacity. 
  • Chest X-ray. A chest X-ray can show emphysema. X-rays also help rule out other lung problems or heart failure. 
  • CT scan. A CT scan of your lungs can detect emphysema and help determine if you might benefit from surgery for your COPD. CT scans can also help screen for lung cancer. 
  • Arterial blood gas analysis. This blood test measures how well your lungs bring oxygen into the blood and remove carbon dioxide. 
  • Laboratory tests. Laboratory tests are not used to diagnose COPD, but they can help determine the cause of symptoms or rule out other conditions. 

Treatment

A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease and need little therapy other than smoking cessation. Even if you have more advanced COPD, therapy can still help control your symptoms, reduce your risk of complications and exacerbations, and improve your ability to live an active life. 

Smoking cessation

The most essential step to treat COPD is to stop all smoking. It’s the only way to keep COPD from worsening. Quitting smoking isn’t easy and can be daunting if you’ve been unsuccessful in quitting in the past. 

Discuss nicotine replacement products and medications that may help, as well as how to handle relapses. Your doctor may also recommend a support group to help quit. You should also try to avoid exposure to secondhand smoke. 

Medications

There are several COPD medications that doctors may prescribe. You may take some medications on a regular basis and others as needed. 

Bronchodilators

These medications (usually inhalers) relax the muscles around your airways. This can help to relieve coughing and shortness of breath and ease breathing. Depending on the severity of your COPD, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator for daily use, or both. 

Short-acting bronchodilators include albuterol (Ventolin HFA, ProAir HFA, etc.), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). Long-acting bronchodilators include salmeterol (Serevent), tiotropium (Spiriva), arformoterol (Brovana), aclidinium (Tudorza), indacaterol (Arcapta), and formoterol (Perforomist, Foradil). 

copd medications
Flovent HFA – one of the many COPD medications

Inhaled steroids

Other COPD medications include inhaled corticosteroids which reduce airway inflammation and help prevent exacerbations. Side effects can include oral infections, hoarseness, or bruising. These medications are useful for people with frequent COPD exacerbations. Budesonide (Pulmicort Flexhaler) and fluticasone (Flonase, Flovent HFA), are examples of corticosteroids. 

Combination inhalers

Some COPD medications combine inhaled steroids and bronchodilators. Salmeterol and fluticasone (Advair) as well as budesonide and formoterol (Symbicort) are examples of these combinations. 

Oral steroids

For those who have a moderate or severe acute exacerbation, short courses of oral corticosteroids prevent further worsening of COPD. However, long-term usage of these medications may have serious side effects. 

Phosphodiesterase-4 inhibitors

A new kind of COPD medications approved for people with symptoms of chronic bronchitis or severe COPD is Daliresp (roflumilast), a phosphodiesterase-4 inhibitor. This medication decreases inflammation in the airways and relaxes them. 

Theophylline

This inexpensive COPD medications can help to improve breathing and prevent exacerbations. Side effects can include nausea, tremor, fast heartbeat, and headache. Side effects are dose related, and low doses are recommended. 

Antibiotics

Respiratory infections like pneumonia, influenza, and acute bronchitis, can aggravate COPD symptoms. Antibiotics help to treat acute exacerbations, but they are not usually recommended for prevention. 

Lung therapies

Along with COPD medications, doctors will often use these therapies for those with moderate to severe COPD: 

  • Oxygen therapy. If there’s not enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs.
    Some people with COPD only use these devices while sleeping or during activities, others use it all the time. 
  • Pulmonary rehabilitation program. These programs usually combine exercise training, counseling, education, and nutrition advice. You work with a variety of specialists who can tailor your rehab program to suit your needs.
    Pulmonary rehab can shorten hospitalizations, improve your quality of life, and increase your ability to participate in every day activities. 

Managing exacerbations

You may experience times where your symptoms get worse for days or weeks even with ongoing treatment. This is an acute exacerbation, and if you don’t receive prompt treatment it can leave to lung failure. 

Exacerbations can be caused by: air pollution, respiratory infection, or other inflammation triggers. If you notice a sustained increase in coughing, a change in mucus or have a hard time breathing seek medical attention. 

When you have an exacerbation you may need additional medication, supplemental oxygen or treatment in a hospital. Once symptoms improve, your doctor will talk with you about how to prevent future exacerbations. 

Surgery

For those with severe emphysema that isn’t helped by medication alone, they may need surgery. Surgical options include: 

  • Lung volume reduction surgery. This is where the surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in the chest cavity so the healthier lung tissue can expand and the diaphragm can work better. 
  • Lung transplant. Lung transplantation can be an option for those who meet specific criteria. This procedure as significant risks and it will be necessary to take life long immune-suppressing medication. 
  • Bullectomy. Large air spaces form in the lungs when the air sac walls are destroyed. These bullae can become large and cause breathing problems. In a bullectomy, doctors remove bullae to improve air flow.