COPD

    Definition

    Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it hard to breathe.

    In people who have COPD, the airways that carry air in and out of the lungs are partially blocked, making it difficult to get air in and out. COPD is a major cause of death and illness throughout the world. It kills more than 120,000 Americans each year. That’s one death every 4 minutes.

    According to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ), 2008 hospital re-admissions within 30 days of initial treatment were 30% higher among black patients aged 40 years or above with chronic obstructive pulmonary disease (COPD), compared to those in Hispanics, Asians and Pacific Islanders and about 9% higher than in whites.

    Causes

    Smoking

    Most cases of COPD develop over time, from breathing in fumes and other things that irritate the lungs. Some of the things that put you at risk for COPD include smoking, environmental exposure, and genetic factors.

    Cigarette smoking is the most common cause of COPD in the United States (either current or former smokers). Pipe, cigar, and other types of tobacco smoking can also cause COPD, especially if the smoke is inhaled.

    Other Causes

    COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD even if they have never smoked or had long-term exposure to harmful pollutants.

    In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. While very few people know if they have AAT deficiency, it is estimated that close to 100,000 Americans have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants.

    Symptoms

    The symptoms of COPD include: constant cough; excess sputum (mucus) production; shortness of breath while doing activities you used to be able to do; wheezing, or whistling sound when you breathe; and tightness in the chest.

    The most common symptoms of COPD are a cough that does not go away and coughing up lots of sputum. These symptoms often start years before the flow of air in and out of the lungs is reduced. Not everyone who has a cough and sputum goes on to develop COPD.

    Exams and Tests

    If your doctor thinks you may have COPD, he or she will examine you, listen to your lungs, and ask you questions about your medical history, and what lung irritants you may have been around for long periods of time.

    To confirm a diagnosis of COPD, your doctor will use a breathing test called spirometry. The test is easy and painless and shows how well your lungs work.

    In a spirometry test, you breathe hard into a large hose connected to a machine called a spirometer. When you breathe out, the spirometer measures how much air your lungs can hold and how fast you can blow air out of your lungs.

    Based on this test, your doctor can determine if you have COPD and how severe it is. There are four levels of severity for COPD:
    •    people at risk for COPD
    •    people with mild COPD
    •    people with moderate COPD
    •    people with severe COPD

    Those at risk for developing COPD have a normal breathing test and mild symptoms such as chronic cough and sputum production.
    Those with mild COPD have mild breathing limitation. Symptoms may include a chronic cough and sputum production. At this stage, you may not be aware that airflow in your lungs is reduced.

    With moderate COPD, your breathing test shows worsening airflow blockages. Symptoms may be worse than with mild COPD and you may experience shortness of breath while working hard, walking fast, or doing brisk activity. At this stage, you would seek medical attention. With severe COPD, the breathing test shows severe limitation of the airflow. People with severe COPD will be short of breath after just a little activity. In very severe COPD, complications like respiratory failure or signs of heart failure may develop. At this stage, quality of life is impaired and worsening symptoms may be life-threatening.

    Other Tests

    Other tests are used to rule out other causes of the symptoms.Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. Your doctor may also order a chest X-ray and an arterial blood gas test. The blood test shows the oxygen level in the blood to see if oxygen treatment is needed.

    Treatments

    Although there is no cure for COPD, treatments and lifestyle changes can help manage symptoms.

    Quit Smoking

    Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke. (Secondhand smoke is smoke in the air from other people smoking.)

    Treatment Goals

    The goals of COPD treatment are to:
    •    relieve symptoms with no or minimal side effects of treatment
    •    slow the progress of the disease
    •    improve the ability to stay active and exercise
    •    prevent and treat any complications from the disease
    •    improve health overall

    Treatment for COPD can be different for each person and is based on whether symptoms are mild, moderate or severe. Treatments include medication, pulmonary or lung rehabilitation, oxygen treatment, and surgery. There are also treatments to manage complications or a sudden onset of symptoms.

    COPD Medications

    •    Bronchodilators are medications that work by relaxing the muscles around your airways, opening them and making it easier to breathe. Bronchodilators can last either 4-6 hours or 12 hours, depending on the type. Most bronchodilators are inhaled directly into the lungs with the use of an inhaler. People with mild COPD may use inhalers only when needed. Those with moderate or severe COPD may need more regular bronchodilator treatment.

    •    Inhaled steroids are used for some people with moderate or severe COPD. They work to reduce the inflammation or swelling in the airways.

    Doctors recommend that people with COPD get a pneumococcal vaccine to prevent pneumonia and an annual flu shot to avoid any breathing complications from the flu.

    Pulmonary Rehabilitation

    In addition to medications, doctors may recommend pulmonary or lung rehabilitation (rehab) to help people with COPD stay active. Pulmonary rehabilitation can include exercise training, nutrition advice, and education about managing the disease. A program of pulmonary rehabilitation would be managed by doctors, nurses, respiratory therapists, exercise specialists, and dietitians, and would be customized for each patient.

    Oxygen Treatment

    For people with severe COPD and low levels of oxygen in the blood, doctors may recommend oxygen therapy to help with shortness of breath. Using extra oxygen more than 15 hours per day can help you perform tasks or activities with less shortness of breath, protect the heart and other organs from damage, help you sleep more, improve your alertness during the day, and help you live longer.

    Surgery

    For some people with severe COPD, surgery may be recommended. Surgery is usually done for patients who have severe symptoms, have not gotten improvement from medications, and have a hard time breathing most of the time.

    There are two types of surgery that are considered in the case of severe COPD: a bullectomy, which removes a large air sac that may compress a good lung, or lung volume reduction surgery (LVRS). LVRS is a procedure in which surgeons remove sections of damaged tissue from the lung. A lung transplant may be done for some people with very severe COPD.

    Possible Complications

    If you have COPD, you might be more likely to get colds and flu. Because your heart can be strained, it will get bigger. You might have high pressure in the vessels that bring blood to your lungs.

    You should have a flu shot every year. You should also have a pneumonia shot. You are less likely to get flu or pneumonia if you have these shots. Rehabilitation and exercise programs specifically for people who have COPD may also be helpful.

    People with COPD often have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. You should call your doctor if you have sudden chest tightness, more coughing, a change in your sputum, or fever. Your doctor will look at things that may be causing these sudden symptoms. Sometimes the symptoms are caused by a lung infection.

    Your doctor might recommend antibiotics to fight the infection, or bronchodilators or glucocorticosteroids to help with breathing.

    Your doctor will recommend that you spend time in the hospital if:
    •    you have a lot of difficulty catching your breath
    •    you have a hard time talking
    •    your lips or fingernails turn blue or gray
    •    you are not mentally alert
    •    your heartbeat is very fast
    •    home treatment of the worsening symptoms does not help

     

    When to Contact a Medical Professional

    You should notify your doctor as soon as possible if you experience any of the following symptoms related to a worsening of COPD:

    •        Dyspnea (shortness of breath) that has gotten worse, occurs more frequently than usual, and/or wakes you up more than once a night
    •        Inability to walk as far as you normally do on a daily basis
    •        Need to elevate your head more than usual to sit or sleep
    •        Increased need for breathing treatments
    •        Changes in mucus production (color, thickness or odor; if it contains blood)
    •        Worsening chronic cough
    •        Increase in wheezing
    •        Swelling in your lower extremities that doesn’t go away with rest or when your legs are elevated
    •        Frequent morning headaches
    •        Weight gain of more than 2 pounds in a day, or 5 pounds in a week
    •        Fever, especially if accompanied by cold or flu symptoms
    •        Increase in restlessness, confusion, irritability, forgetfulness, or slurred speech
    •        Increasing fatigue or weakness that lasts for more than a day

    Remember that the nature of COPD is one of repeated bouts of COPD exacerbations, and that your symptoms may vary with each episode. Don’t wait for your COPD symptoms to become life-threatening to seek medical advice. If you experience any of these symptoms, call your doctor promptly to avoid an emergency situation.

    Preventions

    You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and control the disabling effects of the disease.

    If you smoke, the most important thing you can do to prevent more lung damage is to stop smoking. It is also important to stay away from people who smoke and places where you know there will be smokers.

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