Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. Having COPD makes it hard to breathe.
There are two main forms of COPD:
- Chronic bronchitis, which involves a long-term cough with mucus
- Emphysema, which involves damage to the lungs over time
Most people with COPD have a combination of both conditions.
COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic
Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD.
In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.
Other risk factors for COPD are:
- Exposure to certain gases or fumes in the workplace
- Exposure to heavy amounts of secondhand smoke and pollution
- Frequent use of cooking fire without proper ventilation
- Cough, with or without mucus
- Many respiratory infections
- Shortness of breath (dyspnea) that gets worse with mild activity
- Trouble catching one's breath
Because the symptoms develop slowly, some people may not know that they have COPD.
Exams and Tests
The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away.
Using a stethoscope to listen to the lungs can also be helpful. But sometimes the lungs sound normal even when a person has COPD.
Imaging tests of the lungs, such as x-rays and CT scans, can be helpful. But sometimes the lungs look normal even when a person has COPD and a chest x-ray has been taken.
Some patients may need to have a blood test called arterial blood gas to measure the amounts of oxygen and carbon dioxide in the blood.
There is no cure for COPD. But there are many things you can do to relieve symptoms and keep the disease from getting worse.
If you smoke, now is the time to quit. This is the best way to slow lung damage.
Medicines used to treat COPD include:
- Inhalers (bronchodilators) to help open the airways
- Inhaled or oral steroids to reduce lung inflammation
- Anti-inflammatory drugs to reduce swelling in the airways
In severe cases or during flare-ups, you may need to receive:
- Steroids by mouth or through a vein (intravenously)
- Bronchodilators through a nebulizer
- Oxygen therapy
- Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)
Your doctor may prescribe antibiotics during symptom flare-ups, because infections can make COPD worse.
You may need oxygen therapy at home if you have a low level of oxygen in your blood.
Pulmonary rehabilitation does not cure COPD. But it can teach you to breathe in a different way so you can stay active.
LIVING WITH COPD
You can do things every day to keep COPD from getting worse, protect your lungs, and stay healthy.
Walk to build up strength:
- Ask the doctor or therapist how far to walk.
- Slowly increase how far you walk.
- Try not to talk when you walk if you get short of breath.
- Use pursed lip breathing when you breathe out, to empty your lungs before the next breath.
Things you can do to make it easier for yourself around the home include:
- Avoid very cold air
- Make sure no one smokes in your home
- Reduce air pollution by getting rid of fireplace smoke and other irritants
Eat healthy foods, including fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories.
Surgery may be used to treat COPD, but only a few patients benefit from these surgical treatments:
- Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some patients with emphysema
- Lung transplant for very severe cases
You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.
COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking.
If you have severe COPD, you will be short of breath with most activities. You may be admitted to the hospital more often.
Talk with your doctor about breathing machines and end-of-life care.
With COPD, you may have other health problems such as:
- Irregular heartbeat (arrhythmia)
- Need for breathing machine and oxygen therapy
- Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
- Severe weight loss and malnutrition
- Thinning of the bones (osteoporosis)
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath.
Not smoking prevents most COPD. Ask your health care provider about quit-smoking programs. Medicines are also available to help you stop smoking.
Anderson B, Conner K, Dunn C, et al. Institute for Clinical Systems Improvement. Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). Updated March 2013. Available at: https://www.icsi.org/_asset/yw83gh/COPD.pdf. Accessed April 26, 2014.
Balkissoon R, Lommatzsch S, Carolan B, Make B. Chronic obstructive pulmonary disease: a concise review. Med Clin N. Am. 2011;95:1125-1141.
Shapiro SD, Reilly JJ Jr., Rennard SI. Chronic bronchitis and emphysema. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 39.
Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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