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Disease of the Day: Chronic obstructive pulmonary disease
Who Treats This

Category

This is a Respiratory System Disease

Synonym Name

Chronic obstructive pulmonary disease

Overview

 
Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make breathing difficult. Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Chronic bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Emphysema occurs when the air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed. Damage to your lungs from COPD can't be reversed, but treatment can help control symptoms and minimize further damage.

Risks

Risk factors for COPD include:
 
  • The most significant risk factor for COPD is long-term cigarette smoking: The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers, marijuana smokers and people exposed to large amounts of secondhand smoke also are at risk
  • The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more
  • Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs
  • COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin
  • An uncommon genetic disorder known as alpha-1-antitrypsin deficiency is the source of some cases of COPD: Other genetic factors likely make certain smokers more susceptible to the disease

Causes

 
  • The main cause of COPD is tobacco smoking: However, in the developing world, COPD often occurs in women exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 20 percent of chronic smokers develop COPD. 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 partially collapse, which leaves some air trapped in your lungs when you exhale
Causes of airway obstruction
 
Cigarette smoke and other irritants
 
  • In the vast majority of cases, 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 only about 20 percent of 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 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin: Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the liver can occur in infants and children, not just adults with long smoking histories. For adults with COPD related to AAt deficiency, treatment options are the same as those for people with more common types of COPD. Some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs
  • 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

Symptoms

 
  • People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse and persist for days or longer
Symptoms of COPD often don't appear until significant lung damage has occurred, and they usually worsen over time. For chronic bronchitis, the main symptom is a cough that you have at least three months a year for two consecutive years. Other signs and symptoms of COPD include:
 
  • Chest Tightness
  • Lack Of Energy
  • Wheezing
  • Shortness of breath, especially during physical activities
  • Having to clear your throat first thing in the morning, due to excess mucus in your lungs
  • A chronic cough that produces sputum that may be clear, white, yellow or greenish
  • Blueness of the lips or fingernail beds (cyanosis)
  • Frequent respiratory infections
  • Unintended weight loss (in later stages)

Tests

Chest X-ray
 
  • A chest X-ray can show emphysema, one of the main causes of COPD: An X-ray can also rule out other lung problems or heart failure.
Laboratory tests
 
  • Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions: For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.
Computerized tomography (CT scan)
 
  • A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD: CT scans can also be used to screen for lung cancer.
Lung (pulmonary) function tests
 
  • Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood:
  • Spirometry is the most common lung function test: Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.
Arterial blood gas analysis
 
  • This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide:

Treatments

Treatments and drugs
 
  • A diagnosis of COPD is not the end of the world: For all stages of disease, effective therapy is available which can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life
Smoking cessation
 
  • The most essential step in any treatment plan for COPD is to stop all smoking: It's the only way to keep COPD from getting worse — which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. It's also a good idea to avoid secondhand smoke exposure whenever possible
Medications: Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:
 
  • Bronchodilators: These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza)
  • Inhaled steroids:  Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent) and budesonide (Pulmicort) are examples of inhaled steroids
  • Combination inhalers:  Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers
  • Oral steroids:  For people who have a moderate or severe acute exacerbation, oral steroids prevent further worsening of COPD. However, these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection
  • Phosphodiesterase-4 inhibitors:  A new type of medication approved for people with severe COPD is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss
  • Theophylline:  This very inexpensive medication helps improve breathing and prevents exacerbations. Side effects may include nausea, fast heartbeat and tremor
  • Antibiotics:  Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help fight acute exacerbations. The antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties
Lung therapies: Doctors often use these additional therapies for people with moderate or severe COPD:
 
  • Oxygen therapy:  If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options
  • Pulmonary rehabilitation program:  These programs typically combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program
Managing exacerbations
 
  • Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks: This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution, or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics or steroids), supplemental oxygen or treatment in the hospital. Once symptoms improve, you'll want to take measures to prevent future exacerbations, such as taking inhaled steroids or long-acting bronchodilators, getting your annual flu vaccine and avoiding air pollution whenever possible
Surgery: Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone:
 
  • Lung volume reduction surgery:  In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently. In some people, this surgery can improve quality of life and prolong survival
  • Lung transplant:  Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active, but it's a major operation that has significant risks, such as organ rejection, and it obligates you to take lifelong immune-suppressing medications
Medications: Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:
 
  • Bronchodilators: These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza)
  • Inhaled steroids:  Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent) and budesonide (Pulmicort) are examples of inhaled steroids
  • Combination inhalers:  Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers
  • Oral steroids:  For people who have a moderate or severe acute exacerbation, oral steroids prevent further worsening of COPD. However, these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection
  • Phosphodiesterase-4 inhibitors:  A new type of medication approved for people with severe COPD is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss
  • Theophylline:  This very inexpensive medication helps improve breathing and prevents exacerbations. Side effects may include nausea, fast heartbeat and tremor
  • Antibiotics:  Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help fight acute exacerbations. The antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties