Chronic Obstructive Pulmonary Disease (COPD)

​Overview

Chronic Obstructive Pulmonary Disease, or COPD, is a common, serious condition affecting the lungs and airways, producing chronic cough and shortness of breath. It is most often seen in people who are middle-aged or older. COPD is actually made up of two separate disease processes—emphysema (which destroys the lung tissue itself, where oxygen is taken up and carbon dioxide eliminated, and causes shortness of breath) and chronic bronchitis (which inflames and weakens the conducting airways within the lung, and causes cough and sputum production). Many people with COPD also have some aspects of asthma.

The main feature of COPD from a functional standpoint is a decrease in the flow of air through the bronchial tubes (airway obstruction). As the airway blockage worsens, breathing during times of exertion becomes more difficult. People with severe COPD may have trouble with basic activities of daily living such as doing light housework, walking, or washing their hair.

COPD is the 4th leading cause of death in the United States. More than 12 million people have been diagnosed by a physician as having COPD, according to the National Heart Lung and Blood Institute, part of the National Institutes of Health, and it is estimated that at least that many more have the condition but have not yet been diagnosed.

Symptoms

The symptoms of COPD include:
  • Cough, present every day, especially in the morning, or on most days
  • Sputum (coughing up phlegm)
  • Shortness of breath, especially with exertion
  • Wheezing
(Not all people with COPD have all of these symptoms)

Causes

Smoking is the leading cause of COPD.
Other, less common causes include exposure to:
  • Indoor air pollution, such as second-hand cigarette smoke and smoke from cooking fires
  • Outdoor air pollution
  • Chemical fumes and dusts

Risk Factors

People older than 40 who smoke are most at risk for developing COPD. Cigarette smoking is by far the greatest risk factor for this condition. Other risk factors that may also play a role include:
  • Long-term, heavy exposure to indoor air pollution, such as second-hand smoke or smoke from cooking
  • Long-term exposure to outdoor air pollution
  • Long-term exposure to chemicals, dust or fumes
  • Genetic conditions, such as an alpha-1 antitrypsin, or AAT, deficiency

Diagnosis

There are three components to correctly diagnosing COPD:
  1. The presence of persistent cough, sputum, and/or shortness of breath with exertion
  2. A history of exposure to a known risk factor, especially smoking
  3. Demonstration of airflow obstruction by spirometry. Spirometry is a simple test in which the person blows into a tube or mouthpiece and the rate of air flow during maximal exhalation is measured. The diagnosis of COPD rests on finding a certain pattern and degree of abnormality in the results of this test.

Complications

COPD is a progressive condition whose severity and rate of progression can be modified by appropriate treatment. Complications make the condition worse and can be life-threatening. The most important complications of COPD are exacerbations and chronic hypoxemia.

An exacerbation is an acute worsening of shortness of breath, cough, and/or sputum production that persists for at least a day or two. Exacerbations are usually caused by infections, but can also result from exposure to air pollution or from other processes. Exacerbations are a main cause of illness and disability in people with COPD, and their prevention and treatment are very important.

Exacerbations require prompt treatment. A severe exacerbation may require admission to the hospital or even treatment in the intensive care unit for acute respiratory failure, a condition in which the patient’s ability to maintain respiratory function deteriorates to a life-threatening degree.

Severe COPD may be accompanied by chronic hypoxemia, which means that the patient’s lungs can no longer extract enough oxygen from the air. When this happens, the heart and other vital organs cannot maintain normal function, increasing the risk of death and serious complications. Proper diagnosis and treatment of chronic hypoxemia can greatly decrease this risk, extend the life expectancy, and improve the quality of life for individuals with severe COPD.

Recovery

People with COPD should:
  • Learn about their condition and its management, from their health care provider and from other reputable sources, such as the Global Initiative for Chronic Obstructive Lung Disease, or the American Thoracic Society
  • Quit smoking (help available through their health care provider and from Quitline.com
  • Take their medication as directed
  • Participate in a pulmonary rehabilitation program
  • Avoid pollutants or fumes that can cause lung irritation
  • Get vaccines, such as a flu shot, as directed
  • Avoid crowds and individuals who are ill, especially during flu season

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