Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive lung diseases. The most common are emphysema and chronic bronchitis. Many people with COPD have both of these conditions. Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow. Bronchitis causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up.
The top cause of COPD is tobacco smoking. Long-term exposure to chemical irritants can also lead to COPD. It’s a disease that usually takes a long time to develop. Diagnosis usually involves imaging tests, blood tests, and lung function tests.
There’s no cure for COPD, but treatment can help ease symptoms, lower the chance of complications, and generally improve quality of life. Medications, supplemental oxygen therapy, and surgery are some forms of treatment. Untreated, COPD can lead to a faster progression of disease, heart problems, and worsening respiratory infections.
COPD makes it harder to breathe. Symptoms may be mild at first, beginning with intermittent coughing and shortness of breath. As it progresses, symptoms can become more constant to where it can become increasingly difficult to breathe.
You may experience wheezing and tightness in the chest or have excess sputum production. Some people with COPD have acute exacerbations, which are flare-ups of severe symptoms.
At first, symptoms of COPD can be quite mild. You might mistake them for a cold.
Early symptoms include:
- occasional shortness of breath, especially after exercise
- mild but recurrent cough
- needing to clear your throat often, especially first thing in the morning
You might start making subtle changes, such as avoiding stairs and skipping physical activities.
Symptoms can get progressively worse and harder to ignore. As the lungs become more damaged, you may experience:
- shortness of breath, after even mild exercise such as walking up a flight of stairs
- wheezing, which is a type of higher pitched noisy breathing, especially during exhalations
- chest tightness
- chronic cough, with or without mucus
- need to clear mucus from your lungs every day
- frequent colds, flu, or other respiratory infections
- lack of energy
In later stages of COPD, symptoms may also include:
- fatigue
- swelling of the feet, ankles, or legs
- weight loss
Immediate medical care is needed if:
- you have bluish or gray fingernails or lips, as this indicates low oxygen levels in your blood
- you have trouble catching your breath or cannot talk
- you feel confused, muddled, or faint
- your heart is racing
Symptoms are likely to be much worse if you currently smoke or are regularly exposed to secondhand smoke.
In developed countries like the United States, the single biggest cause of COPD is cigarette smoking. About 90 percent of people who have COPD are smokers or former smokers.
Among long-time smokers, 20 to 30 percent develop COPD. Many others develop lung conditions or have reduced lung function.
Most people with COPD are at least 40 years old and have at least some history of smoking. The longer and more tobacco products you smoke, the greater your risk of COPD is. In addition to cigarette smoke, cigar smoke, pipe smoke, and secondhand smoke can cause COPD.
Your risk of COPD is even greater if you have asthma and smoke.
You can also develop COPD if you’re exposed to chemicals and fumes in the workplace. Long-term exposure to air pollution and inhaling dust can also cause COPD.
In developing countries, along with tobacco smoke, homes are often poorly ventilated, forcing families to breathe fumes from burning fuel used for cooking and heating.
There may be a genetic predisposition to developing COPD. Up to an estimated 5 percent of people with COPD have a deficiency in a protein called alpha-1-antitrypsin. This deficiency causes the lungs to deteriorate and also can affect the liver. There may be other associated genetic factors at play as well.
Treatment can ease symptoms, prevent complications, and generally slow disease progression. Your healthcare team may include a lung specialist (pulmonologist) and physical and respiratory therapists.
Medication
Bronchodilators are medications that help relax the muscles of the airways, widening the airways so you can breathe easier. They’re usually taken through an inhaler or a nebulizer. Glucocorticosteroids can be added to reduce inflammation in the airways.
To lower risk of other respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, and a tetanus booster that includes protection from pertussis (whooping cough).
Oxygen therapy
If your blood oxygen level is too low, you can receive supplemental oxygen through a mask or nasal cannula to help you breathe better. A portable unit can make it easier to get around.
Surgery
Surgery is reserved for severe COPD or when other treatments have failed, which is more likely when you have a form of severe emphysema.
One type of surgery is called bullectomy. During this procedure, surgeons remove large, abnormal air spaces (bullae) from the lungs.
Another is lung volume reduction surgery, which removes damaged upper lung tissue.
Lung transplantation is an option in some cases.
Lifestyle changes
Certain lifestyle changes may also help alleviate your symptoms or provide relief.
- If you smoke, quit. Your doctor can recommend appropriate products or support services.
- Whenever possible, avoid secondhand smoke and chemical fumes.
- Get the nutrition your body needs. Work with your doctor or dietician to create a healthy eating plan.
- Talk to your doctor about how much exercise is safe for you.
There’s no specific diet for COPD, but a healthy diet is important for maintaining overall health. The stronger you are, the more able you’ll be to prevent complications and other health problems.
Choose a variety of nutritious foods from these groups:
- vegetables
- fruits
- grains
- protein
- dairy
Drink plenty of fluids. Drinking at least six to eight 8-ounce glasses of noncaffeinated liquids a day can help keep mucus thinner. This may make the mucus easier to cough out.
Limit caffeinated beverages because they can interfere with medications. If you have heart problems, you may need to drink less, so talk to your doctor.
Go easy on the salt. It causes the body to retain water, which can strain breathing.
Maintaining a healthy weight is important. It takes more energy to breathe when you have COPD, so you might need to take in more calories. But if you’re overweight, your lungs and heart may have to work harder.
If you’re underweight or frail, even basic body maintenance can become difficult. Overall, having COPD weakens your immune system and decreases your ability to fight off infection.
A full stomach makes it harder for your lungs to expand, leaving you short of breath. If that happens, try these remedies:
- Clear your airways about an hour before a meal.
- Take smaller bites of food that you chew slowly before swallowing.
- Swap three meals a day for five or six smaller meals.
- Save fluids until the end so you feel less full during the meal.
One measure of COPD is achieved by spirometry grading. There are different grading systems, and one grading system is part of the GOLD classification. The GOLD classification is used for determining COPD severity and helping to form a prognosis and treatment plan.
There are four GOLD grades based on spirometry testing:
- grade 1: mild
- grade 2: moderate
- grade 3: severe
- grade 4: very severe
This is based on the spirometry test result of your FEV1. This is the amount of air you can breathe out of the lungs in the first one second of a forced expiration. The severity increases as your FEV1 decreases.
The GOLD classification also takes into account your individual symptoms and history of acute exacerbations. Based on this information, your doctor can assign a letter group to you to help define your COPD grade.
As the disease progresses, you’re more susceptible to complications, such as:
- respiratory infections, including common colds, flu, and pneumonia
- heart problems
- high blood pressure in lung arteries (pulmonary hypertension)
- lung cancer
- depression and anxiety
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