An Overview of Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible inflammatory disease in your lungs that makes it hard to breathe. Common symptoms include a chronic cough, wheezing, production of phlegm, shortness of breath, and a feeling of tightness in your chest, though these symptoms may not be noticeable until you're in the later stages of the disease. COPD is not curable, but it's a preventable and treatable illness. The earlier you start treatment, the better your prognosis.

COPD is the third-leading cause of death in the United States, preceded by only heart disease and cancer. It predominantly occurs in people over 40 years of age and affects more than 11 million Americans. However, millions of adults have evidence of impaired lung function, indicating that there is a high probability of under-diagnosis.

Effect on the Lungs

COPD is characterized by the limitation of airflow that is not fully reversible. This means less air flows in and out of your lungs because of one or more of the following factors:

  • The air tubes and alveoli (air sacs where gas exchange take place) lose their elasticity and are unable to stretch when you breathe.
  • The walls that lie between the alveoli get destroyed, causing an enlarged space.
  • The lining of the air tubes becomes thick and inflamed.
  • The air tubes secrete more mucus than they should, causing them to clog.

Airflow limitation in COPD is progressive, meaning it generally worsens over time. It's associated with an abnormal inflammatory response of your lungs to noxious stimuli, like cigarette smoke, air pollution, or harsh chemicals.

Types

COPD is a term that's used to describe a group of lung diseases including:

  • Emphysema: A disease that results from damage to the alveoli, emphysema is most often caused by smoking. Fewer alveoli are available because they are destroyed by inflammation and scarring, and those that remain become scarred themselves, losing their elasticity and causing air trapping. You can picture this as a balloon that has lost its elasticity yet the air remains even when the balloon collapses (as with exhalation). 
  • Chronic bronchitis: With chronic bronchitis, your airways are chronically inflamed, resulting in scarring and thickening. This process also frequently causes an increased production of mucus, which then fills the airways, further obstructing your breathing.
  • Bronchiectasis: In bronchiectasis, your airways are dilated, which is often caused by recurrent respiratory infections during your childhood. The inflammation also results in the production of mucus, obstructing your airways even more.

Quite often, people with COPD have a combination of these disorders at the same time. It's also possible to have an asthma component with the disease, an important factor when considering treatment.

Symptoms

COPD is often asymptomatic (without symptoms) until significant damage to the lungs has already occurred. It's a progressive disease in which most people have periods where they're relatively stable, alternating with intermittent exacerbations (worsening) of the disease.

Common symptoms may include:

  • Shortness of breath (dyspnea), especially after exertion
  • Persistent, daily cough
  • Sputum production (coughing up phlegm) which can be clear, white, yellow, or green in color
  • Wheezing
  • Fatigue
  • Frequent lung infections
  • Chest tightness
  • Cyanosis (a bluish discoloration of the lips and nail beds)

Additional signs and symptoms that may accompany the more severe stages of the disease include weight loss, loss of appetite (anorexia), and fatigue.

Ankle, foot, or leg swelling may occur as a result of medication side effects or co-existing heart problems.

Anxiety and depression are common emotional symptoms of COPD for which additional treatment may be necessary to improve quality of life and lower the risk of COPD exacerbation.

Causes

Some causes of COPD include exposure to cigarette smoking, whether you smoke yourself or you've been exposed to secondhand smoke; occupational exposure to chemicals; indoor and outdoor air pollution; and, far less often, a genetic disorder called alpha-1-antitrypsin (AAT) deficiency. People with asthma sometimes develop COPD as well.

Diagnosis

To make an accurate diagnosis of chronic obstructive pulmonary disease, a complete history, and physical assessment must be taken. It should start with your healthcare provider asking you questions about your family history, as well as your history of exposure to tobacco smoke and other types of environmental and/or occupational exposures.

Diagnostic tests may include:

There are four stages of COPD: mild, moderate, severe, and very severe. Staging is generally diagnosed in your doctor's office with a spirometry test.

Treatment

COPD is not a death sentence; with proper treatment, it can be controlled. That said, there are factors that influence COPD life expectancy, especially your body mass index (BMI), the degree of airway obstruction, dyspnea levels, and your exercise tolerance.

The best treatment for COPD if you're a smoker is to quit as soon as possible. While this won't reverse the damage you already have, it can help slow the progression of your COPD.

Other treatment options include:

  • Medications: Common COPD medications include inhaled bronchodilators, inhaled corticosteroids, oral steroids, expectorantsphosphodiesterase-4 inhibitors, and antibiotics. Treatment is often broken down into two categories: maintenance medications, which are used daily and continuously whether or not symptoms are present; and rescue medications, which are used when symptoms worsen, such as during exacerbations.
  • Oxygen therapy: When symptoms become more severe, supplemental oxygen therapy may be needed. Thankfully there are now lightweight portable oxygen units that allow many people with COPD to live relatively active lives.
  • Pulmonary rehabilitation: Just like rehabilitation for other ailments, pulmonary rehabilitation can make a big difference for some people living with COPD.
  • Flu shots and pneumonia vaccine: These help prevent infection.
  • Lung surgery: Three forms of surgery may be considered for severe COPD: Volume reduction surgery may be used to remove damaged lung tissue. Your doctor may recommend a bullectomy, which is the removal of enlarged bullae in your lungs. In very severe COPD, lung transplantation may be recommended. Only a small percentage of COPD patients qualify for surgical intervention, however. While it can improve quality of life, it cannot prolong survival.
  • Airway clearance techniques: These are techniques to clear mucus from your airway, including controlled coughing, chest physiotherapy, and using expectorants.

Coping

Living with COPD involves physical, emotional, social, and practical components. You'll need to watch for depression and anxiety, start or maintain an exercise program, work to quit smoking, find support, make sure you have a nutritious diet, communicate with the people in your life, and reduce your stress.

Caregiving

If you're caring for a loved one with COPD, you can help him or her manage symptoms, quit smoking, exercise, maintain a healthy diet, conserve energy, and deal with end-of-life issues such as pain management, depression, and confusion.

Prevention

Although the disease is treatable, it must be emphasized that once you have COPD, the damage is irreversible and there is no known cure. However, it's important to take whatever steps you can to prevent the damage from worsening.

If you don't already have COPD but think you are at risk, the following steps can also help you prevent it from occurring:

  • If you smoke, try to quit ASAP.
  • If you live with someone who smokes, make sure they don't smoke around you. Additionally, no one should ever smoke when a child is present.
  • If you work around hazardous chemicals, dust, or other types of occupational hazards that may irritate your lungs, be sure to wear protective equipment including a mask and gloves.
  • If you are at risk for developing the disease, as determined by your doctor, get a yearly flu shot.
  • Learn how to improve the air quality in your home.
  • Take a spirometry test to improve your chances of early detection.

A Word From Verywell

If you have risk factors for COPD or think you may have it, see your doctor as soon as possible. The earlier you begin treatment, the better your prognosis will likely be. There are things you can do to slow some of the progressive symptoms of COPD, too. The biggest and most effective is to quit smoking. Smoking cessation improves both the survival time and quality of life for people living with COPD. Proper nutrition and daily exercise are also key to living well. With treatment and management of your symptoms, you can live the best life possible.

What COPD Feels Like
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