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Chronic obstructive pulmonary disease
Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe chronic lung diseases including emphysema, and chronic bronchitis. This disease is characterized by breathlessness.
COPD is (currently) an incurable disease, but with the right diagnosis and treatment, there are many things you can do to breathe better and enjoy life and live for many years.
This means that the disease lasts a long time and is always present. While the symptoms may take years to develop and the severity may differ at times, there is still much you can do to slow the progress of the disease.
The ability to move air in and out of your lungs is blocked or obstructed. This is caused by swelling and extra mucus in the tubes of the lungs (airways) which carry air in and out.
This means that the disease is located in your lungs.
Your lungs have some damage. But even though a cure hasn’t been found yet, your symptoms can be treated.
Damage to the air sacs (alveoli - al-vee-oh-lee) causes emphysema (m-pha-zee ma). The walls inside the alveoli disappear, making the many small sacs become larger sacs. These larger sacs do not transfer oxygen from the air to the blood as well. Also, when the alveoli are damaged, the lungs become stretched out and lose their springiness. The airways become flabby, and air is trapped in the lungs. This creates a feeling of shortness of breath.
Damage to the bronchial (brawn-key-el) tubes causes chronic bronchitis. Bronchitis (brawn-ki-tus) occurs when the bronchial tubes are irritated and swollen. This causes coughing and shortness of breath. If mucus comes up with the cough and the cough lasts at least three months for two years in a row, the bronchitis is called chronic bronchitis.
There are hair-like fibers lining the bronchial tubes of the lungs. These tiny hairs are called cilia (seal lee ah). The cilia help move mucus up the bronchial tubes so it can be coughed out. In chronic bronchitis, the tubes lose their cilia.
This makes it hard to cough up mucus out of the lungs, which causes more coughing. . Smoking, even just a little, keeps the cilia from working normally. Mucus can build up in the lungs. This can cause more damage.
Signs and Symptoms of COPD
It’s easy to think of shortness of breath and coughing as a normal part of aging, but these could be signs of COPD. COPD can progress for years without noticeable shortness of breath. That’s why it is important to talk with your health care provider as soon as you notice these symptoms. Ask your health care provider about ordering a Spirometry test.
Symptoms of COPD can be different for each person, but common symptoms are:
Increased shortness of breath
Frequent coughing (with and without mucus)
Tightness in the chest
Not all COPD is the same
There are different types of COPD. Each type may affect how well different treatments work, how your symptoms affect your everyday life, and how they progress. If you have another health condition in addition to COPD (comorbidity), such as high blood pressure, heart disease, heartburn, depression, or diabetes, this can also affect your COPD and how it is managed.
Here are some things that can help determine your particular type of COPD. Taking these things into consideration can be useful in addition to your spirometry numbers and other factors.
Do you have a cough? If so, do you cough up mucus on most days for at least three months in a period of at least two years? If yes, you may have a chronic bronchitis type of COPD that will respond to different medicines.
Have you been told that your lungs are stretched out and bigger than normal? If so, are they stretched out throughout your whole lung or just in certain places? If so, this is emphysema which is diagnosed by a radiology test (a chest X-ray or a computed tomography [CT] scan). Sometimes it is possible to decrease the size of the big, stretched out places in your lungs.
To diagnose chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, your doctor will evaluate your symptoms, ask for your complete health history, conduct a health exam and examine test results.
Your doctor will want to know if you:
Smoke or have a history of smoking
Are exposed to secondhand smoke, air pollution, chemicals or dust
Have symptoms such as shortness of breath, chronic cough or lots of mucus
Have family members who have had COPD
Testing for COPD
Spirometry: If you are at risk for COPD or have symptoms of COPD, you should be tested through spirometry. Spirometry is a simple test of how well your lungs work. For this test, you blow air into a mouthpiece and tubing attached to a small machine. The machine measures the amount of air you blow out and how fast you can blow it.
Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.
Other tests: Your doctor may also want you to have a chest X-ray and/or other tests, such as an arterial blood gas test, which measures the oxygen level in your blood. This test can show how well your lungs are able to move oxygen into your blood and remove carbon dioxide from your blood.
Many people with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, slow progression, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.
The most essential step in any treatment plan for COPD is to quit all smoking. Stopping smoking can keep COPD from getting worse and reducing 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. Your doctor may also recommend a support group for people who want to quit smoking. Also, avoid secondhand smoke exposure whenever possible.
Several kinds of medications are used to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed.
Bronchodilators are medications that usually come in inhalers — they 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.
Examples of short-acting bronchodilators include:
Albuterol (ProAir HFA, Ventolin HFA, others)
Ipratropium (Atrovent HFA)
Examples of long-acting bronchodilators include:
Aclidinium (Tudorza Pressair)
Indacaterol (Arcapta Neoinhaler)
Umeclidinium (Incruse Ellipta)
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. Examples of inhaled steroids include:
Fluticasone (Flovent HFA)
Budesonide (Pulmicort Flexhaler)
Some medications combine bronchodilators and inhaled steroids. Examples of these combination inhalers include:
Fluticasone and vilanterol (Breo Ellipta)
Fluticasone, umeclidinium and vilanterol (Trelegy Ellipta)
Formoterol and budesonide (Symbicort)
Salmeterol and fluticasone (Advair HFA, AirDuo Digihaler, others)
Combination inhalers that include more than one type of bronchodilator also are available. Examples of these include:
Aclidinium and formoterol (Duaklir Pressair)
Albuterol and ipratropium (Combivent Respimat)
Formoterol and glycopyrrolate (Bevespi Aerosphere)
Glycopyrrolate and indacaterol (Utibron)
Olodaterol and tiotropium (Stiolto Respimat)
Umeclidinium and vilanterol (Anoro Ellipta)
For people who experience periods when their COPD becomes more severe, called moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids may prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.
A medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss.
When other treatment has been ineffective or if cost is a factor, theophylline (Elixophyllin, Theo-24, Theochron), a less expensive medication, may help improve breathing and prevent episodes of worsening COPD. Side effects are dose related and may include nausea, headache, fast heartbeat and tremor, so tests are used to monitor blood levels of the medication.
Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat episodes of worsening COPD, but they aren't generally recommended for prevention. Some studies show that certain antibiotics, such as azithromycin (Zithromax), prevent episodes of worsening COPD, but side effects and antibiotic resistance may limit their use.
fluticasone / umeclidinium / vilanterol
budesonide / formoterol / glycopyrrolate
Current research & peer reviewed journals
American Lung Association – COPD
American Thoracic Society – COPD
Global Initiative for Chronic Obstructive Lung Disease
National Institutes of Health – COPD
National Library of Medicine – COPD
World Health Organization – COPD
Patient /Family Stories; Suggestions for improvement
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