Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease that gets worse over time. The disease has three traits that must be present to be diagnosed:

  • Emphysema: A condition that causes the air spaces inside the lungs to become permanently larger. This happens because the disease destroys the walls of the tiny air sacs inside the lungs.
  • Chronic bronchitis: A cough that does not go away, creates mucus or phlegm, and lasts at least three months in two consecutive years. To be considered bronchitis, tests must rule out infections or diseases such as tuberculosis, lung cancer or chronic heart failure.
  • Blocked airflow in and out of the lungs, such as with asthma. This symptom generally gets worse over time.

COPD can be managed with treatment and treatment should be started early on to ensure the best quality of life possible.

Symptoms

Most patients won’t notice symptoms of COPD until the condition has caused major lung damage. Symptoms will usually get worse over time, especially if the patient continues to be exposed to smoking or other lung irritants.

Generally, the first symptom a patient with COPD will have is coughing and difficulties breathing typical of bronchitis, emphysema and asthma.

Other signs of COPD include:

  • Redness of the skin because the capillaries are congested
  • Fluid in the lungs and airways and linings of the throat
  • Production of a great deal of mucous and other secretions, sometimes including pus
  • Enlarged glands
  • Changes in the cells of the lungs and airways that can be seen with a microscope
  • Blue tint to skin around the lips or fingernails
  • Frequent respiratory infections

People who have smoked more than 20 cigarettes a day for more than 20 years may begin to cough up mucus in their 40s or early 50s. Breathlessness during exercise or exertion usually doesn't become bad enough to see to a doctor until the COPD patient is in their 50s or mid-60s.

Gradually, patients may produce more and more fluid or mucus in their lungs or airways.

Severe chest conditions (coughs, production of pus-filled fluid or mucus, wheezing, breathlessness and sometimes fever) may happen from time to time. As the disease gets worse, the time between severe fits gets shorter.

Late in the disease, these fits may be so severe that the blood doesn't get enough oxygen and the person's skin turns bluish. The patient may develop a morning headache that indicates too much carbon dioxide in their blood. There may also be a loss of weight.


Causes and Risk Factors

COPD is most commonly caused by tobacco smoke. It mostly affects adults, with symptoms appearing between the ages of 30 and 40 years old. Age and cigarette smoking account for more than 85% of the risk of developing COPD.

In rare cases, the condition can develop in younger patients when it is associated with Alpha-1 Antitrypsin Deficiency (A1AD).

COPD affects more men than women and is most frequently diagnosed in Caucasian people.

It is not yet understood what the role of air pollution is in causing COPD. But working around large amounts of various chemical fumes, such as welding fumes, or various dusts, such as mineral dust, may put you at greater higher risk of developing COPD.

Diagnosis

Diagnosis of COPD usually begins with a review of medical history and symptoms, as well as a physical exam. In the early stages of COPD, a physical exam may show very little except wheezing when breathing out. As the disease develops, the lungs begin to show signs of overinflating with air. The size of the chest gets larger.

The doctor may notice that the diaphragm moves less than that of a healthy person. The sounds of the heart become distant. Crackles may be heard at the base of the lungs. The veins of the neck may stick out, mostly when a person is breathing out, showing increased pressure inside the chest.

The patient may also have jerky movements because of buildup of carbon dioxide in the blood.

After the physical exam, the doctor will do tests to rule out other conditions, such as cancer, tuberculosis or chronic heart failure, which may cause similar symptoms. The doctor will also determine whether the patient has COPD rather than bronchitis, emphysema or asthma alone.

Chest x-rays, computed tomography (CT) scans or a bronchoscopy may be used to rule out tuberculosis or other conditions if a person is coughing up blood. Two-dimensional echocardiography and Doppler techniques may be used to find out whether there is high blood pressure in the lungs.

Other tests such as blood oxygen tests, as well as lung function and exercise testing may be conducted to find out how much damage has been done and how well the lungs are working.

Treatments

There is no cure for COPD. Current treatments focus on managing symptoms or underlying conditions and improving the patient’s quality of life. Treatment approaches, including lifestyle changes, medication, rehabilitation and therapy, as well as surgery, vary depending on how severe the COPD is and what has caused it.

Patients with COPD may need to make lifestyle changes once they have been diagnosed with the condition. The single most important lifestyle change a patient can make is to stop smoking . This is extremely important for patients who have mild or moderate COPD. It can improve some symptoms of COPD and delay others.

Other lifestyle changes may include removing lung irritants from the home and workplace, as well as learning how to save energy during daily activities.

Maintaining proper nutrition is also very important for patients with COPD because their daily activities often require more energy than normal. The extra challenge of breathing with COPD causes the patient's resting use of energy to rise. Without food to balance this energy usage, someone with a chronic condition such as COPD will begin to lose weight.

Medications may be prescribed to improve airflow, reduce inflammation and muscle spasms inside the lungs, and cut or thin down mucus and fluid buildup. Antibiotics may be helpful in taking care of infections that may contribute to COPD. Staying current on flu and pneumonia shots can reduce the chances of infection that can cause COPD symptoms to become worse.

Physical or occupational therapy can help manage the symptoms of COPD. Oxygen therapy may be used if the amount of oxygen in the blood is low. This therapy may help with shortness of breath and extend the patient's ability to stay active. Many doctors will recommend pulmonary rehabilitation, which provides information and counseling to patients to help them manage the condition.

For some, surgery may be a treatment option. Lung volume reduction surgery or a lung transplant may be the best option, particularly those younger than 65 with no other medical problems who aren't responding to medications.

The multidisciplinary team at the Chronic Obstructive Pulmonary Disease Program can determine the best treatment option for each patient.