Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, or COPD, is a group of lung diseases that makes it hard for a person to breathe. It is the fourth leading cause of death in the United States and Canada. In COPD, airflow through the airways (bronchial tubes) within the lungs is partially blocked, resulting in difficulty breathing. As the disease progresses, breathing becomes more difficult and it may become difficult to carry out everyday activities. COPD develops over many years (sometimes 10 to 30 years) and is most commonly diagnosed in people over the age of 60.

COPD is a group of lung diseases. The two diseases that generally are associated with COPD are chronic bronchitis and emphysema. Although a person with COPD sometimes can have either chronic bronchitis or emphysema, he or she often has a mixture of the symptoms of both diseases. COPD is most often caused by smoking cigarettes. Nearly all people with COPD (80% to 90%) have a history of significant cigarette use and research supports the fact that smoking cigarettes clearly increases the risk of developing COPD. Other lung irritants that are inhaled over a long period of time, such as industrial dust and chemical fumes, are also believed to cause COPD. Some people may be more susceptible to developing COPD than others. This is also believed to be because of genetic factors.

Both chronic bronchitis and emphysema affect the lungs and how well you can breathe. In people with chronic bronchitis, tobacco smoke and other lung irritants over time can lead to inflammation in the airways (bronchial tubes) that deliver air deep into the lungs. As a result, the airways produce more mucus than they would normally. Inflammation and excess mucus reduce air flow and cause coughing. Long-term (chronic) mucus production and inflammation over many years may lead to progressive and permanent lung damage. Inflammation, scarring, and the excess mucus make the airways smaller. It is more difficult to move air quickly through a small tube than a large tube. The extra effort of breathing through a smaller airway can make a person feel short of breath. Almost all people with chronic bronchitis are, or have been, tobacco smokers. Frequent lung infections, especially in a person who smokes, may lead to more rapid development of chronic bronchitis than might occur otherwise.

In emphysema, tobacco smoke and other irritants can damage the elastic fibers that are an important part of the lung's structure. This damage causes the tiny air sacs (alveoli) at the end of the airways to be damaged. These air sacs are where the blood exchanges carbon dioxide for oxygen. When air sacs are damaged or destroyed, their walls break down and the sacs become larger. These large air sacs move less oxygen into the blood, which can leave the person feeling short of breath. Once air sacs are destroyed, they cannot be replaced. Also, when elastic fibers are destroyed, the smaller airways (bronchioles) tend to collapse when a person breathes out, trapping air in the tiny air sacs (alveoli). As a result, oxygen-rich air has difficulty entering the air sacs and the bloodstream which makes it more difficult to move air into the lungs.

The symptoms of COPD you experience depend on whether your COPD is mainly chronic bronchitis or emphysema. If you have the chronic bronchitis component of COPD, you usually will first notice a cough that brings up mucus. If you have primarily emphysema, you may not have much cough and may not have symptoms until shortness of breath appears. As COPD progresses, lung function declines. You begin to experience increased shortness of breath during exertion. In severe COPD, you may become out of breath with little or no exertion and find it difficult to perform everyday activities.

You may have times when your shortness of breath may suddenly get much worse, known as COPD exacerbation. These exacerbations can be life-threatening and often lead to hospitalization. COPD exacerbations often occur more frequently, last longer, and are more severe the longer a person has COPD. The symptoms of a COPD exacerbation are a sudden worsening of a person's usual symptoms, including increased shortness of breath and wheezing, and increased cough with or without mucus and a change in the color of the mucus. Fever, insomnia, fatigue, depression, and confusion may also be present. Because a COPD exacerbation can be serious, if you have a sudden worsening in your usual shortness of breath that does not improve after using your medication, have someone take you to the emergency room. Some doctors recommend that certain people with frequent COPD exacerbations keep a supply of antibiotic medication at home to take right away if they develop early signs of bronchitis (increased cough and discolored mucus).

Diagnosis of COPD is determined from a medical history, physical exam, and most importantly lung function tests. Early detection of COPD is very important. The sooner a person quits smoking and avoids other environmental factors that contribute to COPD, the better the chances are of slowing damage to the airways and lungs. There is no cure for COPD. Damage to the airways and lungs cannot be reversed once it has occurred. The focus is on slowing the progression of the disease and relieving symptoms. The best way to slow the disease is to stop smoking. Medications may reduce or relieve your symptoms. If you have severe COPD, a pulmonary rehabilitation program that includes counseling, education, exercise, breathing exercises, and nutrition may also help reduce your symptoms. Oxygen therapy may be needed when oxygen levels in the blood are low.

Call your doctor immediately if you have been diagnosed with chronic obstructive pulmonary disease and you:

  • Have shortness of breath or wheezing that is rapidly getting worse.
  • Are coughing more deeply or more frequently, especially if the cough brings up green, yellow, or rust-colored sputum (mucus) from your lungs.
  • Cough up blood.
  • Have increased swelling in your legs or abdomen.
  • Have a high fever (over 100 degrees F.
  • Feel severe chest pain.
  • Develop flulike symptoms.

Call your doctor if your symptoms are gradually getting worse and you have not seen a health professional recently. Call your doctor for an appointment if you have not been diagnosed with COPD but are experiencing relevant symptoms. A history of smoking greatly increases the likelihood that symptoms are due to COPD. Talk with your doctor at your next regular appointment about the following if you have COPD:

  • Getting a yearly flu shot and the pneumococcal vaccine every 5 to 6 years
  • Participating in an exercise program or pulmonary rehabilitation
  • Updating your medications or treatment routine
  • Getting help to stop smoking

If you have been diagnosed with COPD, a written plan for taking your medication and for when to see the doctor or go to the emergency room can be very helpful. An older adult who has a history of lung or heart disease should call his or her doctor if shortness of breath becomes worse or if it occurs with fever, discolored sputum (mucus), or chest pain. If you have a cold, it can be treated at home with humidity, cough suppressants, aspirin or acetaminophen (Tylenol), lots of fluids, and rest. However, a doctor should be called if a fever lasts longer than 2 to 3 days, breathlessness occurs or becomes noticeably worse, or a cough worsens or lasts for longer than 7 to 10 days.