An Overview of Chronic Obstructive Pulmonary Disease (COPD)

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Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible inflammatory disease of the lungs that makes it hard to breathe. Common symptoms include a persistent 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 fourth-leading cause of death in the United States, preceded by heart disease, cancer, and accidents. It affects more than 8 million Americans and predominantly occurs in people who are middle-aged or older. However, millions of adults have evidence of impaired lung function, indicating that there is a high probability of underdiagnosis.

Types of Chronic Obstructive Pulmonary Diseases (COPD)
Verywell / Emily Roberts

Effect on the Lungs

COPD is characterized by lung obstruction and a limitation of airflow in the lungs. It is associated with an abnormal inflammatory response of your lungs to noxious stimuli, like cigarette smoke, air pollution, or harsh chemicals.

In COPD, airflow is diminished due to one or more of the following factors:

  • The bronchi (air tubes) and alveoli (air sacs where gas exchange takes place) lose their elasticity and are unable to adequately stretch open when you inhale (breath in).
  • The walls that lie between the alveoli get destroyed, causing enlarged spaces throughout the lungs.
  • 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 generally worsens unless the risk factors (such as smoking) are discontinued. Even then, it is not fully reversible.

Effects of COPD on air tubes and alveoli.

Types

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

  • Emphysema: A disease that results from damage to the alveoli, emphysema is most often caused by smoking. Fewer alveoli are available for oxygen exchange because they become destroyed by inflammation and scarring. The remaining alveoli lose their elasticity, which causes them to trap air with each exhalation. This is similar to a latex balloon that has lost its elasticity and traps air as it collapses.
  • Chronic bronchitis: With chronic bronchitis, your airways become 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 (widened), often as a result of recurrent respiratory infections during your childhood. The inflammation also increases the production of mucus, further clogging your airways.

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, which is 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 characterized by stretches of relative stability, alternating with intermittent exacerbations (worsening).

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 due to co-existing heart problems.

Anxiety and depression are common emotional symptoms of COPD. Treatment aimed at managing mood may be necessary to improve your quality of life and lower your risk of COPD exacerbation.

Causes

Some causes of COPD include exposure to cigarette smoking (whether you smoke yourself or have 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.

Asthma is also a risk factor for COPD.

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.

COPD Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Treatment

With proper treatment, COPD can be controlled. That said, there are factors that influence COPD life expectancy, especially the degree of airway obstruction, the severity of your dyspnea, your exercise tolerance, and your body mass index (BMI).

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 disease.

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.
  • Airway clearance techniques: These are techniques to clear mucus from your airway, including controlled coughing and chest physiotherapy. Other pulmonary hygiene techniques may also be suggested.
  • Pulmonary rehabilitation: Pulmonary rehabilitation involves working with a therapist to optimize control of your breathing and coughing. Pulmonary exercises can increase your ability to tolerate physical activity without becoming short of breath.
  • Oxygen therapy: When symptoms become more severe, supplemental oxygen therapy may be needed. There are many lightweight portable oxygen units that allow people with COPD to live relatively active lives.
  • Lung surgery: Three forms of surgery are typically considered for the treatment of highly advanced COPD: Volume reduction surgery may be used to remove damaged lung tissue. Alternatively, 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 those living with COPD qualify for surgical intervention. While COPD surgery can sometimes improve quality of life, it may not prolong survival, and these major surgical procedures entail a challenging recovery period.

COPD increases your predisposition to lung infections. Because of this, doctors recommend that patients get flu shots and the pneumonia vaccine.

Coping

Living with COPD presents physical, emotional, social, and practical challenges. Working to quit smoking, starting or maintaining an exercise program, and making sure you have a nutritious diet are great places to start and can have a tremendous impact on how you feel.

It is also important to identify signs of depression and anxiety (so that you can start treatment if necessary) and to consider taking steps to reduce your stress levels. Some people with COPD also benefit from reaching out to a support group.

Caregiving

Caring for a loved one with COPD can look different depending on how the disease is impacting someone and what stage they are in. You might offer moral support to encourage smoking cessation, practical support such moving their bedroom to the ground floor for easier access, or even help dealing with end-of-life issues such as pain management, depression, and confusion.

Being a caretaker may be new to you. Add that with the fact that your loved one's needs may change over time, and even as their symptoms wax and wane, and how to help can be a challenging question to answer.

Ask if you can attend doctor's visits so you can hear information firsthand, as well as ask questions of your own. And be sure to ask your loved one what would be most beneficial to them, too.

And don't forget to pay attention to your own self-care so that you can stay healthy and maintain a good quality of life.

Prevention

Although the disease is treatable, it must be emphasized that once you have COPD, the lung damage is irreversible and there is no known cure.

If you don't already have COPD but think you are at risk, the following steps can 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 your doctor says that you are at risk of developing COPD, be sure to get a yearly flu shot.
  • Learn how to improve the air quality in your home.
  • Have regular screening tests, such as 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 developed the condition, see your doctor as soon as possible. The earlier you begin treatment, the better your chances of a good prognosis.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res. 2017;18(1):67. doi:10.1186/s12931-017-0548-3

  2. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease. Updated May 3, 2017.

  3. Cornwell WD, Kim V, Song C, Rogers TJ. Pathogenesis of inflammation and repair in advanced COPD. Semin Respir Crit Care Med. 2010;31(3):257-66. doi:10.1055/s-0030-1254066

  4. National Heart, Lung, and Blood Institute. COPD, Also known as Chronic Obstructive Pulmonary Disease, Emphysema.


  5. American Lung Association. Chronic Obstructive Pulmonary Disease (COPD). Updated December 2017.

  6. InformedHealth. Chronic obstructive pulmonary disease (COPD): Overview. Updated March 14, 2019.

  7. Vijayan VK. Chronic obstructive pulmonary disease. Indian J Med Res. 2013;137(2):251-69.

  8. Burkhardt R, Pankow W. The diagnosis of chronic obstructive pulmonary disease. Dtsch Arztebl Int. 2014;111(49):834-45, quiz 846. doi:10.3238/arztebl.2014.0834

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