Chronic obstructive pulmonary disease, or COPD, is a group progressive disease where inflammation in the lungs damages lung tissue and traps air in the lungs. As the disease worsens, it takes longer and longer to exhale. The lungs become overinflated and shortness of breath develops. Inflammation is most often due to cigarette smoking. Once started, the inflammation is difficult to stop. The most common are emphysema and chronic bronchitis. Many people with COPD have both of these conditions.
Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production. Bronchitis causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up.
Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow.
COPD (chronic obstructive pulmonary disease) is a lung disease caused by chronic interference with lung airflow that impairs breathing, and is not fully reversible.
Asthma is a respiratory condition marked by spasms of the bronchi, due to inflamed and narrowed airways in the lungs. Asthma causes difficulty in breathing that often results from an allergic reaction.
Similarities in signs and symptoms are between the two conditions are:
Comorbidities are diseases and conditions that you have in addition to the main disease. Comorbidities for asthma and COPD are also often similar. They include:
One measure of COPD disease is by stage. The stages are:
Stage 0 – At risk: Symptoms include coughing and noticeable mucus. You don’t actually have COPD, so treatment isn’t necessarily needed. But do heed the warning. If you smoke, stop now. It would be wise to reassess your diet and exercise routines to improve overall health. Once you have COPD, it’s not reversible or curable.
Stage 1 – Mild: At this stage, some people still don’t notice symptoms, which may include chronic cough and increased mucus production. If you visit a doctor at this point, chances are you’ll start using a bronchodilator as needed.
Stage 2 – Moderate: Symptoms are becoming more noticeable. In addition to the cough and mucus, you may start to experience shortness of breath. You may need a long-acting bronchodilator.
Stage 3 – Severe: Symptoms become more frequent and you may have occasional flare-ups of severe symptoms. You might find that it’s difficult to function normally. Your doctor may recommend corticosteroids, other medications, or oxygen therapy.
Stage 4 – Very severe: Symptoms are progressing and it’s harder to complete everyday tasks. Flare-ups can be life-threatening. You may be a candidate for surgical treatment.
The staging as mentioned above is based on the results of a pulmonary function test. Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used.
Specifically, the forced expiratory volume (how much air one can exhale forcibly) in one second (FEV1) of a standard predicted value is measured, based on the individual patient’s physical parameters. The staging of chronic obstructive pulmonary disease by this method is as follows:
The clinician will take a history of the patient emphasising on:
You should have a physical examination focused on the heart and lungs. The examination is often normal unless COPD is severe.
You should have spirometry (breathing tests) performed to measure lung function. COPD can’t be diagnosed without them.
Other tests that may help in diagnose or treat COPD include:
Certain lifestyle changes may also help alleviate your symptoms or provide relief.
If your blood oxygen levels are low, you can receive oxygen through a mask or nasal prongs to help you breathe better. A portable unit can make it easier to get around.
Varenicline (Chantix) is an oral medication that is prescribed to promote cessation of smoking. This is also an alternative to try to quit smoking.
Bupropion (Zyban) is an antidepressant that helps reduce symptoms of nicotine withdrawal.
Some medications are used “off label” (that is, they are normally prescribed for another condition) to help people quit smoking. These drugs are recommended by the Agency for Healthcare Research and Quality to help smokers kick the habit, but have not been approved by the FDA for this use. These medications include nortriptyline (Pamelor), an older type of antidepressant. It’s been found to help smokers double their chances of quitting compared to taking no medicine. Another drug used off label is clonidine (Catapres). Normally used to treat high blood pressure it can help smokers quit.
Bronchodilators are used for COPD treatment because they open up the airway tubes and allow air to more freely pass in and out of the lung tissue. There are both short-term (several hours) and long-term (12 or more hours) types of bronchodilators.
Examples of short-term bronchodilators
Examples of long-term bronchodilators
Other bronchodilators such as theophylline (Elixophyllin, Theo-24) are occasionally used, but are not favored because of unwanted side effects including anxiety, tremors, seizures, and arrhythmias.
Also on the market are combined to drugs using steroids and long-acting bronchodilators. Roflumilast (Daxas, Daliresp) is a new drug that inhibits the enzyme phosphodiesterase type 4, has been utilized in patients with symptoms of chronic bronchitis.
Sometimes bronchodilators are combined with inhaled glucocorticosteroids. Using the two together can reduce inflammation in the airways and lower mucus production. Corticosteroids are also available in pill form.
This newer medication in pill form reduces inflammation and changes mucus production. It’s generally prescribed for severe COPD.
This medicine eases chest tightness and shortness of breath. It may help prevent flare-ups. It’s available in pill form.
Antibiotics or antivirals may be prescribed when you develop respiratory infections.
Surgery may not be available or desirable for many people with COPD.
Other supplementary therapies such as treatment with antibiotics to reduce pathogen (viral, fungal, bacterial) damage to lung tissue, mucolytic agents to help unblock mucus-clogged airways, or oxygenation therapies to increase the available oxygen to lung tissues may also reduce the symptoms of COPD.
In some people, oxygen therapy will increase his/her life expectancy, and improve the quality of life. This is especially true with people with COPD who have chronically low oxygen levels in the blood. It may also help exercise endurance. Oxygen delivery systems are now easily portable and have reduced in cost in comparison to earlier designs.
Yoga may be another form of beneficial exercise that helps with breathing efficiency and breathing muscle control.