Chronic Obstructive Pulmonary Disease (COPD)

What is chronic obstructive pulmonary disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a serious lung disease that makes it hard to breathe. It also makes your heart have to work harder. COPD symptoms get worse over time and never completely go away.

There is no cure for COPD, but treatment will help control your symptoms and slow down worsening of the disease.

What is the cause?

COPD happens when your airways are damaged. The airways are the tubes and sacs that carry air in and out of your lungs. The damage is almost always caused by irritation of the lungs over many years. Cigarette smoking is the most common cause of irritation. Other causes are exposure to secondhand smoke, air pollution, chemical fumes, dust, and frequent lung infections.

There are 2 main types of COPD: chronic bronchitis and emphysema.

• In chronic bronchitis, the insides of the airways thicken and swell, making the airways smaller and more easily blocked. Your lungs also have a lot of mucus that blocks air flow, making it hard to breathe.
• In emphysema, the air sacs in the lungs are damaged or destroyed and lose their ability to get bigger and smaller as air moves in and out. This makes it harder for the lungs to get oxygen into your blood when you breathe in. It’s also harder for your lungs to get rid of carbon dioxide when you breathe out.

Many people with COPD have both chronic bronchitis and emphysema.

COPD is not contagious. You cannot give it to someone or get it from someone else.

What are the symptoms?

In the early stages of the disease, you may not have any symptoms even though the lungs are damaged. Early symptoms of COPD may include:

• shortness of breath, trouble breathing
• deep, persistent cough that produces lots of mucus
• thick mucus that is hard to cough up
• wheezing

As COPD gets worse, symptoms may include:

• fast breathing
• skin that looks blue or purple, especially the fingers, toes, and lips
• weight loss
• frequent lung infections
• swelling in the legs, ankles, and feet

How is it diagnosed?

Your healthcare provider will ask about your symptoms, medical history, family history, work history, smoking habits, and exposure to cigarette smoke. Your provider will examine you. You may have the following tests:

• lab tests of mucus to look for bacterial infection and other medical problems that might be the cause of your symptoms
• chest X-ray
• blood tests
• a breathing test called spirometry

When you have the breathing test, you will breathe into a tube to measure how well air moves into and out of your lungs. The test can show how well your lungs are working.

How is it treated?

There is no cure for COPD, but there are treatments that can:

• Help keep the disease from getting worse.
• Relieve symptoms so you can breathe and feel better.
• Help you be more active.
• Treat infections.
• Help prevent complications.

If you are a smoker, the most important part of your treatment is to quit smoking. Talk to your healthcare provider about ways to quit. You might find it helpful to join a quit-smoking program, use nicotine patches or gum, or try one of the prescription medicines that can help you quit.

Your healthcare provider may prescribe one or more of the following medicines:

• Bronchodilator: This medicine relaxes the muscles of the airways. It makes the openings inside the airways bigger, so it’s easier to breathe. Usually you take this medicine by inhaling it (breathing it into your lungs), but it may also be taken as pills or liquid.
• Steroid: Steroid medicine helps keep down the swelling inside your airways. You may need steroids if your symptoms are severe or if you are having symptoms more often. Steroids are usually inhaled, but they may also be taken as a pill.

  Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

• Antibiotic: If you have a bacterial infection, your provider will prescribe an antibiotic.

Your healthcare provider may also recommend:

• regular exercise, such as walking or riding a stationary bicycle
• breathing exercises
• a humidifier to add moisture to the air
• changes in your work environment so you are not around things that irritate your lungs
• oxygen

Rarely, in cases of severe disease, surgery may be an option. Your healthcare provider can remove some of the diseased part of the lungs, but only if enough working lung will be left after the surgery. Or, in rare cases, a lung transplant might be considered, depending on your overall health and whether you’re able to avoid the things that caused your COPD.

How can I take care of myself?

Follow your healthcare provider’s instructions and recommended treatment. This includes:

• Take all of your medicine according to your provider's instructions.
• Ask your provider if a pulmonary rehab program might be helpful. Pulmonary rehab can help you with exercise training, emotional support, and even planning healthy meals.
• Take good care of your heart. Keep your blood pressure and cholesterol levels normal. This disease can damage the heart over time, so work to keep your heart healthy.
• Ask your healthcare provider what symptoms you should watch for and when you should call for help. Be sure to call your healthcare provider if your symptoms do not get better and especially if they get worse.
• Ask your provider what activities you should avoid and when you can return to your normal activities.
• Make sure you know when you should come back for a checkup. Keep your follow-up appointments.

Stay as safe and healthy as you can.

• Quit smoking. Ask your healthcare provider for help to stop smoking.
• Avoid exposure to tobacco smoke dust, fumes, chemicals and mold.
• Get a flu shot every year and avoid close contact with people who have colds or the flu. Wash your hands often and well, especially when you are in public places or around children.
• Ask about getting a pneumococcal shot to protect against a serious infection.
• Avoid extreme changes in temperature and humidity.
• If you use a humidifier, keep the humidifier clean and free of bacteria and fungus.
• Get plenty of rest and sleep.
• If you plan to travel, discuss your plans with your healthcare provider. It's good to make sure there will be no problems with high altitude, humidity, temperature, pressurized airplane cabins, or smoggy cities, especially if you are using oxygen.

Eat a healthy diet.

• Eat healthy meals. Getting the right nutrition can help your lungs work better.
• Eat high-calorie snacks between meals if you are underweight. Take vitamin and mineral supplements if recommended by your healthcare provider.
• Drink more liquids (water or tea) every day to help you cough up mucus more easily unless your provider says you need to limit fluids.

Get the exercise recommended by your healthcare provider.

• If you are able to exercise, get regular exercise according to your healthcare provider's recommendations. Exercise will help keep your heart and other muscles healthy. Don’t start an exercise program without your provider's approval.
• Do the breathing exercises recommended by your provider. They can help strengthen the muscles used for breathing. You may need a physical therapist to help you learn to do them properly.

How can I help prevent COPD?

COPD is usually caused by tobacco smoke. This includes people who smoke and people who are exposed to secondhand smoke. In most cases you can prevent COPD by never smoking and by not being around others who are smoking.