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Chronic obstructive pulmonary disease (COPD)

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

Chronic obstructive pulmonary disease (COPD) is a common lung disease. 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.

 

Smoking Myths & Facts

  • Cigarette smoking is the leading cause of COPD.

  • Quitting smoking doesn't help once you have COPD.

  • Smoking both marijuana and tobacco increases your risk of COPD.

  • Most people can quit smoking on the first try.

  • Smokers have more COPD flare-ups than nonsmokers.

  • Men's lungs are more likely to be damaged by smoking than women's.

  • Smoking is not addictive.

  • How you smoke can affect how much nicotine gets into your body.

  • When you quit smoking, your heart rate and blood pressure return to normal levels.

  • Taking a puff of a cigarette can reduce your craving for more.

Causes

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 a cooking fire without proper ventilation
Symptoms

Symptoms may include any of the following:

  • Cough, with or without mucus
  • Fatigue
  • Many respiratory infections
  • Shortness of breath (dyspnea) that gets worse with mild activity
  • Trouble catching one's breath
  • Wheezing

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 may be ordered. With an x-ray, the lungs may look normal, even when a person has COPD. A CT scan will usually show signs of COPD.

Sometimes, a blood test called arterial blood gas may be done to measure the amounts of oxygen and carbon dioxide in the blood.

If your health care provider suspects you have alpha-1 antitrypsin deficiency, a blood test will likely be ordered to detect this condition.

Treatment

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:

  • Quick-relief drugs to help open the airways
  • Control drugs to reduce lung inflammation
  • Anti-inflammatory drugs to reduce swelling in the airways
  • Certain long-term antibiotics

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 from a machine to help breathing by using a mask or through the use of an endotracheal tube

Your provider may prescribe antibiotics during symptom flare-ups, because an infection 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 more about the disease, train you to breathe in a different way so you can stay active and feel better, and keeps you functioning at the highest level possible.

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 provider or therapist how far to walk.
  • Slowly increase how far you walk.
  • Avoid talking if you get short of breath when you walk.
  • 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 or very hot weather
  • Make sure no one smokes in your home
  • Reduce air pollution by not using the fireplace and getting rid of other irritants
  • Manage stress and your mood
  • Use oxygen if prescribed for you

Eat healthy foods, including fish, poultry, and lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a provider or dietitian about eating foods with more calories.

Surgery may be used to treat COPD. Only a few people benefit from these surgical treatments:

  • Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some people with emphysema.
  • Lung transplant for a small number of very severe cases.

Test Your Knowledge of COPD Triggers

  • People with COPD should take care to avoid getting a cold or the flu.

  • The air quality outside can affect your COPD symptoms.

  • Secondhand smoke doesn't affect people with COPD.

  • Smoke from a wood-burning stove can trigger a flare-up.

  • Painting your living room can trigger COPD symptoms.

  • You can reduce your exposure to pollen by:

  • You can keep mold out of your home by controlling moisture.

  • Dust mites are common in dry areas of your home.

  • Which of the following can cause a flare-up?

  • Your appliances can cause indoor pollution.

Support Groups

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.

Outlook (Prognosis)

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 provider about breathing machines and end-of-life care as the disease progresses.

Possible Complications

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)
  • Pneumonia
  • Collapsed lung (pneumothorax)
  • Severe weight loss and malnutrition
  • Thinning of the bones (osteoporosis)
  • Debilitation
  • Increased anxiety
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.

Prevention

Not smoking prevents most COPD. Ask your provider about quit-smoking programs. Medicines are also available to help you stop smoking.

References

Celli BR, Zuwallack RL. Pulmonary rehabilitation. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 105.

Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society guideline. Chest. 2015;147(4):894-942. PMID: 25321320 www.ncbi.nlm.nih.gov/pubmed/25321320.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2019 report. goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Updated November 14, 2018. Accessed April 15, 2019.

Han MK, Lazarus SC. COPD: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

National Institutes of Health, National Heart, Lung, and Blood Institute website. COPD national action plan. www.nhlbi.nih.gov/sites/default/files/media/docs/COPD%20National%20Action%20Plan%20508_0.pdf. Updated May 22, 2017. Accessed April 15, 2019.

Review Date: 5/28/2018

Reviewed By: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutgers New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 04/15/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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