Overview

Chronic obstructive pulmonary disease, or COPD, is a group progressive disease where inflammation in the lungs damages lung tissue and traps air in the lungs. As the disease worsens, it takes longer and longer to exhale. The lungs become overinflated and shortness of breath develops. Inflammation is most often due to cigarette smoking. Once started, the inflammation is difficult to stop. The most common are emphysema and chronic bronchitis. Many people with COPD have both of these conditions.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production. Bronchitis causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow.

COPD Versus Asthma

COPD (chronic obstructive pulmonary disease) is a lung disease caused by chronic interference with lung airflow that impairs breathing, and is not fully reversible.

Asthma is a respiratory condition marked by spasms of the bronchi, due to inflamed and narrowed airways in the lungs. Asthma causes difficulty in breathing that often results from an allergic reaction.

Symptoms and Signs — 6 similarities between COPD and Asthma

Similarities in signs and symptoms are between the two conditions are:

• Coughing
• Shortness of breath
• Chest tightness
• Exercise intolerance
• Wheezing (a whistling or squeaking sound in the chest)
• Anxiety with increased heart rate may occur in both diseases.

Symptoms and Signs — 6 Differences between COPD and Asthma

• In asthma, breathing can return to normal between attacks, while breathing with COPD usually does not return to normal.
• The symptoms of COPD gradually become more severe. (This also may occur if you have asthma.)
• COPD produces more mucus and phlegm compared to asthma.
• Chronic cough is common with COPD.
• People with COPD often have chronic blueness to fingernail beds and/or lips (cyanosis).
• Asthma can occur in a person of almost any age, while COPD usually occurs in those over age 40. (Although it is possible in some individuals to develop COPD a younger age.)

Causes Of COPD

• Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.
• In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.
• Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD.
• Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)—a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly.
• Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.

Symptoms Of COPD

Symptoms of chronic obstructive pulmonary disease include:

• cough
• chest discomfort
• shortness of breath (dyspnea)
• wheezing

Progressive or more serious symptoms may include:

• respiratory distress
• tachypnea (excessively rapid breathing)
• cyanosis (chronic blueness to fingernail beds and/or lips)
• use of accessory respiratory muscles
• peripheral edema (accumulation of fluid causing swelling in tissues perfused by the peripheral vascular system, usually in the lower limbs)
• hyperinflation
• chronic wheezing
• abnormal lung sounds
• prolonged expiration
• elevated jugular venous pulse

Comorbidities

Comorbidities are diseases and conditions that you have in addition to the main disease. Comorbidities for asthma and COPD are also often similar. They include:

• high blood pressure
• impaired mobility
• insomnia
• sinusitis
• migraine
• depression
• stomach ulcers
• cancer

Stages Of COPD

One measure of COPD disease is by stage. The stages are:

Stage 0 – At Risk

Symptoms include coughing and noticeable mucus. You don’t actually have COPD, so treatment isn’t necessarily needed. But do heed the warning. If you smoke, stop now. It would be wise to reassess your diet and exercise routines to improve overall health. Once you have COPD, it’s not reversible or curable.

Stage 1 – Mild

At this stage, some people still don’t notice symptoms, which may include chronic cough and increased mucus production. If you visit a doctor at this point, chances are you’ll start using a bronchodilator as needed.

Stage 2 – Moderate

Symptoms are becoming more noticeable. In addition to the cough and mucus, you may start to experience shortness of breath. You may need a long-acting bronchodilator.

Stage 3 – Severe

Symptoms become more frequent and you may have occasional flare-ups of severe symptoms. You might find that it’s difficult to function normally. Your doctor may recommend corticosteroids, other medications, or oxygen therapy.

Stage 4 – Very Severe

Symptoms are progressing and it’s harder to complete everyday tasks. Flare-ups can be life-threatening. You may be a candidate for surgical treatment.

Diagnosis Of COPD

The staging as mentioned above is based on the results of a pulmonary function test. Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used.

Specifically, the forced expiratory volume (how much air one can exhale forcibly) in one second (FEV1) of a standard predicted value is measured, based on the individual patient’s physical parameters. The staging of chronic obstructive pulmonary disease by this method is as follows:

• Stage I is FEV1 of equal or more than 80% of the predicted value
• Stage II is FEV1 of 50% to 79% of the predicted value
• Stage III is FEV1 of 30% to 49% of the predicted value
• Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure

The clinician will take a history of the patient emphasising on:

• Symptoms suggesting COPD and how these affect your life
• Hospitalizations, particularly ones for breathing problems
• Smoking and home/work exposure history
• Family history of lung disease
• Other medical conditions, particularly asthma, sinus disease, sleep apnea, lung infections, cancer, heart disease, anxiety/depression, osteoporosis (thin bones) and muscle disease

You should have a physical examination focused on the heart and lungs. The examination is often normal unless COPD is severe.

You should have spirometry (breathing tests) performed to measure lung function. COPD can’t be diagnosed without them.

Other tests that may help in diagnose or treat COPD include:

• A chest X-ray
• Oxygen level, measured by pulse oximetry (finger or ear probe) or by a blood sample
• A blood test for Alpha-1, an inherited form of COPD
• Additional breathing tests
• Exercise testing. The most common test measures how far you can walk in 6 minutes.

Treatment For COPD

Lifestyle Changes

Certain lifestyle changes may also help alleviate your symptoms or provide relief. These include:

• If you smoke, quit. Your doctor can recommend appropriate products or support services.
• Whenever possible, avoid secondhand smoke and chemical fumes.
• Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
• Talk to your doctor about how much exercise is safe for you.

Oxygen Therapy

If your blood oxygen levels are low, you can receive oxygen through a mask or nasal prongs to help you breathe better. A portable unit can make it easier to get around.

Oral Medications to Quit Smoking (Smoking Cessation)

Varenicline (Chantix) is an oral medication that is prescribed to promote cessation of smoking. This is also an alternative to try to quit smoking.

Bupropion (Zyban) is an antidepressant that helps reduce symptoms of nicotine withdrawal.

Some medications are used “off label” (that is, they are normally prescribed for another condition) to help people quit smoking. These drugs are recommended by the Agency for Healthcare Research and Quality to help smokers kick the habit, but have not been approved by the FDA for this use. These medications include nortriptyline (Pamelor), an older type of antidepressant. It’s been found to help smokers double their chances of quitting compared to taking no medicine. Another drug used off label is clonidine (Catapres). Normally used to treat high blood pressure it can help smokers quit.

Medications For COPD

Bronchodilators

Bronchodilators are used for COPD treatment because they open up the airway tubes and allow air to more freely pass in and out of the lung tissue. There are both short-term (several hours) and long-term (12 or more hours) types of bronchodilators.

Examples of short-term bronchodilators

• albuterol (Ventolin, Proventil)
• metaproterenol (Alupent)/li>
• levalbuterol (Xopenex)
• pirbuterol (Maxair)

Examples of long-term bronchodilators

• salmeterol (Serevent)
• formoterol (Foradil)
• arformoterol (Brovana)
• indacaterol (Arcapta)

Anticholinergicbronchodilators

• ipratropium (Atrovent)
• tiotropium (Spiriva)
• aclidinium (Tudorza)

Other bronchodilators such as theophylline (Elixophyllin, Theo-24) are occasionally used, but are not favored because of unwanted side effects including anxiety, tremors, seizures, and arrhythmias.

Also on the market are combined to drugs using steroids and long-acting bronchodilators. Roflumilast (Daxas, Daliresp) is a new drug that inhibits the enzyme phosphodiesterase type 4, has been utilized in patients with symptoms of chronic bronchitis.

Corticosteroids

Sometimes bronchodilators are combined with inhaled glucocorticosteroids. Using the two together can reduce inflammation in the airways and lower mucus production. Corticosteroids are also available in pill form.

Phosphodiesterase-4 inhibitors

This newer medication in pill form reduces inflammation and changes mucus production. It’s generally prescribed for severe COPD.

Theophylline

This medicine eases chest tightness and shortness of breath. It may help prevent flare-ups. It’s available in pill form.

Antibiotics and antivirals

Antibiotics or antivirals may be prescribed when you develop respiratory infections.

Surgical Treatments

Surgery may not be available or desirable for many people with COPD.

• Bullectomy surgeryis the removal of giant bullae. Air-filled spaces usually located in the lung periphery that occupy lung space most often in people with emphysema are termed bullae. Giant bullae may occupy over 33% of the lung tissue, compress adjacent lung tissue, and reduce blood flow and ventilation to healthy tissue. Surgical removal can allow compressed lung tissue that is still functional to expand.
• Lung volume reduction surgery is removal of lung tissue that has been most damaged by tobacco smoking, usually the 20% to 30% of lung tissue located in the upper part of each lung. This procedure is not done often; it is usually done on people who have severe emphysema and marked hyperinflation of the airways and air spaces.
• Lung transplantation is surgical therapy for people with advanced lung disease. People with COPD are the largest single category of people who undergo lung transplantation. In general, these people with COPD usually are at COPD stage three or four with severe symptoms and generally, without transplantation, have a life expectancy of about two years or less.

Home Remedies for COPD include:

• Vitamin E to improve lung function
• Omega-3 fatty acids to decrease inflammation (found in supplements or foods such as salmon, herring, mackerel, sardines, soybeans, canola oil)
• Antioxidants to reduce inflammation (found in kale, tomatoes, broccoli, green tea, red grapes)
• Breathing techniques relaxation therapy, meditation
• Acupuncture COPD symptom reduction by needle placement

Other supplementary therapies such as treatment with antibiotics to reduce pathogen (viral, fungal, bacterial) damage to lung tissue, mucolytic agents to help unblock mucus-clogged airways, or oxygenation therapies to increase the available oxygen to lung tissues may also reduce the symptoms of COPD.

In some people, oxygen therapy will increase his/her life expectancy, and improve the quality of life. This is especially true with people with COPD who have chronically low oxygen levels in the blood. It may also help exercise endurance. Oxygen delivery systems are now easily portable and have reduced in cost in comparison to earlier designs.

Yoga may be another form of beneficial exercise that helps with breathing efficiency and breathing muscle control.