COPD: Causes, Symptoms and Treatment of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that make it hard to breathe and get worse over time.

What goes wrong in the lungs

Healthy airways and air sacs are elastic. When you breathe in, air flows through the airways and fills the air sacs like small balloons; when you breathe out, they deflate and push the air out. In COPD, less air flows in and out because:

• the airways and air sacs lose their stretch;
• the walls between many air sacs are destroyed;
• the airway walls become thick and inflamed;
• the airways make extra mucus and can clog.

The two main types

Most people with COPD have both, though how severe each is varies from person to person.

Causes and risk factors

COPD usually comes from years of breathing in irritants that damage the lungs and airways. In the United States, cigarette smoke is the main cause — up to 75% of people with COPD smoke or used to. Pipe, cigar and other tobacco smoke can also cause it, especially if inhaled.

Other risks:

• long-term exposure to secondhand smoke, air pollution, or chemical fumes and dusts at home or at work;
• age — most people are at least 40 when symptoms begin;
• genetics — including a rare condition, alpha-1 antitrypsin deficiency; and smokers with a family history of COPD are more likely to develop it;
• asthma — which raises the risk, though most people with asthma never get COPD.

Symptoms

At first there may be none, or only mild ones. As COPD progresses, symptoms usually worsen:

• frequent cough, or a cough that brings up a lot of mucus;
• wheezing — a whistling or squeaky sound when breathing;
• shortness of breath, especially with activity;
• chest tightness;
• fatigue.

Some people get frequent respiratory infections such as colds and flu. Severe COPD can cause weight loss, weakness in the lower muscles, and swelling in the ankles, feet and legs.

Diagnosis

A provider may ask about your symptoms, your family history, and any smoking or exposure to secondhand smoke and other irritants, and may order lung function tests, a chest X-ray or CT scan, and blood tests such as an arterial blood gas or alpha-1 antitrypsin test.

Treatment

There's no cure, but treatment can ease symptoms, slow the disease, help you stay active, and prevent or treat complications.

• Lifestyle: quitting smoking — the single most important step; avoiding secondhand smoke and other irritants; eating to meet your nutritional needs; and being as active as your condition allows, which strengthens breathing muscles. Ask your provider how much activity is right.
• Medicines: bronchodilators, usually inhaled, relax the muscles around the airways; in more severe cases the inhaler may also contain steroids. Flu and pneumococcal vaccines, because COPD raises the risk of serious illness from them. Antibiotics for bacterial lung infections. Biologics, made from living sources, may reduce inflammation in certain types of COPD.
• Oxygen therapy for severe COPD with low blood oxygen, all the time or only at certain times.
• Pulmonary rehabilitation: exercise, disease management training, and nutritional and psychological counseling.
• Surgery, usually a last resort: removing damaged lung tissue or large air spaces (bullae) in emphysema, or, for severe COPD, a lung transplant.

Get emergency care for severe symptoms, such as trouble catching your breath or talking. Call your provider if symptoms worsen or you have signs of infection, such as fever.

Prevention

Because smoking causes most COPD, the best prevention is not to smoke — and to avoid secondhand smoke, air pollution, chemical fumes and dusts.

Sources

Based on the MedlinePlus health topic "COPD," National Library of Medicine, with text from the National Heart, Lung, and Blood Institute, National Institutes of Health; works of the United States government in the public domain.