Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a group of serious lung diseases in which subsets of patients may have dominant features of chronic bronchitis, asthma, and emphysema. These diseases cause breathing problems and airflow blockage. According to the CDC, about 16 million people suffer from this disease. There is no cure for COPD, but there are treatments to enable people to manage it better. COPD is the fifth leading cause of death in the United States.

How normal lungs work

Breathing is natural and easy when you have healthy lungs. The diaphragm is a dome-shaped muscle below the lungs. According to the American Lung Association, this muscle is responsible for doing 80% of the work to fill the lungs with oxygen and send out waste gases. The diaphragm contracts rhythmically, continuously, and (for the most part) automatically. Our lungs operate as springs, like a screen door opening and closing on its own. But, with COPD, they lose that springiness and don’t return to the same level. As a result, the air gets strapped into our lungs.

Stale air builds up over time, which leaves less area for the diaphragm to contract and bring in the fresh air. Because the diaphragm cannot work to its full extent, the body starts to use other muscles (such as the neck, back, and chest) to do the work when breathing. Oxygen levels are lower, so there is less energy available for exercise and physical activity, including self-care.

COPD causes damage to the large or central airways, the small or peripheral airways, and the lungs themselves. Your lungs also have tiny sacs in them called alveoli. Every time you breathe, they fill up with your breath like a balloon. When someone has COPD, the walls of the alveoli break down and they do not get enough oxygenated breath. Most of the time, this is a very slow process. In many cases, symptoms develop so slowly that it may be years before you notice them.

Symptoms

• Daily cough with mucus production.
• Shortness of breath, especially during physical activity.
• Wheezing.
• Tightness in the chest.
• Bluish fingernails or lips.
• Regular respiratory infections.
• Decreased energy levels.
• Unexplained weight loss.
• Swelling of the legs, ankles, or feet.

Causes

Cigarette smoke - The most common cause of COPD is cigarette smoke, including pipe and cigar smoke. This is especially a contributing factor if you breathe in the smoke.

Secondhand smoke - You can still breathe in smoke if you live with someone who smokes, so secondhand smoke is another cause of COPD.

Fumes and pollution – Breathing in pollution, chemical fumes (such as cadmium fumes and those that result from welding), toxic gases (chlorine, fungal spores in damp buildings, and asbestos), and dust (grain, flour, silica, and coal dust) can also be a cause of COPD.

Your genes - Some people have a defect in their DNA that causes an alpha-1 antitrypsin deficiency. This deficiency decreases the amount of protein needed to protect your lungs.

Untreated asthma - Over time, this can develop into COPD without proper medical management.

Risk factors for COPD

Things that can make you more likely to get COPD to include smoking, asthma and age since symptoms usually occur in people 40 years and older. Some people have jobs that expose them to dust, chemical fumes, or vapors, which all put them at a greater risk of COPD due to lung damage. These jobs include agriculture, brickmaking, construction, mining, dock work, and others. Someone can also experience lung damage from extended exposure to air pollution. Many childhood respiratory illnesses also increase someone’s COPD risk.

Diagnosis

Unfortunately, COPD is commonly misdiagnosed and may not be diagnosed until the disease has advanced. Your physician will review your signs, symptoms, medical and family history, and exposure to cigarette smoke and other lung irritants. Your doctor may then prescribe several different tests including a lung function test, which measures the amount of air you can inhale and exhale. During a test called spirometry, you will be asked to blow into a large tube connected to a small device that measures how much air your lungs can hold and how fast you can blow it out of your lungs. Other lung tests include pulse oximetry, measurement of lung volume and diffusing capacity, and the 6-minute walk test.

A chest x-ray and CT scan can show signs of emphysema (a symptom of COPD) and rule out other lung problems. Doctors can measure how well your lungs bring oxygen into your blood and remove carbon dioxide using an arterial blood gas analysis. Although they are not used to diagnose COPD, lab tests may be used to determine if you have the genetic alpha-1-antitrypsin deficiency. Labs will also be done if you have a family history of COPD and it occurs at a young age.

Medical treatments

Smoking cessation is the first line of treatment for COPD. This is done through nicotine replacement therapy, which reduces withdrawal symptoms. The medication comes in different forms including chewing gum and patches, which absorb nicotine through the skin. Eventually, the nicotine provided by the patches is slowly reduced to wean someone off of nicotine. These therapies are for those who are very serious about quitting tobacco.

Bronchodilators are the most common medications given once a person has developed COPD. Bronchodilators relax the bands of smooth muscle that tighten around the airways. This quickly opens the airways to let more air in and out of the lungs. As a result, the breathing improves and symptoms such as coughing and shortness of breath decrease.

Bronchodilators also assist in clearing mucus from the lungs, since mucus can move more easily when the lungs are open. These medications come in different forms including tablets, inhalers, and nebulizers. A nebulizer is a device that administers a medication into the lungs in the form of a mist. Bronchodilators come in both short and long-acting forms.

Corticosteroids decrease inflammation and prevent COPD flare-ups. Some inhalers combine a bronchodilator with a steroid. Combination inhalers are available and include more than one type of bronchodilator. When someone’s COPD becomes more severe, a short period of oral steroids may be necessary. All these medications and others not mentioned must be considered in light of their side effects.

Antibiotics may be used to treat a variety of respiratory infections including pneumonia, bronchitis, and influenza, which are known to exacerbate COPD symptoms. They are not used as preventative measures and are only intended to treat worsening COPD episodes. Their use may also be limited to sidestep antibiotic resistance.

In cases of moderate to severe COPD, oxygen therapy may be prescribed. Someone may need additional oxygen if there isn’t enough in their blood. There are a variety of devices that deliver oxygen to the lungs using lightweight, portable units that can be used during sleep or activity. Some people need oxygen constantly and oxygen therapy is the only COPD treatment proven to extend their life.

Your physician may prescribe a pulmonary rehabilitation program that will have you work with specialists on education, exercise, nutrition, behavioral intervention, and counseling. This rehab is designed to improve how people with COPD function in their daily lives and improve their quality of life with a chronic disease.

Another breathing device for use at home is called a bilevel-positive airway pressure (BiPAP) machine. It is a non-invasive ventilation device with a mask that helps with breathing and reduces the retention of CO2. The respiratory rate can be changed to deliver more or less O2.

Surgery may be necessary for some people with severe forms of COPD that were not helped by alternate therapies. Lung reduction requires the removal of a small damaged portion of the lung to allow the healthier lung tissue to expand and the diaphragm to work more effectively. Endoscopic lung volume reduction focuses on placing a tiny one-way valve in the lung to allow damaged lung tissue to shrink. This helps the healthier portion of the lung to function better.

A lung transplant is an option for some people, but this procedure comes with significant risks and will require someone to use immune-suppressing medications for the rest of their life. Another procedure that allows someone to breathe easier is a bullectomy. This destroys large air spaces that typically cause breathing difficulties.