A Guide to COPD: What Is Chronic Obstructive Pulmonary Disease? 

Medically Reviewed by Dr. Samantha Miller

Photo Courtesy: Robina Weermeijer/Unsplash

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory condition of the lungs. As a progressive condition, COPD worsens over time, making it difficult to breathe. Often, COPD is accompanied by a cough, wheezing, shortness of breath, and/or chest tightness. 

According to the World Health Organization, over 250 million people worldwide have COPD — with 65 million having moderate to severe COPD. More than 90% of deaths from COPD occur in low- and middle-income countries, where strategies for prevention and control are often lacking. 

It is also one of the most common forms of lung disease in the United States, causing more than 150,000 deaths in 2018, making it the third leading disease-related cause of death. Although COPD impacts people of all genders, at one time COPD was most common in men. But due to an increased use of tobacco products and a higher risk of exposure to indoor air pollution — such as fuels used for cooking and heating — in low-income countries, the disease now affects men and women almost equally.

As mentioned above, COPD is characterized by breathing problems caused by blockage and constriction of the airways. COPD causes the lungs to lose their natural elasticity, which impairs the ability to inhale and exhale fully. Three of the most common subtypes of COPD are emphysema, chronic bronchitis, and serious cases of asthma. Often, an affected individual will have a combination of these subtypes.

  • Emphysema arises when the alveoli (air sacs) at the end of the smallest air passages (called the bronchioles) of the lungs are damaged by exposure to cigarette smoke or other irritating gases and particulate matter (such as air pollution). This damage prevents the exchange of air and CO2 in the lungs, leading to shortness of breath and the struggle for oxygen.
  • Chronic bronchitis is an inflammation of the bronchial tubes that carry air to and from the alveoli of the lungs. It is characterized by daily cough and mucus production. 
  • Serious cases of asthma also involve chronic inflammation and narrowing of the airway due to excess mucus production.

Risk Factors & Causes

Although there is no cure for COPD, it can often be prevented. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke; however, about one quarter of people with COPD have never smoked. Exposure over a long time to other lung irritants such as air pollution or dust can also cause COPD. Moreover, a rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease in about 1% of people with COPD. 

In addition to smoking cigarettes and having AAT, other specific risk factors for the illness include the following:

  • Inhaling secondhand smoke
  • Environmental air pollution
  • Indoor air pollution, such as wet paint or fumes emitted by industrial cleaners
  • Occupational fumes, such as vapors, dust, chemicals, and irritants
  • Frequent lower respiratory infections during childhood
  • Family history and genetics

Although you cannot do much about outdoor air pollution, you can improve air quality at home by using an air purifier; wearing a breathing mask when painting or using harsh cleaners; or simply ventilating the area when possible.

Signs & Symptoms

A diagnosis of COPD is confirmed by a test called spirometry, which measures how deeply a person can breathe and how fast air can move into and out of the lungs. Your doctor might order spirometry if you have symptoms of a chronic cough, sputum production, difficult or labored breathing, and a history of exposure to COPD risk factors.

The overarching symptoms of COPD are:

  • Breathlessness, or the need for air
  • Shortness of breath
  • Excess sputum (mucus)
  • Chronic cough
  • Frequent chest infections
  • Fatigue and lack of energy
  • Swelling in the legs, ankles, and feet

Moreover, a person with COPD may use their accessory muscles — muscles other than the diaphragm and chest muscles — to inhale. For example, this may involve straining one’s neck muscles in order to breathe. To this end, a person with COPD might use a “tripod” breathing position while sitting; in this position they will be hunched over with both arms placed in front of the body as support. 

Photo Courtesy: Mockup Graphics/Unsplash

Complications Associated With COPD

If you have COPD, there are some complications to watch out for:

  • Respiratory Infections: Because COPD has already impaired the respiratory system, a person with COPD is at increased risk for other respiratory infections, such as the flu or pneumonia.
  • Lung Cancer: People with COPD have a higher risk of developing lung cancer.
  • Cardiovascular Problems: COPD can cause high blood pressure and put a lot of strain on the heart. The heart tries to compensate for the poor oxygen exchange in the lungs by attempting to pump blood harder throughout the body, which may lead to cardiac failure. The additional stress on the heart can also lead to heart attacks.
  • Depression: The constant struggle for air can greatly decrease the quality of life of affected individuals, as daily activities may become greatly limited. Hence, people with COPD are at a greater risk for depression than healthy individuals.

Treatment

Unfortunately, there is no cure for COPD, but, nonetheless, many forms of treatment can decrease symptoms and improve quality of life. Proper management of the condition can help most people achieve good symptom control and reduce the risk of developing other associated conditions.

The mainstay of COPD treatment is medication. Common forms of medication include:

  • Bronchodilators, which are usually administered via inhaler, help to relax the muscles of the airway so the patient can breathe more easily. These come in short-acting and long-acting forms.
  • Steroids, which reduce inflammation and swelling of the airways, can also improve breathing. 
  • Methylxanthines, such as theophylline, helps to dilate (widen) the airways
  • Mucus-reducing drugs, such as carbocysteine, help to make the mucus more watery and easier to expectorate (cough up).

Other adjuvant therapies may include:

  • Respiratory Physiotherapy: This is a specialized set of exercises usually initially taught by a specialized respiratory physiotherapist to help maintain lung function.
  • Oxygen: In severe cases of COPD where the lungs cannot take in enough oxygen, supplementary oxygen may be required. Oxygen can be used at home, and can be delivered in lightweight, portable units.
  • Surgery: Lung surgery can benefit certain types of COPD sufferers, such as those with emphysema. A lung transplant is another treatment option for the most severe cases. However, be sure to discuss with your doctor about the risk and benefits of receiving surgery before making any decisions.
  • Lifestyle Changes: The most important lifestyle change to make is to stop smoking if you are a smoker. Although exercise might be difficult for those with COPD, talk with your doctor about what types of activity are safe for you. Physical activity can help strengthen the muscles that help you breathe and improve your overall wellness. Also talk to your doctor about an eating plan that will meet your nutritional needs.
  • Vaccinations: Ensure you get an annual flu shot to reduce the risk of flu-associated pneumonia or other infections. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. Ask your doctor about the pneumococcal vaccine, too, as this may also help prevent chest infections.

Although a diagnosis of COPD seems bleak, it has a relatively simple path for prevention. The easiest step? Limit your exposure to secondhand smoke and other air pollution. For folks who are chronic smokers, seek out resources that can support you in giving up the habit. And if inhaling fumes and chemicals is a common occupational hazard for you, talk to your employer about safety measures to protect yourself and decrease your chances of developing COPD. Ultimately, protecting your lungs will serve you well in the long run.

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