Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a term used to describe a group of conditions that affect the lungs and cause difficulty breathing. The two main conditions that make up COPD are chronic bronchitis and emphysema. These conditions cause shortness of breath, coughing and wheezing.

COPD, which is usually caused by smoking, is a serious disease and a major cause of death across the world. The symptoms of COPD generally get worse over time. However, there are medications and lifestyle changes that can help slow the progression of the disease and reduce the symptoms.

Causes and risk factors

Smoking

By far the biggest risk factor for developing COPD is being a smoker or having a history of smoking. Smoking can irritate the lungs and lead to airway inflammation. Over many years, this inflammation can cause irreversible damage to the lungs, which makes it progressively more difficult to breathe.

Alpha-1 antitrypsin deficiency (ATT)

Alpha-1 antitrypsin is a protein that is normally found in the blood of healthy people. It plays an important role in protecting your lungs from damage. Some people have a genetic disorder that results in their body producing very small amounts of alpha-1 antitrypsin, which makes the lungs more prone to injury and eventually leads to COPD.

Other factors

Breathing in other substances that irritate and inflame the lungs can also cause COPD. People who live and/or work in areas for many years where there are high levels of air pollution are at greater risk of developing COPD.

Types

The two main forms of COPD are chronic bronchitis and emphysema. These two conditions can occur separately or together.

Chronic bronchitis

Chronic bronchitis is a long-term condition that occurs when the lining of the large airways, called bronchi, become inflamed and swollen in response to irritants. This causes the airways to narrow and makes it more difficult to breathe. It also causes the airways to produce more mucus than usual, which can further block the airways.

Emphysema

Emphysema is a condition in which the air sacs in the lungs, called alveoli, are damaged due to inflammation from irritants. In a healthy lung, these air sacs allow oxygen in the air to be transferred into the blood. In emphysema, there is a progressive decline in the number of air sacs, which then limits the amount of oxygen entering the blood. Furthermore, with increasing damage to the air sacs, the natural elasticity of the lungs is lost, which makes it more difficult to breathe.

COPD causes damage to the airways and alveoli of the lungs. 

Signs and symptoms

The main symptom of COPD is shortness of breath, particularly with minimal exertion. In severe cases, it can occur even when resting. You may also experience the following:

• Coughing;
• Sputum or mucus production;
• Tightness in the chest, and;
• Wheezing.

In the advanced stages of the disease, the symptoms can also include tiredness and weight loss.

People with COPD may sometimes experience periods where their symptoms flare up and become worse than usual. Flare-ups, which are also known as exacerbations, can often lead to serious complications and some people may need hospital treatment.

COPD can cause wheezing, coughing and tightness in the chest. 

Methods for diagnosis

To assess if you have COPD, your doctor will generally take a thorough medical history, including current or previous cigarette-smoking habits. It is also routine to have a physical exam of your lungs and heart.

The most common test used to diagnose COPD and its severity is called spirometry. This measures your lung function by assessing how much air you can breathe in and out, and how forcibly you can exhale.

Your doctor may also recommend some other tests, such as an X-ray or computerised tomography (CT) scan of your chest to look for signs of damage to your lungs, or a blood test to measure how much oxygen is in your blood.

Types of treatment

There are lifestyle changes and medications that can help manage the condition:

Smoking cessation

Quitting smoking is the most important action you can take if you have COPD. Lung function naturally declines as you get older, but smoking can make this happen much faster. Even though you may not be able to undo the lung damage, preventing further damage from smoking can stop the condition from getting worse.

Quitting smoking is the most important action for managing COPD. 

Self care

There are several other things a person with COPD can do to help manage their symptoms and prevent their condition from getting worse. These include:

• Avoiding second-hand cigarette smoke;
• Avoiding breathing in dust and fumes;
• Getting flu vaccinations annually and pneumococcal vaccinations every five years, and;
• Physical activity.

Medication

There are several types of medication available to help people with COPD manage their symptoms and reduce how often they get flare-ups.

Bronchodilators

Bronchodilators are medications that may help to relieve some of the symptoms of COPD, such as wheezing and shortness of breath. These medications are usually inhaled and work by relaxing the muscles around the airways, which helps the airways to open up. Common bronchodilators used to treat COPD include:

• Short-acting beta-2 agonists, such as salbutamol or terbutaline;
• Short-acting anticholinergics, such as ipratropium bromide;
• Long-acting beta-2 agonists, such as eformoterol or salmeterol, and;
• Long-acting anticholinergics, such as tiotropium bromide.

Corticosteroids

Inhaled corticosteroids, such as budesonide or beclomethasone, are sometimes used to help reduce lung inflammation and treat exacerbations. Sometimes a treatment plan for COPD can include the use of bronchodilators and corticosteroids. This is sometimes referred to as combination therapy.

Oral corticosteroids may be needed for short periods, especially during exacerbations where inhalers can be less effective.

Pulmonary rehabilitation

Pulmonary rehabilitation is a program that is used together with medication to help manage COPD, and often forms an important part of management of this condition. It can involve education about the disease and how it is managed, exercise training and breathing techniques to assist with control of symptoms.

Oxygen therapy

Some people with COPD may need to have oxygen therapy if they have low levels of oxygen in their blood. This can be carried out at home with a small machine that concentrates oxygen from normal air, or a gas cylinder that contains oxygen. Oxygen therapy can help to restore your oxygen levels back to normal to avoid any complications. How long you need to spend on oxygen therapy can differ from person to person and depends on how severe your condition is. It is usually not possible to receive oxygen therapy while you are a smoker.

Surgery

Surgery is rarely indicated for COPD. Some people with COPD may need to undergo lung reduction surgery to remove diseased parts of their lung.

Potential complications

People with COPD have a higher risk of developing numerous complications including:

• Exacerbations - a flare-up of symptoms is common and usually mild if managed well. However, some exacerbations can be severe and potentially life-threatening, needing intensive care management;
• Pneumonia - there is an increased risk of developing pneumonia, which is generally more severe and much more difficult to treat, compared to healthy individuals with it;
• Pneumothorax - some individuals with COPD can develop large air pockets in the lung (known as bullae), which can spontaneously rupture, causing the lung to collapse;
• Heart failure - there is increased strain on the heart due to comparably lower oxygen levels and fewer capillaries in the chronically damaged lungs. This can predispose a person with COPD to heart failure in the future;
• Lung cancer - COPD is strongly associated with an increased risk of developing lung cancer; however, this is often explained by a significant smoking history, and;
• Potential death - COPD is one of the leading causes of death in Australia.

Prognosis

COPD is a major cause of death across the world. There is currently no cure for the condition and there is no way to reverse lung damage that has already occurred. As the disease progresses, the symptoms can get worse and breathing can become more difficult, making it hard to do daily activities.

Prevention

The best way to prevent developing COPD is to not smoke. The risk of developing COPD may also be reduced by avoiding second-hand smoke and exposure to air pollution and dusty or smoky environments.