WHAT IS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)?

WHAT IS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)?

Chronic obstructive lung disease (COPD) describes a group of lung conditions (diseases) that make it difficult to empty the air out of the lungs. This difficulty can lead to shortness of breath (also called breathlessness) or the feeling of being tired. COPD is a word that can be used to describe a person with chronic bronchitis, emphysema or a combination of these. COPD is a different condition from asthma, but it can be difficult to distinguish between COPD and chronic asthma.

Two people may have COPD, but one may have more symptoms of chronic bronchitis while another may have more symptoms of emphysema. It is helpful to understand the difference between the two conditions, as COPD means a person may have some chronic bronchitis as well as emphysema.

How do I know I have COPD?

Cough, sputum production or shortness of breath that will not go away are all common signs of COPD. These signs and a history of smoking will usually indicate the need for a test called spirometry, which measures if you have airway obstruction or not.

How does my healthcare provider know I have COPD?

Your healthcare provider will decide if you have COPD based on both your reports of symptoms and test results. The single most important test to determine if you have COPD is spirometry. The most important things you can do to help your healthcare provider in determining if you have COPD is to: 1) be honest about your smoking history; 2) share your exposures to pollutants and chemicals; and 3) remember, as best you can, when your symptoms first started.

How is COPD treated?

The first most important treatment if you are a smoker is to stop smoking. As well as helping you quit smoking, your healthcare provider may prescribe medicines that widen the breathing tubes (bronchodilators), reduce swelling in the breathing tubes (anti-inflammatory drugs) or treat infection (antibiotics). Medications have been shown to help stabilize the breathing passages and decrease swelling. In order to provide control of your COPD, these medications must be taken every day, probably for the rest of your life.

Currently, there is no treatment available to restore damaged bronchi from bronchitis or alveoli affected by a large amount of emphysema. Unfortunately, the damage that has been done to the alveoli is permanent. In some parts of the world, surgery (lung volume reduction) can be performed as a way of removing some (but not all) areas of the lungs with large amounts of emphysema.

With COPD you can learn to use the lung power you have more efficiently. You should learn as much as you can about your condition. Attending groups or enrolling in a Pulmonary Rehabilitation Program can be helpful. Pulmonary rehabilitation may also be recommended so that you can learn to be in control of your breathing, instead of your breathing controlling you.

What causes COPD?

COPD can be caused by many factors, although the most common cause is cigarette smoke. Inhaling irritating particles, such as smoke or air pollutants, can cause the mucus glands that line the bronchial tubes (bronchi) to produce more mucus than normal, and can cause the walls of the bronchi to thicken and swell (inflame). This increase in mucus causes you to cough, frequently resulting in raising mucus (or phlegm). COPD can develop if small amounts of these irritants are inhaled over a long period of time or if large amounts are inhaled over a short period of time.

Environmental factors and genetics may also cause COPD. For example, heavy exposure to certain dusts at work, chemicals and indoor or outdoor air pollution can contribute to COPD. The reason why some smokers never develop COPD and why some never-smokers get COPD is not fully understood. Family genes or heredity probably play a major role in who develops COPD.

What is asthma?

Asthma is a condition of chronic swelling of the airways. These airways are sensitive to stimulation by a number of things, such as infection, cold air, exercise, pollens, etc. The swelling may produce an obstruction of the airways, similar to COPD. Some people with COPD also have asthma.

What is bronchiectasis?

Bronchiectasis is a permanent enlargement of the bronchi and bronchioles. The enlarged airways produce abnormal amounts of mucus, which can block (obstruct) the breathing passages. Bronchiectasis may occur after severe pneumonia. While bronchiectasis may at first appear to be COPD, the evaluation and treatment are different.

What is bronchiolitis?

Bronchiolitis is characterized by swelling of the small airways (bronchioles), usually resulting from inflammation or infection. This condition is more commonly seen in children after severe lung problems and in adults after lung transplantation. The narrowing of the breathing passages can be confused with COPD.

What is chronic bronchitis?

Chronic bronchitis is a constant swelling and irritability of the breathing tubes (bronchi or bronchioles) and results in increased mucus (phlegm) production. Chronic bronchitis is diagnosed when a person reports cough and mucus on most days for 3 months during 2 consecutive years when other lung conditions have been eliminated as a cause. This means that other conditions (and there are many) that may cause sputum production or cough are not the cause. Airway obstruction occurs in chronic bronchitis because the swelling and excessive mucus production cause the inside of the breathing tubes to be narrower than normal. The narrowing of the airways prevents the normal amount of air from reaching the lungs. The amount of narrowing is measured with a breathing test called spirometry.

What is emphysema?

Emphysema is a disease that involves the alveoli (air sacs) of the lung. Normally there are over 300 million alveoli in the lung. These alveoli are stretchy and springy, like little balloons. Like a balloon, it takes effort to blow-up a normal alveoli, however, it takes no energy to empty the air sac because the alveoli spring back to their original size. In emphysema, the walls of some of the alveoli have been ruined. When this happens the alveoli become stretchy and act more like paper bags. A paper bag is easy to blow-up, but you need to squeeze the bag to get the air out. So, instead of just needing effort to get air into the lungs, it also takes energy to squeeze the air out. As it is difficult to push all of the air out of the lungs, they do not empty efficiently and therefore contain more air than normal. This is called hyperinflation or air trapping. The combination of constantly having extra air in the lungs and the extra effort needed to breathe, results in the feeling of shortness of breath.

The "obstruction" in emphysema is because the breathing tubes tend to collapse on exhalation, preventing you from getting the normal amount of air out of your lungs. This is a result of the loss of stable alveolar walls, which normally hold the breathing tubes open as your exhale. Airway obstruction is measured with spirometry (a breathing test). Several other tests can be performed that can tell your provider if it is likely that you have a lot of emphysema causing your COPD.

Will COPD ever go away?

The term chronic in chronic obstructive respiratory disease means all of the time, therefore, you will have COPD for life. While the symptoms sometimes are less after you stop smoking, they may never go away entirely. Improvements in symptoms depend on how much damage has occurred to your lungs.