Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease that obstructs airflow, making it difficult to breathe. It is a long-term condition that develops over many years and typically worsens over time. While there is no cure for COPD, treatments are available to manage symptoms and improve quality of life.
The Two Main Forms of COPD
COPD is an umbrella term that primarily includes two main conditions: chronic bronchitis and emphysema. Individuals with COPD often have features of both conditions, which cause distinct but related types of damage within the respiratory system.
Chronic bronchitis is defined by the inflammation and narrowing of the bronchial tubes, the primary airways that carry air into the lungs. This inflammation leads to an overproduction of mucus, resulting in a chronic cough as the body attempts to clear the airways. The combination of narrowed tubes and excess mucus increases the effort required for respiration.
Emphysema involves damage to the alveoli, the tiny air sacs where oxygen and carbon dioxide are exchanged. The walls of these sacs become damaged and lose their elasticity, which can lead to the destruction of the walls between them. This process traps air in the enlarged sacs, making it difficult to exhale fully and reducing the lungs’ capacity to absorb oxygen.
Causes and Risk Factors
The primary cause of COPD is long-term exposure to irritants that damage the lungs, with tobacco smoke being the most common. Smoking is the underlying cause in 80% to 90% of all cases. Other risk factors include prolonged exposure to secondhand smoke, air pollution, and occupational hazards like coal dust, grain dust, or chemical fumes.
Genetics can also play a part in the onset of COPD. A genetic condition, alpha-1 antitrypsin deficiency (AATD), leaves the lungs vulnerable to damage because the body lacks a protein that protects lung tissue. A deficiency of this protein increases susceptibility to developing emphysema. Repeated respiratory infections during childhood may also predispose a person to the condition.
Symptoms and Progression
The symptoms of COPD develop slowly, and individuals may not notice them until significant lung damage has occurred. Early signs are often subtle and can be mistaken for aging or a “smoker’s cough.” The most common initial symptom is a persistent cough that produces mucus, or sputum, and may be present for months at a time over several years.
As the disease advances, symptoms become more pronounced. Shortness of breath (dyspnea) is a hallmark of COPD, initially occurring with physical activity but eventually happening even during rest. Other common symptoms include wheezing, a whistling sound when breathing, and chest tightness. Some individuals may experience a lack of energy and unintended weight loss as breathing becomes more laborious.
The gradual worsening of these symptoms can limit a person’s ability to perform routine activities like walking or climbing stairs. People with COPD may also experience periods called exacerbations, or flare-ups, where their symptoms suddenly worsen and may require hospitalization. These exacerbations are often triggered by respiratory infections or pollutants and can lead to a further decline in lung function.
Diagnosis and Medical Evaluation
Diagnosing COPD involves an evaluation by a healthcare provider, considering a patient’s symptoms, medical history, and exposure to risk factors. A doctor will ask about smoking, occupational irritants, and family history of lung disease. A physical examination will also be performed, where the doctor listens to the lungs.
The definitive test to confirm a COPD diagnosis is spirometry, a non-invasive breathing test that measures lung function. During the test, a patient blows as hard and fast as possible into a spirometer. The machine measures the total volume of air exhaled and how quickly it is expelled, which reveals the airflow obstruction characteristic of COPD.
In some cases, additional tests may be ordered to gather more information or rule out other conditions. A chest X-ray or a computed tomography (CT) scan can provide detailed images of the lungs to identify emphysema or other problems. Blood tests may be used to check for alpha-1 antitrypsin deficiency, especially in those with a family history or who develop COPD at a younger age.
Medical Treatments and Lifestyle Management
A combination of medical treatments and lifestyle changes can effectively manage COPD. The single most important step for individuals who smoke is to quit, as this is the most effective way to slow the disease’s progression and preserve remaining lung function.
Medications are central to managing symptoms. Bronchodilators, typically delivered via an inhaler, relax the muscles around the airways to make breathing easier. Inhaled steroids may also be used to reduce airway inflammation and help prevent exacerbations. For those with low blood oxygen levels, long-term oxygen therapy may be prescribed to protect organs from damage.
Pulmonary rehabilitation is a comprehensive program recommended for people with COPD. It combines exercise training, disease management education, and counseling to improve physical and emotional well-being. This program helps strengthen respiratory muscles and improves overall endurance, making daily activities more manageable.
Other lifestyle adjustments are also beneficial. Maintaining a healthy diet provides the energy needed for breathing, and getting recommended vaccinations helps prevent infections that trigger flare-ups. Avoiding exposure to lung irritants like smoke and air pollution is another important self-care measure.