COPD (Chronic Obstructive Pulmonary Disease)
COPD is an umbrella term for a group of diseases that cause blockages (obstructions) in your lung’s airways. This makes it hard to breathe in new, fresh air, which in turn gets in the way of everyday activities.
Diseases that fall under the COPD umbrella
- Chronic bronchitis refers to long-term (chronic) swelling and inflammation of the lung’s airways.
- Emphysema is a chronic lung disease that damages the lung’s air sacs (alveoli).
- Refractory (nonreversible) asthma causes chronic asthma symptoms or low lung function despite treatment.
You may only have one of these diseases. However, they often occur together. COPD and the diseases that fall under it are not contagious.
Don't let COPD go untreated
COPD often gets worse over time. While there is no cure, there are treatments that can help you manage your symptoms and make the most of every day.
COPD causes and risk factors
Smoking is the primary cause of COPD
Chronic obstructive pulmonary disease is usually caused by cigarette smoking. Cigarette smoke irritates and damages the fragile, elastic tissue of the airways and alveoli.
The chemicals in cigarette smoke are also toxic to your cells. While not everyone who smokes will develop COPD, your risks are greater the longer you smoke.
Other risk factors
Other risk factors for developing COPD include:
- Asthma causes inflammation of the airways and can increase your risk of developing COPD. Most people with asthma will not develop COPD. However, the combination of cigarette smoking and asthma significantly increases your risk.
- Exposure to tobacco smoke and other products. COPD is usually associated with cigarette smoking, but people who smoke pipes, cigars, and marijuana are also at risk for COPD.
- Exposure to fumes from fuels used for cooking and heating, especially in a poorly ventilated home, can increase your risk for developing COPD.
- Genetics. Alpha-1 antitrypsin deficiency emphysema is caused by genes. Additionally, some people who smoke may have genes that make them more susceptible to developing COPD. These instances remain rare.
Symptoms of COPD
Early on, you may only experience mild COPD symptoms, such as:
- Mild but persistent cough.
- Needing to clear your throat often.
- Occasional shortness of breath, usually after physical activity.
These symptoms may be mistaken as normal parts of aging or as being out of shape. But if you are at risk for COPD, you should talk to your doctor about them.
More severe symptoms
As COPD progresses—and more lung tissue is damaged—you you may experience more severe symptoms:
- Barrel chest: The lungs become chronically over-inflated with air because you’re not able to breathe out effectively. This can give the appearance of a slight barrel chest.
- Chest tightness.
- Chronic cough, with or without phlegm or mucus.
- Clubbing: Your fingertips appear rounded.
- Feeling like you’re not able to get enough air.
- Frequent respiratory infections, like colds, the flu, or pneumonia.
- Ongoing fatigue or lack of energy.
- Pursed-lip breathing.
- Swelling of the feet, legs, or ankles.
- Unintended weight loss.
- Wheezing, a high-pitch whistling sound when you breathe through your nose or mouth
When to seek medical attention
You should seek immediate medical attention if you experience any of the following symptoms:
- You are unable to climb a flight of stairs due to shortness of breath.
- Your lips or fingernails take on a bluish tinge.
- You have trouble talking because you can’t catch your breath.
- Your heart is racing.
- You feel confused or like you might faint.
If you have symptoms of COPD, you should talk to your doctor. Sometimes COPD is not diagnosed until it is advanced because symptoms are easy to dismiss as something else. However, getting an accurate diagnosis early is your first step to preserving as much of your lung function as possible.
Your doctor will start by asking you about:
- Your family history.
- Your medical history.
- Whether or not you smoke, and how often.
- Any other work-related exposures that may be causing your symptoms.
From there, your doctor will perform a physical exam, and listen to your breathing. The way that your lung sounds can provide a clue about the underlying cause of your symptoms.
If your doctor suspects COPD, they may also recommend the following tests:
Your doctor may take a small blood sample to check the level of oxygen and carbon dioxide.
These tests allow your doctor to see inside your body and examine your organs. They include:
- Chest X-ray: An x-ray uses high-energy beams to create a picture of your body. A chest x-ray can show signs of advanced emphysema and can be used to rule out lung cancer or heart problems.
- CT xcan: A CT scanner takes multiple X-ray images to create a cross-sectional view of the body. This can help your doctor see lung damage and diagnose COPD and lung cancer.
Lung function test
This test measures how much air your lungs can hold and how well you can inhale and exhale. Generally, this involves breathing into and out of a machine while following a doctor’s instructions.
Depending on the severity of your results, your doctor might assign a “stage” to the condition. A stage is just a way to talk about how severe the disease is and discuss treatment options:
- Stage 1: Mild symptoms.
- Stage 2: Moderate symptoms.
- Stage 3: Severe symptoms.
- Stage 4: Very severe symptoms. This is sometimes referred to as end-stage COPD, and you may need surgery.
Nonsurgical treatments for COPD
There is no way to cure COPD or reverse the lung damage that has already occurred. However, many nonsurgical treatments can help you manage your COPD symptoms.
These lifestyle changes will not necessarily resolve your symptoms, but they will prevent further damage.
- Quit smoking. If you smoke and are diagnosed with COPD, your first step to treatment is to quit smoking. This will prevent further lung damage and make it easier to breathe.
- Avoid secondhand smoke. Like smoking, continuous exposure to secondhand smoke means continuous damage to your alveoli and bronchial tubes. Avoid places where there may be lots of smoke or other lung irritants.
- Wear the appropriate protective equipment, such as face masks or respirators, while at work.
- Maintain a healthy weight. Carrying excess weight requires your body to use more energy when you breathe. Your doctor may recommend that you lose excess weight to reduce some of your symptoms. Additionally, as COPD progresses, you may inadvertently lose weight. In this case, your doctor may recommend you see a dietician to help you gain weight.
Therapies to treat COPD
- Oxygen therapy. If you have severe COPD, your body may not be getting enough oxygen, and you need additional oxygen. You may only need to use oxygen when performing physical activities, or you may need it all the time.
- Pulmonary rehabilitation. This type of rehabilitation involves learning different breathing techniques and exercises to improve your ability to carry out daily activities.
Medications for COPD
- Anti-inflammatory medications. Airway inflammation caused by COPD can make symptoms like shortness of breath worse. Your doctor may prescribe you an inhaler containing corticosteroids, strong anti-inflammatory medications, to ease symptoms. These may be combined with bronchodilator medications.
- Bronchodilators are medications that relax the muscles in your airways and make it easier for you to breathe. This reduces coughing and shortness of breath. You will use an inhaler to get the medication directly to your lungs. Depending on the severity of your COPD, your doctor may recommend you use the inhaler only as needed or on a regular schedule.
- Oral steroids. Your doctor may prescribe a pill version of the corticosteroids usually available in inhalers. This is usually done to treat severe COPD exacerbation. Usually, the prescription is only for 5 or so days of medication, since long-term use of corticosteroids can cause negative side effects.
- Phosphodiesterase-4 inhibitors. These medications help relax the airways and are used to treat COPD with chronic bronchitis. However, it can come with some uncomfortable side effects, like diarrhea and weight loss.
In addition to the above medications, your doctor may recommend that you get the annual flu vaccine and two doses of a COVID vaccination.
Additionally, if you get pneumonia or another infection, you will need to take antibiotics.
Surgical treatments for COPD
- Lung volume reduction surgery. Your surgeon removes a wedge of damaged lung tissue. This gives the rest of your lungs more space to expand and work more efficiently.
- Endobronchial valve (EBV). This procedure is minimally invasive, meaning you will spend less time on the operating table and in recovery. Your doctor places a small, one-way valve into the bronchial tubes leading to the damaged part of your lung. This causes the damaged part to shrink and gives the healthier parts of your lungs more space to expand.
- Lung transplant. A lung transplant is considered a last resort for emphysema treatment. In this procedure, your damaged lung will be removed and replaced by a lung from a donor. There are many risks associated with a lung transplant, such as rejection. Additionally, the wait times for a lung transplant are usually long, as donors are few and far between.
Complications of COPD
COPD can lead to serious conditions if left untreated.
COPD exacerbation (flare-up). COPD exacerbation happens when your symptoms suddenly get more severe. This can last for anywhere from a few days to a few weeks. As the disease progresses, flare-ups can become more frequent and severe. You may need to take antibiotics, steroid medications, or even be hospitalized due to the severity of your symptoms.
Collapsed lung (pneumothorax). This is rare but serious complication. It happens when air gets into your chest cavity and puts pressure on the lung, causing it to collapse. A collapsed lung can be life-threatening and requires immediate medical attention. If you have a collapsed lung, you may experience sharp chest pain and very sudden shortness of breath.
Heart problems. Having COPD also increases your risk for congestive heart failure and heart damage. This is because your heart has to work so much harder to make up for the low oxygen levels in your blood. You are also at greater risk for atrial fibrillation, a condition in which your heart beats irregularly and increases your risk for blood clots.
Lung cancer. COPD increases your risk of developing lung cancer.
Respiratory infections. If you have COPD, you are more likely to experience colds, the flu, or pneumonia. You are also more likely to experience complications from these infections, like hospitalization and potentially more lung damage. Likewise, you are more likely to experience complications and hospitalization if you get infected with SARS-CoV-19, the virus that causes COVID-19.
Reduced quality of life. COPD makes it hard for you to breathe and engage in normal, physical activities. It can also increase your risk for anxiety and depression. All of these can reduce your quality of life.
Center for Disease Control and Prevention (CDC). Chronic Obstructive Pulmonary Disease (COPD) (https://www.cdc.gov/copd/index.html)
National Heart, Lung, and Blood Institute (NHLBI). COPD – What Is COPD? (https://www.nhlbi.nih.gov/health/copd)
MedlinePlus: National Library of Medicine. COPD (https://medlineplus.gov/copd.html)
National Cancer Institute (NCI). chronic obstructive pulmonary disease (https://www.cancer.gov/publications/dictionaries/cancer-terms/def/chronic-obstructive-pulmonary-disease)