Chronic Obstructive Pulmonary Disease

COPD stands for chronic obstructive pulmonary disease, a serious lung disease that affects more than 12 million people in the U.S. The diagnosis of COPD includes chronic bronchitis and emphysema. Many people with COPD have both of these conditions. This is what happens with each:

• Chronic bronchitis is a condition in which your airways in your lungs are swollen and produce too much mucus. The swelling and excess mucus narrow the airways and make breathing difficult.
• Emphysema is a condition in which the bronchioles (small airways) and alveoli (small air sacs) are damaged and lose their normal elasticity. Like worn-out balloons, the alveoli become over-expanded. They don’t contract to push air out as easily when you breathe out. Air tends to stay trapped inside your lungs, and fresh air outside your body has a hard time getting in. This limits the oxygen going in — and the carbon dioxide going out — of your bloodstream. These problems are made worse because the small blood vessels around the alveoli are also damaged.

The lung damage that happens with COPD cannot be repaired, and the disease cannot be cured. However, you can do a lot to reduce your symptoms and improve your quality life.

Call your doctor if these symptoms last longer than a day:

• Short of breath (call 911 immediately if you feel like you can’t breathe or are very short of breath, and quick-relief medicine doesn’t help)
• Mucus is thicker than usual or colored
• Coughing or wheezing more
• Chest feels tight or “full” (call 911 immediately if you have chest pain or severed chest tightness)
• Some trouble with daily activities
• Trouble concentrating
• No appetite
• Feeling very tense or restless
• Sore throat and runny nose
• Fever and chills
• Sudden weight gain (3 to 5 pounds overnight) and swelling in ankles.

Most people develop COPD after many years of breathing in a substance that damages the lungs and airways, such as:

• Cigarette smoke. Cigarette smoking is the most common cause of COPD. Smoking a pipe, cigar, or anything else can also cause COPD. Even second-hand smoke — exposure from smokers you live or work with — can be a factor.
• Dust or fumes. Your lungs can be damaged by things you breathe in at work — such as dust from a mine or quarry — or chemical fumes from a factory or paint shop.
• Fuel or gases. In a poorly ventilated home, fuel for daily cooking or heating can damage your lungs.

Not all cases of COPD come from breathing in substances from the environment. Family history can play a role too. People with alpha-1 antitrypsin deficiency, for example, have an inherited form of emphysema.

Breathing problems can come from many different conditions. Before diagnosing COPD, your doctor will assess your lungs and overall health in these ways:

• Medical history. The doctor asks questions about your symptoms (“How long have you had this problem?”), your family history (“Does anyone in your family have this problem?”), and your lifestyle (“Have you ever smoked?). This conversation gives the doctor clues about what may be causing the breathing problem or making it worse.
• Physical exam. The doctor examines your body — for example, by looking at your skin color or listening to your chest as you breathe — for additional information.
• Imaging tests. Your doctor may order imaging (such as a chest x-ray) to get pictures of the inside of your chest and lungs. The images can’t be used to diagnose COPD, but they may reveal other problems such as a lung infection.
• Lung function tests (pulmonary function tests). Lung function tests are the only way to diagnose COPD. They’re also used to monitor your response to treatment and measure your condition over time. Common types of lung function tests are:
• Breathing tests to measure how well your lungs are working. The simplest breathing test is spirometry, which can be done in your doctor’s office or in a hospital. Your doctor may also order more complex lung tests to get additional information about your lungs.
• Tests of oxygen level to see how well your lungs deliver oxygen to your bloodstream. Pulse oximetry uses a special light clipped to your finger to measure oxygen in your blood. An arterial blood gas test measures the oxygen in a sample of blood from your artery.
• Exercise tests, which are sometimes combined with tests of your oxygen level, as in the 6-minute walk test. These tests help your doctor know how your heart and lungs respond to the stress of physical activity. They can also help your doctor determine the severity of your condition.

Treatment for COPD depends on the severity of your disease, your daily habits, and your overall health. Generally, treatment includes:

• Quitting smoking. This is the most powerful step you can take toward better health.
• Other daily lifestyle changes, such as exercising, practicing breathing techniques, lowering stress, and eating well. Your healthcare team can give you information and plans to help you care for yourself at home.
• Medicine. Nearly everyone with COPD can be helped with medicine. COPD medicines include:
• Quick-relief, or “rescue,” medicines that you inhale to help you breathe better right away.
• Maintenance medicines that help control symptoms and prevent exacerbations.
• Oxygen therapy. If your COPD is mild, you may not need oxygen. Yet as COPD progresses, oxygen can be vital for helping you feel better and stay active. Studies have shown that oxygen therapy can extend your life, as well.
• Surgery. A small number of people with COPD may be helped by lung volume reduction surgery. This surgery removes damaged lung tissue and creates more space for the diaphragm to move and help pull air into the lungs. Lung transplant may also be an option for treatment of severe COPD.

Your doctor can explain the plan for your treatment. Be sure to ask questions, and consider attending pulmonary rehabilitation.

To prevent COPD you must:

• Stop smoking
• Avoid breathing substances that irritate the lungs, including second-hand smoke

Complete avoidance of cigarette smoke — not just cutting — is the only way to prevent permanent lung damage. If you already have COPD, complete avoidance of cigarette smoke will help you live better and longer. Quitting now will help you:

• Prevent further damage to your lungs. Every cigarette you don’t smoke prevents further damage to lung tissue.
• Slow the damage to your lungs. Quitting is one of the most important steps you can take to slow down the disease.
• Improve your symptoms. Your coughing, sinus congestion, fatigue, and shortness of breath will all decrease.
• Lower your chance of stroke, heart disease, and lung cancer. Smoking hurts your health in many ways. Quitting improves your health in every way.
• Stay out of the hospital. Studies show that periods of severe breathing problems decrease when a person quits smoking.

Keep in mind that the average person makes at least five unsuccessful attempts to quit smoking before they’re able to stop for good. So try again. Millions of people have quit, and so can you.

Accept that you may need help to quit — many people do. Ask your doctor for medication or nicotine replacement therapy to help manage withdrawal symptoms and the desire to smoke. Check out Intermountain’s Quitting Tobacco: Your Journey to Freedom.

• COPD: Chronic Obstructive Pulmonary Disease Patient Fact Sheet
• COPD Personal Action Plan
• Breathing Better: A handbook for people with COPD and other chronic lung conditions
• Quitting Tobacco: Your Journey to Freedom
• Pulmonary Rehab Patient Fact Sheet

COPD takes many years to develop, and in its early stages doesn’t usually cause noticeable symptoms. Eventually, people with COPD experience these symptoms:

• Coughing and shortness of breath, especially when physically active
• Extra mucus with a cough
• Wheezing (a faint whistling sound when breathing)

As COPD worsens, people may have these symptoms:

• Fatigue
• Ankle swelling
• Poor concentration due to the low oxygen and high carbon dioxide levels

COPD symptoms tend to sneak up on people. Without being aware of it, people with COPD gradually do less and less, limiting their daily activity so they can avoid becoming out of breath. Most people only seek medical help later in life, at age 50 or more, when their breathing problems are difficult to ignore.