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Chronic obstructive pulmonary disease (COPD)

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Overview

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that leads to a blockage of airflow from the lungs. It commonly arises from two conditions: emphysema and chronic bronchitis. When diagnosed with COPD, it implies that the patient exhibits symptoms or has both of these damaging lung conditions. As COPD progresses, breathing can become increasingly challenging.

  • Chronic bronchitis: This is an inflammation of the bronchial tubes’ lining, which transports air to and from the lungs’ air sacs (alveoli). When triggered, the tubes undergo swelling, leading to the accumulation of mucus (commonly known as “phlegm” or “snot”) along the inner lining. This build-up constricts the opening of the tubes, resulting in difficulty in both inhaling and exhaling air from the lungs. Daily coughing and mucus (sputum) production are its main symptoms.
  • Emphysema: Emphysema is a condition where the alveoli at the end of the tiniest air channels (bronchioles) of the lungs are destroyed as a result of harmful exposure to cigarette smoke and other irritating chemicals and particulate matter.

The air sacs are essential for transporting carbon dioxide out and oxygen into the circulation. Emphysema damage obliterates the air sac walls, making it challenging to take a full breath.

Heart disease, lung cancer, and a number of other diseases are more likely to occur in people with COPD.

COPD, while being a chronic and progressive disease, is manageable with appropriate treatment. Patients with COPD can achieve effective symptom control, experience an improved quality of life, and reduce the risk of developing other associated medical conditions through proper care.

Symptoms

The symptoms of COPD often go unnoticed until significant damage to the lungs has occurred, and they tend to worsen gradually, particularly in cases of ongoing exposure to smoking.

COPD signs and symptoms may include:

  • Persistent cough that occasionally produces sputum that may be clear, white, yellow, or greenish in color.
  • Problem taking deep breaths.
  • Breathing difficulties, particularly when exercising.
  • Wheezing
  • Chest tightness
  • Frequent respiratory infections
  • Lack of energy
  • Unintentional weight loss.
  • Ankle, foot, or leg swelling

Individuals with COPD are prone to experiencing exacerbations, which are episodes characterized by a worsening of their symptoms that can persist for several days or longer.

When patients with COPD identify early signs and symptoms of exacerbation, it is recommended that they promptly inform their healthcare provider. This allows for potential modifications in treatment or the prescription of different medications to address the symptoms effectively. It is important to note that altering or discontinuing the medication regimen should never be done without prior consultation with a healthcare provider.

In the event that symptoms fail to improve or worsen despite treatment, or if signs of infection such as fever or changes in sputum are observed, it is crucial to seek immediate medical attention.

If an individual experiences difficulty breathing, pronounced cyanosis (bluish lips or nail beds), rapid heartbeat, dizziness, or difficulty maintaining focus, it is imperative to seek emergency medical attention without delay.

Causes

The primary cause of COPD is smoking. People who are exposed to fumes from burning fuel for cooking and heating in inadequately ventilated homes frequently acquire COPD.

Although many smokers with extended smoking histories may experience decreased lung function, only a small percentage of chronic smokers acquire clinically apparent COPD. Smokers can acquire other less typical lung diseases. They may be incorrectly diagnosed with COPD up until a more complete examination is done.

To force air out of the body, the lungs rely on the natural flexibility of the bronchial tubes and air sacs. When patients exhale, some air is retained in the lungs due to the COPD-induced loss of their flexibility and overexpansion.

COPD cause may also include:

  • Smoking and other irritants: The primary cause of lung damage in the vast majority of COPD patients is chronic cigarette smoking. However, given that not all smokers acquire COPD, there may be additional factors at play, such as a genetic predisposition to the condition.

Other irritants that can lead to COPD include air pollution, exposure to dust, smoke, or fumes at work, and cigar, pipe, and secondhand smoke.

  • Alpha-1-antitrypsin (AAT) deficiency: AAT deficiency is a rare inherited disorder that could cause emphysema. A condition that results in low amounts of the protein alpha-1-antitrypsin causes COPD in roughly 1% of patients. AAT is produced in the liver and secreted into the bloodstream in order to help in protecting the lungs. A lack of alpha-1-antitrypsin can result in lung, liver, or both types of diseases. Adults with COPD related to Alpha-1 Antitrypsin (AAT) deficiency are offered treatment options similar to those used for individuals with more prevalent forms of COPD. In some cases, the AAT protein can be replaced to cure the condition and possibly stop additional lung damage.

Risk factors

The following factors increase the risk of COPD:

  • Age: Older people who are more than 65 years old.
  • Gender: Female are more prone to get this condition than men.
  • Smoke exposure: Long-term cigarette smoking is the main risk factor for COPD. The risk increases with the patient’s smoking history and pack count. Smokers who use pipes, cigars, or marijuana, as well as those who are exposed to a lot of secondhand smoke, may also be at risk.
  • Medical condition: A risk factor for developing COPD is a chronic inflammatory airway disease called asthma. The risk of COPD is further increased when smoking is combined with asthma.
  • Occupational exposure: The lungs can get irritated and inflamed from prolonged exposure to chemical fumes, vapors, and dusts at work.
  • Fumes exposure: People in the developing world are more likely to develop COPD if they are exposed to the fumes from burning fuel for cooking and heating in inadequately ventilated buildings.
  • Genetics: Some cases of COPD are brought on by the rare genetic condition known as alpha-1-antitrypsin deficiency. Certain smokers may be more prone to the disease due to other genetic variables.

Diagnosis

A significant number of individuals with COPD may not receive a proper diagnosis until their condition has reached an advanced stage.

To diagnose COPD, healthcare providers will assess the patient’s signs and symptoms, inquire about their medical history and family history, and gather information regarding exposure to lung irritants, notably cigarette smoke. Additionally, the healthcare provider may request a series of tests to aid in the diagnosis.

  • Lung function tests: These examinations check the patient’s ability to breathe in and out as well as their ability to provide the blood with enough oxygen. In order to determine how much air the lungs can contain and how quickly they can expel it, the most frequent test, called spirometry, requires the patient to blow into a big tube that is attached to a small machine. Additional tests comprise the assessment of lung volumes and diffusing capacity, the six-minute walk test, as well as pulse oximetry.
  • Chest X-ray: Emphysema, one of the main causes of COPD, can be seen on a chest X-ray. Additionally, an X-ray can rule out heart failure or any lung issues.
  • CT scan: Emphysema can be found on a lung CT scan, which can also help doctors decide whether or not you need COPD surgery. Lung cancer screening can also be done with CT scans.
  • Arterial blood gas analysis: This blood test evaluates how well the lungs remove carbon dioxide from the blood and deliver oxygen to it.
  • Laboratory tests: Although lab tests aren’t utilized to diagnose COPD, they can be used to identify the symptom’s underlying cause or rule out other diseases. The genetic condition alpha-1-antitrypsin deficiency, which in some cases may be the cause of COPD, can be detected via laboratory tests, for instance, to see if the patient has it. If COPD runs in the family or if the person develops the disease at a young age, this test might be conducted.

Stages

COPD may progressively worsen. It varies from person to person how quickly it goes from mild to severe.

  • Stage 1 (Mild or early stage): When doing simple workouts like walking up stairs, the first indicator of COPD is frequently feeling out of breath. Many people don’t know they have COPD because it’s simple to attribute this symptom to becoming older or being out of shape.
  • Stage 2-3 (Moderate to severe): The more severe the COPD, the more obvious shortness of breath is. Even during routine activities, a patient may experience shortness of breath. Higher stages of COPD are also more likely to encounter exacerbations, which are episodes in which a person experiences more phlegm, phlegm that is discolored, and more shortness of breath. Infections of the lungs, such as pneumonia and bronchitis, also become more likely in the patient.
  • Stage 4 (Severe): Almost anything the patient do can make them feel out of breath if their COPD is severe. The movement is so limited. A portable tank of oxygen can be required for the patient.

Treatment

Effective treatments for COPD can effectively manage symptoms, minimize the progression of the disease, reduce the likelihood of complications and exacerbations, and improve the overall quality of life, even in advanced stages of the condition. It is worth noting that while quitting smoking is a crucial step in managing COPD, many patients with milder forms of the disease may not require additional treatment.

  • Quit smoking: Stopping up all smoking is the most important step in any COPD treatment plan. Ceasing smoking can prevent COPD from worsening and help in preserving your lung function, thereby reducing the decline in your ability to breathe. It’s not easy to stop smoking.

Consult your healthcare physician regarding medications and nicotine replacement therapies, and seek their advice on relapse prevention strategies. They may also recommend joining a support group specifically designed for individuals who want to quit smoking. Furthermore, it is important to minimize exposure to secondhand smoke and avoid environments with poor air quality, characterized by dust, smoke, gases, and unpleasant odors. Taking these measures can greatly contribute to managing COPD effectively.

  • Medications: The signs, symptoms, and problems of COPD are managed with a variety of medications. Some medications may be taken routinely by the patient and others only when necessary.
    • Bronchodilators: The medications known as bronchodilators, which typically come in inhalers, relax the muscles surrounding the airways. This can facilitate easier breathing by reducing coughing and shortness of breath. The patient may require a short-acting bronchodilator before activities, a long-acting bronchodilator that may be used every day, or both, depending on the severity of the condition.
      • Short-acting bronchodilators include levalbuterol, ipratropium, and albuterol.
      • Long-acting bronchodilators includes Aclidinium, Arformoterol, Formoterol, Indacaterol, Tiotropium, Salmeterol, and Umeclidinium.
    • Inhaled steroid: Corticosteroids that are inhaled can lessen airway irritation and assist in preventing exacerbations. Hoarseness, oral infections, and bruising are possible side effects. For those whose COPD frequently worsens, these drugs can be helpful. Examples of inhaled steroid include Fluticasone, and Budesonide.
    • Combination inhalers: Inhaled steroids and bronchodilators are both components of several medicines. Formoterol and budesonide (Symbicort), fluticasone and vilanterol (Breo Ellipta), fluticasone, umeclidinium and vilanterol (Trelegy Ellipta), and salmeterol and fluticasone (Advair HFA, AirDuo Digihaler, among others) are some examples of these combination inhalers.

There are also combination inhalers that include many types of bronchodilators. Formoterol and glycopyrrolate (Bevespi Aerosphere), glycopyrrolate and indacaterol (Utibron), olodaterol and tiotropium (Stiolto Respimat), and umeclidinium and vilanterol (Anoro Ellipta) are a few examples of these.

    • Oral steroids: Short courses (for instance, five days) of oral corticosteroids may help persons with moderate or severe acute exacerbations of COPD avoid further deterioration of their condition. On the other hand, prolonged use of these drugs may cause major adverse effects include weight gain, diabetes, osteoporosis, cataracts, and an elevated risk of infection.
    • Phosphodiesterase-4 inhibitors: Roflumilast, a phosphodiesterase-4 inhibitor, is a medication authorized for adults with severe COPD and symptoms of chronic bronchitis. This medication relaxes airway and reduces airway inflammation.
    • Theophylline: Theophylline, a less expensive medicine, may assist improve breathing and prevent episodes of worsening COPD when other treatments have proven ineffective.
    • Antibiotics: Infections of the respiratory system, such as influenza, pneumonia, and acute bronchitis, can make COPD symptoms worse. Although they are often not advised for prevention, antibiotics assist in the treatment of episodes of COPD that are getting worse. Azithromycin (Zithromax), according to some studies, prevents episodes of COPD worsening, however its usage may be constrained by side effects and antibiotic resistance.
  • Lung therapies: For patients with moderate to severe COPD, healthcare provider frequently employ these additional treatments.
    • Oxygen therapy: They could require supplemental oxygen if the blood doesn’t contain enough oxygen. They can take light, portable units with them to carry around as well as other equipment to supply oxygen to the lungs.

Certain individuals with COPD utilize oxygen solely during specific activities or while sleeping. Others regularly utilize oxygen. Only oxygen therapy has been shown to extend life and can enhance quality of life in COPD patients.

    • Rehabilitation program (pulmonary): These programs typically include counseling, education, fitness instruction, and nutrition recommendations. They will collaborate with a range of experts, and they can modify the rehabilitation program to suit the needs.

After episodes of COPD worsening, pulmonary rehabilitation may lower the need for readmission to the hospital, boost one’s capacity for daily tasks, and enhance one’s quality of life.

    • In-home noninvasive ventilation therapy: Bilevel positive airway pressure (BiPAP), for example, is supported by evidence when used in hospitals, but some new study suggests that using it at home can also be beneficial. Improved breathing is made possible with a noninvasive ventilation therapy system with a mask, which also reduces carbon dioxide retention (hypercapnia), which can cause acute respiratory failure and hospitalization.
    • Managing exacerbations: The patient may occasionally encounter episodes where symptoms worsen for days or weeks even while receiving continuing treatment. This is known as an acute exacerbation and could cause lung failure if they don’t get immediate medical attention.

A respiratory infection, air pollution, or other inflammatory stimuli may be the cause of exacerbations. Regardless of the cause, it’s critical to seek immediate medical attention if they experience a continuous increase in coughing, a change in their mucus, or difficulty breathing.

Exacerbations may require the patient to take additional medications (such as antibiotics, steroids, or both), supplemental oxygen, or hospital treatment. Once the patient’s symptoms have improved, the healthcare provider can discuss ways to prevent relapses, such as stopping smoking, using long-acting bronchodilators, inhaled steroids, or other drugs; obtaining an annual flu shot; and avoiding air pollution wherever feasible.

  • Surgery: When medication alone is insufficient to treat some forms of severe emphysema, surgery may be an alternative. the following surgical options:
    • Lung volume reduction surgery: Small wedges of damaged upper lung tissue are cut out during this procedure by the surgeon. As a result, the chest cavity is given greater room, allowing the diaphragm to function more effectively and the remaining, healthier lung tissue to expand. This operation may increase quality of life and lengthen survival in some patients.

The U.S. Food and Drug Administration recently approved the minimally invasive method endoscopic lung volume reduction to treat COPD. In order to give the healthy portion of the lung more room to grow and function, a tiny one-way endobronchial valve is implanted into the lung, allowing the more damaged lobe to shrink.

    • Bullectomy: When the alveolar walls are damaged, large air pockets (called bullae) develop in the lungs. Breathing issues may result from these bullae as they grow in size. For the purpose of enhancing airflow, surgeons perform bullectomy on the lungs.
    • Lung transplant: A lung transplant may be an option for some patients who meet certain requirements. Breathing abilities can be enhanced by transplantation. However, patients will need to take lifetime immune-suppressing drugs, and the operation carries a number of risks, such as organ rejection.

Doctors who treat this condition

Diseases & Conditions Chronic obstructive pulmonary disease (COPD)