What Is COPD?
COPD, or chronic obstructive pulmonary
(PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe.
"Progressive" means the disease gets worse over time.
COPD can cause coughing that produces large amounts
of mucus (a slimy substance), wheezing, shortness of breath, chest tightness,
and other symptoms.
Cigarette smoking is the leading cause of COPD. Most
people who have COPD smoke or used to smoke. Long-term exposure to other lung
irritants, such as air pollution, chemical fumes, or dust, also may contribute
to COPD.
Overview
To understand COPD, it helps to understand
how
the lungs work. The air that you breathe goes down your windpipe into tubes
in your lungs called bronchial tubes, or airways.
The airways are shaped like an upside-down tree with
many branches. At the end of the branches are tiny air sacs called alveoli
(al-VEE-uhl-eye).
The airways and air sacs are elastic. When you
breathe in, each air sac fills up with air like a small balloon. When you
breathe out, the air sac deflates and the air goes out.
In COPD, less air flows in and out of the airways
because of one or more of the following:
- The airways and air sacs lose their elastic
quality.
- The walls between many of the air sacs are
destroyed.
- The walls of the airways become thick and
inflamed (swollen).
- The airways make more mucus than usual, which
tends to clog the airways.
Healthy Alveoli and Damaged
Alveoli
The illustration shows the
respiratory system and images of healthy alveoli and alveoli damaged by
COPD.
In the United States, the term "COPD" includes two
main conditionsemphysema (em-fi-SE-ma) and chronic obstructive bronchitis
(bron-KI-tis).
In emphysema, the walls between many of the air sacs
are damaged, causing them to lose their shape and become floppy. This damage
also can destroy the walls of the air sacs, leading to fewer and larger air
sacs instead of many tiny ones.
In chronic obstructive bronchitis, the lining of the
airways is constantly irritated and inflamed. This causes the lining to
thicken. Lots of thick mucus forms in the airways, making it hard to
breathe.
Most people who have COPD have both emphysema and
chronic obstructive bronchitis. Thus, the general term "COPD" is more
accurate.
Outlook
COPD is a major cause of disability, and it's the
fourth leading cause of death in the United States. More than 12 million people
are currently diagnosed with COPD. An additional 12 million likely have the
disease and don't even know it.
COPD develops slowly. Symptoms often worsen over
time and can limit your ability to do routine activities. Severe COPD may
prevent you from doing even basic activities like walking, cooking, or taking
care of yourself.
Most of the time, COPD is diagnosed in middle-aged
or older people. The disease isn't passed from person to personyou can't
catch it from someone else.
COPD has no cure yet, and doctors don't know how to
reverse the damage to the airways and lungs. However, treatments and lifestyle
changes can help you feel better, stay more active, and slow the progress of
the disease.
Other Names for COPD
- Chronic obstructive airway disease
- Chronic obstructive bronchitis
- Chronic obstructive lung disease
- Emphysema
What Causes COPD?
Most cases of COPD develop after long-term exposure
to lung irritants that damage the lungs and the airways.
In the United States, the most common irritant that
causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke
also can cause COPD, especially if the smoke is inhaled. Secondhand
smokethat is, smoke in the air from other people smokingalso can
irritate the lungs and contribute to COPD.
Breathing in air pollution and chemical fumes or
dust from the environment or workplace also can contribute to COPD.
In rare cases, a genetic condition called
alpha-1
antitrypsin deficiency may play a role in causing COPD. People who have
this condition have low levels of alpha-1 antitrypsin (AAT)a protein made
in the liver.
Having a low level of the AAT protein can lead to
lung damage and COPD if you're exposed to smoke or other lung irritants. If you
have this condition and smoke, COPD can worsen very quickly.
Who Is At Risk for COPD?
The main risk factor for COPD is smoking. Most
people who have COPD smoke or used to smoke. People who have a family history
of COPD are more likely to get the disease if they smoke.
Long-term exposure to other lung irritants also is a
risk factor for COPD. Examples of other lung irritants include air pollution
and chemical fumes and dust from the environment or workplace.
Most people who have COPD are at least 40 years old
when symptoms begin. Although it isn't common, people younger than 40 can have
COPD. For example, this may happen if a person has
alpha-1
antitrypsin deficiency, a genetic condition.
What Are the Signs and Symptoms of COPD?
The signs and symptoms of COPD include:
- An ongoing cough or a cough that produces large
amounts of mucus (often called "smoker's cough")
- Shortness of breath, especially with physical
activity
- Wheezing (a whistling or squeaky sound when you
breathe)
- Chest tightness
These symptoms often occur years before the flow of
air into and out of the lungs declines. However, not everyone who has these
symptoms has COPD. Likewise, not everyone who has COPD has these symptoms.
Some of the symptoms of COPD are similar to the
symptoms of other diseases and conditions. Your doctor can determine if you
have COPD.
If you have COPD, you may have frequent colds or
flu. If your COPD is severe, you may have swelling in your ankles, feet, or
legs; a bluish color on your lips due to low levels of oxygen in your blood;
and shortness of breath.
COPD symptoms usually slowly worsen over time. At
first, if symptoms are mild, you may not notice them, or you may adjust your
lifestyle to make breathing easier. For example, you may take the elevator
instead of the stairs.
Over time, symptoms may become bad enough to see a
doctor. For example, you may get short of breath during physical exertion.
How severe your symptoms are depends on how much
lung damage you have. If you keep smoking, the damage will occur faster than if
you stop smoking. In severe COPD, you may have other symptoms, such as weight
loss and lower muscle endurance.
Some severe symptoms may require treatment in a
hospital. Youwith the help of family members or friends, if you're
unableshould seek emergency care if:
- You're having a hard time catching your breath or
talking.
- Your lips or fingernails turn blue or gray. (This
is a sign of a low oxygen level in your blood.)
- You're not mentally alert.
- Your heartbeat is very fast.
- The recommended treatment for symptoms that are
getting worse isn't working.
How Is COPD Diagnosed?
Your doctor will diagnose COPD based on your signs
and symptoms, your medical and family histories, and test results.
He or she may ask whether you smoke or have had
contact with lung irritants, such as air pollution, chemical fumes, or dust. If
you have an ongoing cough, your doctor may ask how long you've had it, how much
you cough, and how much mucus comes up when you cough. He or she also may ask
whether you have a family history of COPD.
Your doctor will examine you and use a stethoscope
to listen for wheezing or other abnormal chest sounds.
You also may need one or more tests to diagnose
COPD.
Lung Function Tests
Lung
function tests measure how much air you can breathe in and out, how fast
you can breathe air out, and how well your lungs can deliver oxygen to your
blood.
The main test for COPD is spirometry
(spi-ROM-eh-tre). Other lung function tests, such as a lung diffusing capacity
test, also may be used. (For more information, see
"Types of Lung Function Tests.")
Spirometry
During this painless test, a technician will ask you
to take a deep breath in and then blow as hard as you can into a tube connected
to a small machine. The machine is called a spirometer.
The machine measures how much air you breathe out.
It also measures how fast you can blow air out.
Spirometry
The photo shows how spirometry is
done. The patient takes a deep breath and then blows hard into a tube connected
to a spirometer. The spirometer measures the amount of air exhaled and how fast
it was blown out.
Your doctor may have you inhale medicine that helps
open your airways and then blow into the tube again. He or she can then compare
your test results before and after taking the medicine.
Spirometry can detect COPD long before its symptoms
appear. Doctors also may use the results from this test to find out how severe
your COPD is and to help set your treatment goals.
The test results also may help find out whether
another condition, such as
asthma
or heart
failure, is causing your symptoms.
Other Tests
Your doctor may recommend other tests. These tests
include:
- A
chest
x ray or
chest
computed tomography (CT) scan. These tests create pictures of the
structures inside your chest, such as your heart and lungs. The pictures can
show signs of COPD. They also may show whether another condition, such as heart
failure, is causing your symptoms.
- An arterial blood gas test. This blood test
measures the oxygen level in your blood using a sample of blood taken from an
artery. The test can help find out how severe your COPD is and whether you may
need supplemental oxygen therapy.
How Is COPD Treated?
COPD has no cure yet. However, treatments and
lifestyle changes can help you feel better, stay more active, and slow the
progress of the disease.
Quitting smoking is the most important step you can
take to treat COPD. Talk to your doctor about programs and products that can
help you quit. Many hospitals have programs that help people quit smoking, or
hospital staff can refer you to a program. Ask your family members and friends
to support you in your efforts to quit. Also, try to avoid secondhand
smoke.
The National Heart, Lung, and Blood Institute's
"Your
Guide to a Healthy Heart" booklet has more information about how to quit
smoking.
Other treatments for COPD may include medicines,
vaccines, pulmonary rehabilitation (rehab), oxygen therapy, surgery, and
managing complications.
The goals of COPD treatment are to:
- Relieve your symptoms
- Slow the progress of the disease
- Improve your exercise tolerance (your ability to
stay active)
- Prevent and treat complications
- Improve your overall health
Specialists Involved
To assist with your treatment, your family doctor
may advise you to see a pulmonologist. This is a doctor who specializes in
treating people who have lung problems.
Medicines
Bronchodilators
Bronchodilators relax the muscles around your
airways. This helps open your airways and makes breathing easier.
Depending on how severe your disease is, your doctor
may prescribe short-acting or long-acting bronchodilators. Short-acting
bronchodilators last about 4 to 6 hours and should be used only when needed.
Long-acting bronchodilators last about 12 hours or more and are used every
day.
Most bronchodilators are taken using a device called
an inhaler. This device allows the medicine to go right to your lungs. Not all
inhalers are used the same way. Ask your health care team to show you the right
way to use your inhaler.
If your COPD is mild, your doctor may only prescribe
a short-acting inhaled bronchodilator. In this case, you may only use the
medicine when symptoms occur.
If your COPD is moderate or severe, your doctor may
prescribe regular treatment with short- and long-acting bronchodilators.
Inhaled Glucocorticosteroids (Steroids)
Inhaled steroids are used for some people who have
moderate or severe COPD. These medicines may reduce airway inflammation
(swelling).
Your doctor may ask you to try inhaled steroids for
a trial period of 6 weeks to 3 months to see whether the medicine is helping
with your breathing problems.
Vaccines
Flu Shots
The flu (influenza) can cause serious problems for
people who have COPD. Flu shots can reduce your risk for the flu. Talk with
your doctor about getting a yearly flu shot.
Pneumococcal Vaccine
This vaccine lowers your risk for pneumococcal
pneumonia
(nu-MO-ne-ah) and its complications. People who have COPD are at higher risk
for pneumonia than people who don't have COPD. Talk with your doctor about
whether you should get this vaccine.
Pulmonary Rehabilitation
Pulmonary rehab is a medically supervised program
that helps improve the health and well-being of people who have lung problems.
Rehab may include an exercise program, disease management training, and
nutritional and psychological counseling. The program aims to help you stay
more active and carry out your day-to-day activities.
Your rehab team may include doctors, nurses,
physical therapists, respiratory therapists, exercise specialists, and
dietitians. These health professionals work together and with you to create a
program that meets your needs.
Oxygen Therapy
If you have severe COPD and low levels of oxygen in
your blood, oxygen therapy can help you breathe better. For this treatment,
you're given oxygen through nasal prongs or a mask.
You may need extra oxygen all the time or just
sometimes. For some people who have severe COPD, using extra oxygen for most of
the day can help them:
- Do tasks or activities, while having fewer
symptoms
- Protect their hearts and other organs from
damage
- Sleep more during the night and improve alertness
during the day
- Live longer
Surgery
In rare cases, surgery may benefit some people who
have COPD. Surgery usually is a last resort for people who have severe symptoms
that have not improved from taking medicines.
Surgeries for people who have COPD that's mainly
related to
emphysema include bullectomy (bul-EK-to-me) and lung volume
reduction surgery (LVRS). A lung transplant may be done for people who have
very severe COPD.
Bullectomy
When the walls of the air sacs are destroyed, larger
air spaces called bullae form. These air spaces can become so large that they
interfere with breathing. In a bullectomy, doctors remove one or more very
large bullae from the lungs.
Lung Volume Reduction Surgery
In LVRS, surgeons remove damaged tissues from the
lungs. This helps the lungs work better. In carefully selected patients, LVRS
can improve breathing and quality of life.
Lung Transplant
A lung transplant may benefit some people who have
very severe COPD. During a lung transplant, your damaged lung is removed and
replaced with a healthy lung from a deceased donor.
A lung transplant can improve your lung function and
quality of life. However, lung transplants have a high risk of complications.
These include infections and death due to the body rejecting the transplanted
lung.
If you have very severe COPD, talk to your doctor
about whether a lung transplant is an option. Discuss with your doctor the
benefits and risks of this type of surgery.
Managing Complications
COPD symptoms usually slowly worsen over time.
However, they can become more severe suddenly. For instance, a cold, the flu,
or a lung infection may cause your symptoms to quickly worsen. You may have a
much harder time catching your breath. You also may have chest tightness, more
coughing, changes in the color or amount of your sputum (spit), and a
fever.
Call your doctor right away if this happens. He or
she may prescribe antibiotics to treat the infection and other medicines, such
as bronchodilators and glucocorticosteroids, to help with your breathing.
Some severe symptoms may require treatment in a
hospital. For more information, see
"What
Are the Signs and Symptoms of COPD?"
How Can COPD Be Prevented?
You can take steps to prevent COPD before it starts.
If you already have COPD, you can take steps to prevent complications and slow
the progress of the disease.
Prevent COPD Before It Starts
The best way to prevent COPD is to not start smoking
or to quit smoking before you develop the disease. Smoking is the leading cause
of COPD.
If you smoke, talk to your doctor about programs and
products that can help you quit. Many hospitals have programs that help people
quit smoking, or hospital staff can refer you to a program. The National Heart,
Lung, and Blood Institute's
"Your Guide to a Healthy Heart" booklet has more information about how to
quit smoking.
Also, try to avoid secondhand smoke and other lung
irritants that can contribute to COPD, such as air pollution, chemical fumes,
and dust.
Prevent Complications and Slow the Progress of
COPD
If you have COPD, the most important step you can
take is to quit smoking. This can help prevent complications and slow the
progress of the disease. You also should avoid exposure to the lung irritants
mentioned above.
Follow your treatments for COPD exactly as your
doctor prescribes. They can help you breathe easier, stay more active, and
avoid or manage severe symptoms.
Talk with your doctor about whether and when you
should get flu and
pneumonia
vaccines. These vaccines can lower your chances of getting these illnesses,
which are major health risks for people who have COPD.
Living With COPD
COPD has no cure yet. However, you can take steps to
manage your symptoms and slow the progress of the disease. You can:
- Avoid lung irritants
- Get ongoing care
- Manage the disease and its symptoms
- Prepare for emergencies
Avoid Lung Irritants
If you smoke, quit. Smoking is the leading cause of
COPD. Talk to your doctor about programs and products that can help you quit.
Many hospitals have programs that help people quit smoking, or hospital staff
can refer you to a program. The National Heart, Lung, and Blood Institute's
"Your
Guide to a Healthy Heart" booklet has more information about how to quit
smoking.
Try to avoid secondhand smoke and other lung
irritants that can contribute to COPD, such as air pollution, chemical fumes,
and dust. Keep these irritants out of your home. If your home is painted or
sprayed for insects, have it done when you can stay away for awhile.
Keep your windows closed and stay at home (if
possible) when there's a lot of air pollution or dust outside.
Get Ongoing Care
If you have COPD, it's important to get ongoing
medical care. Take all of your medicines as your doctor prescribes. Make sure
to refill your prescriptions before they run out. Bring all of the medicines
you're taking when you have medical checkups.
Talk with your doctor about whether and when you
should get flu and
pneumonia
vaccines. Also, ask him or her about other diseases for which COPD may increase
your risk, such as heart disease, lung cancer, and pneumonia.
Manage COPD and Its Symptoms
You can do things to help manage your disease and
its symptoms. Depending on how severe your disease is, you may ask your family
and friends for help with daily tasks. Do activities slowly. Put items that you
need often in one place that's easy to reach.
Find very simple ways to cook, clean, and do other
chores. Some people find it helpful to use a small table or cart with wheels to
move things around and a pole or tongs with long handles to reach things. Ask
for help moving things around in your house so that you will not need to climb
stairs as often.
Keep your clothes loose, and wear clothes and shoes
that are easy to put on and take off.
Prepare for Emergencies
If you have COPD, knowing when and where to seek
help for your symptoms is important. You should seek emergency care if you have
severe symptoms, such as trouble catching your breath or talking. (For more
information on severe symptoms, see
"What
Are the Signs and Symptoms of COPD?")
Call your doctor if you notice that your symptoms
are worsening or if you have signs of an infection, such as a fever. Your
doctor may change or adjust your treatments to relieve and treat symptoms.
Keep phone numbers handy for your doctor, hospital,
and someone who can take you for medical care. You also should have on hand
directions to the doctor's office and hospital and a list of all the medicines
you're taking.
Key Points
- COPD, or chronic obstructive pulmonary disease,
is a progressive disease that makes it hard to breathe. "Progressive" means the
disease gets worse over time.
- COPD can cause coughing that produces large
amounts of mucus (a slimy substance), wheezing, shortness of breath, chest
tightness, and other symptoms.
- Cigarette smoking is the leading cause of COPD.
Most people who have COPD smoke or used to smoke. Long-term exposure to other
lung irritants, such as air pollution, chemical fumes, or dust, also may
contribute to COPD.
- In the United States, the term "COPD" includes
two main conditionsemphysema and chronic obstructive bronchitis. Most people who
have COPD have both conditions. Thus, the general term "COPD " is more
accurate.
- COPD is a major cause of disability, and it's the
fourth leading cause of death in the United States.
- COPD develops slowly. Symptoms often worsen over
time and can limit your ability to do routine activities. Severe COPD may
prevent you from doing even basic activities like walking, cooking, or taking
care of yourself.
- Your doctor will diagnose COPD based on your
signs and symptoms, your medical and family histories, and test results.
- COPD has no cure yet. However, treatments and
lifestyle changes can help you feel better, stay more active, and slow the
progress of the disease.
- Quitting smoking is the most important step you
can take to treat COPD. Other treatments include medicines, vaccines, pulmonary
rehabilitation, oxygen therapy, surgery, and managing complications.
- You can take steps to prevent COPD before it
starts. The best way to prevent COPD is to not start smoking or to quit smoking
before you develop the disease. Also, try to avoid other lung irritants that
can contribute to COPD.
- If you have COPD, you can take steps to manage
your symptoms and slow the progress of the disease. Quit smoking and try to
avoid other lung irritants. Also, get ongoing care, manage the disease and its
symptoms, and prepare for emergencies.
Links to Other Information About COPD
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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