Chronic Obstructive Pulmonary Disease (COPD)

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Overview

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.



Symptoms

Many people don't recognize the symptoms of COPD until later stages of the disease. Sometimes people think they are short of breath or less able to go about their normal activities because they are "just getting older." Shortness of breath can be an important symptom of lung disease. If you experience any of these symptoms, or think you might be at risk for COPD, it is important to discuss this with your doctor.


Chronic cough

Shortness of breath while doing everyday activities (dyspnea)

Frequent respiratory infections

Blueness of the lips or fingernail beds (cyanosis)

Fatigue

Producing a lot of mucus (also called phlegm or sputum)

Wheezing


Causes

The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.

Only some chronic smokers develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.

How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).

The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and over-expand, which leaves some air trapped in your lungs when you exhale.

Emphysema

EmphysemaOpen pop-up dialog boxBronchitis

BronchitisOpen pop-up dialog box

Causes of airway obstruction

Causes of airway obstruction include:

Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.

Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.

Cigarette smoke and other irritants

In the vast majority of people with COPD, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because not all smokers develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution, and workplace exposure to dust, smoke or fumes.

Alpha-1-antitrypsin deficiency

In about 1% of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin (AAt). AAt is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can cause liver disease, lung disease or both.

For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs.

Risk factors

Risk Factors for Chronic Obstructive Pulmonary Disease (COPD)

Risk Factors

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Symptoms

Diagnosis

Treatment

Screening

Reducing Your Risk

Talking to Your Doctor

Resource Guide

A risk factor is something that increases your chance of getting a disease or condition.


It is possible to develop COPD with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing COPD. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.


Risk factors include:


Smoking

The most important risk factor for COPD is cigarette smoking. Almost all COPD cases are caused by cigarette smoking. However, not all smokers develop COPD. Factors in your environment or genetic make-up also contribute to the development of COPD.


Smoking more "exotic" forms of tobacco, such as Chinese waterpipes, are can be even more harmful. In some cases, these can increase your risk more than traditional cigarettes.


Research suggests that people who are chronically exposed to secondhand smoke (in any form) may have an increased risk of developing COPD.


Genetic Factors

COPD usually develops in older persons with a long history of cigarette smoking. However, one form of emphysema has a genetic component. It runs in families. It is also more common in people of northern European descent. People with this form of COPD have a hereditary deficiency of a blood component. It is known as alpha-1-protease inhibitor (alpha-1-antitrypsin [AAT]). People with this defect can develop COPD at an earlier age. If you have close relatives who developed COPD in their 30s or 40s, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected with blood tests.


Age

You are more likely to develop COPD as you get older. This is partly related to the number of cigarettes smoked and the number of years as a smoker.


Medical Conditions

A history of frequent childhood lung infections increases your risk of developing COPD.


Gender

COPD is much more common in men than in women. However, this may be largely related to the higher rate of smoking among men. As the number of women who have significant smoking histories has increased, the number of COPD-related deaths in women has also risen.


Exposure to Environmental and Occupational Pollutants

Chronic exposure to dust, gases, chemicals, and biomass fuels increases your risk of developing COPD. These include smoke from burning wood, charcoal, and crop residue. Exposure to these can also worsen symptoms of the disease

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Complications

COPD makes it hard to breathe in as much air as you need. And without enough oxygen, you may have other problems.

Fortunately, there are simple things you can do. Stop smoking, exercise, and closely follow your doctor's instructions about treating your COPD to prevent many of these complications.

Lung Infections

Your disease makes it harder to fight off lung infections like pneumonia. Getting sick can then make it harder for you to breathe.

Prevention is a must. Talk to your doctor about which vaccines to get. Some are for pneumonia, while others target illnesses that can make you more prone to pneumonia, like the flu and whooping cough. Wash your hands often to avoid picking up these germs.

Collapsed Lung (Pneumothorax)

COPD can damage lung tissue. And if air leaks into the space between a lung and your chest wall, that lung can collapse like a deflated balloon. You might have sudden shortness of breath, feel sharp chest pain or tightness, or have a hacking cough.

Treatments range from extra oxygen to surgery. To help prevent a collapsed lung from happening, stop smoking and see your COPD doctor regularly.

Poor Gas Exchange

Blood carries oxygen to cells throughout your body and carbon dioxide away from them. But because you're not breathing in and out fully, you may have less oxygen than you need or more carbon dioxide than you should in your blood. Either of these may be why you have shortness of breath. A high carbon dioxide level can also give you a headache and make you woozy.

A simple device called an oximeter that goes on your fingertip can check your oxygen level. Extra oxygen should help get that level up to where your doctor recommends. But if you're using oxygen, keep the flow within the range your doctor prescribed. Sometimes, too much oxygen can decrease your breathing rate. 

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Heart Problems

Low blood oxygen levels can lead to narrowed arteries and higher blood pressure in the blood vessels that go from your heart to your lungs, as well as within your lungs. That can put a lot of stress on your heart, making it work harder than it should. It could become right-sided heart failure, a permanent condition in which your heart is too weak to do its job well.

The right side of your heart may get bigger. Doctors call this cor pulmonale. It can cause irregular heartbeats, trouble with blood circulation, an enlarged liver, and swelling in your feet and legs.

Being active helps keep your blood moving so you're less likely to get serious blood clots that can travel to your lungs.

Atrial Fibrillation

COPD can damage nerve fibers that connect to the heart and cause unusual heartbeats called arrhythmia. Atrial fibrillation (AFib) is the most common arrhythmia. In a study of more than 1.3 million people with COPD, about 18% also had AFib.

It’s caused by erratic beating in your heart’s two upper chambers, the atria. Some people describe AFib as feeling like a flutter, a racing heart, skipped beats, or lightheadedness, but others feel nothing at all.

AFib is more likely to start as your COPD worsens. If you have both conditions, it’s important to control them. AFib complicates COPD, and COPD can make it harder for AFib treatments to work.

Follow your doctor’s advice to keep your COPD symptoms and AFib in check. Doing that will go a long way toward keeping you healthier longer. And, if you smoke, stop. Smoking can cause physical changes in your atria that can lead to or worsen AFib.

Treatment for AFib may include taking medications or getting a procedure called cardioversion, which sends electrical impulses to your heart to restore it to a regular rhythm.


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Thinning Bones (Osteoporosis)

It's common for people with COPD to get osteoporosis. They've often been smokers, they take steroids, it's hard for them to get enough bone-strengthening exercise, and they can be low on bone-building vitamin D.

Brittle, weak bones break more easily. And a break will sideline you from activity.

Protect your bones with weight-bearing exercise like walking and strength training with stretchy bands. Learn how to prevent falls.

Your doctor may want to check your bone density with the painless X-ray test called a DEXA scan. They might want you to take calcium and vitamin D supplements or bone-building drugs.

Weak Arms and Legs

Some of the same things that cause bone loss can cause muscle loss, too. Those weak muscles make it even harder to do everyday activities.

Ask your doctor to check how well your limbs work. A pulmonary rehab program can help preserve muscle. It may include strength training to build up muscle tissue you've lost.

Weight Issues

When you're overweight, your lungs have to work harder. This can make your COPD worse and complications more likely.

As COPD progresses, you might have the opposite problem: severe weight loss, sometimes because you're too short of breath to eat enough. Being underweight can also worsen symptoms and make you more vulnerable to bone thinning and infections.

Whether you need to lose or gain weight, your doctor or a registered dietitian can tell you how many calories you should get each day. And you may need supplements, like extra protein and vitamins.

Sleep Problems

COPD symptoms can wake you up during the night, which will leave you tired during the day. Even more serious is sleep apnea, a condition in which you have repeated pauses in breathing while you sleep. The pauses, along with low oxygen levels, could make your COPD worse.

Ask your doctor if you should get tested for sleep apnea. If you have it, you can use a breathing device called a CPAP machine when sleeping. Extra oxygen might help, too.

Untreated sleep apnea raises the chance of high blood pressure, heart disease, and stroke.

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Depression and Anxiety

At least 1 in 10 people with early COPD get depression or anxiety, and that number climbs as the disease gets worse. Medication can help, along with exercise and even music therapy.

Work with your doctor or a therapist on self-care skills, too. People who problem-solve do better physically and emotionally than people who ignore health issues.

Lung Cancer

You’re more likely to get lung cancer if you have COPD because both conditions share the same risk factor: smoking cigarettes. And when you do get it, the outcome after diagnosis and treatment tends to be worse than someone without COPD.

Pulmonary Hypertension

This means the pressure in the blood vessels from the heart to the lungs is too high, which causes excess muscle in the wall of the blood vessels. It’s a common and serious complication of COPD. Symptoms include breathlessness and tiredness that typically get worse with exercise or sleep.

Pulmonary hypertension often worsens symptoms and outcomes for people with COPD and shortens lifespan as well.

It’s also likely to increase the need for medical services including medication, assessments, and therapies.

Secondary Polycythemia

The “polycythemia” means that the number of red blood cells has increased. The “secondary” means that it is the result of an underlying condition like sleep apnea, obesity hypoventilation syndrome, and COPD.

COPD lessens oxygen, which can raise levels of erythropoietin and lead to secondary polycythemia. You might have a headache and feel tired, sluggish, or confused. It also raises your risk for stroke

Proper treatment of the underlying condition -- in this case COPD -- can help control secondary polycythemia.

Prevention

The best way to prevent COPD is to never start smoking, and if you smoke, quit. Talk with your doctor about programs and products that can help you quit. Also, stay away from secondhand smoke, which is smoke from burning tobacco products, such as cigarettes, cigars, or pipes.

Don't Smoke. ...

Avoid Exposure to Indoor Pollutants That Can Damage Your Lungs. ...

Minimize Exposure to Outdoor Air Pollution. ...

Prevent Infection. ...

Get Regular Check-ups. ...

Exercise.