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COPD (Emphysema & Chronic Bronchiectasis)

Chronic obstructive pulmonary disease includes emphysema and chronic bronchitis,

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COPD

COPD

What is chronic obstructive pulmonary disease (COPD)?

“Chronic obstructive pulmonary disease” (COPD) is a term for lung and airway diseases that restrict your breathing. People with COPD have airway inflammation and scarring, damage to the air sacs in their lungs or both. Emphysema and chronic bronchitis are both forms of COPD. Treatments can manage symptoms and reduce exacerbations.

Changes in your lungs and airways in COPD include:

  • Loss of elasticity in your airways and air sacs in your lungs (alveoli).
  • Inflammation, scarring (fibrosis) and narrowing of your airways.
  • Thick mucus in your airways.
  • Destruction of the walls between your alveoli, which enlarges them and traps air.

People with COPD often get exacerbations, or worsening of symptoms, like severe difficulty breathing, thicker mucus, wheezing, and cough. You might need to go to the hospital for severe exacerbations.

COPD gets progressively worse over time. Flare-ups get more severe and happen more often. This usually takes years or decades, though some people get worse faster.

Types of chronic obstructive pulmonary disease

COPD includes both emphysema and chronic bronchitis. People with COPD often have features of both.

Emphysema is when your alveoli become damaged and enlarged. The most common symptom is shortness of breath (dyspnea). Chronic bronchitis is inflammation in your large airways, which narrows your airways and produces lots of mucus. Cough is the most common symptom.

Symptoms and Causes

What are the symptoms of COPD?

Symptoms of COPD include:

  • Cough with mucus that you’ve had for a long time (for three months or longer at a time for at least two years).
  • Difficulty taking a deep breath.
  • Shortness of breath, especially when performing daily activities or with mild exertion.
  • Wheezing or other lung sounds.
  • Barrel-shaped chest.
  • Bluish skin (cyanosis).
What causes COPD?

Damage to your lungs from smoking is the most common cause of COPD. Other causes include:

  • Alpha-1 antitrypsin deficiency (“alpha-1”), a genetic disorder that can lead to lung damage.
  • Secondhand smoke.
  • Air pollution.
  • Exposure to dust and fumes from your job or hobbies.
What are the risk factors for this condition?

While smoking is the biggest risk factor for COPD, not everyone who smokes will develop it. You may be at higher risk for COPD if you:

  • Are a person assigned female at birth.
  • Are over the age of 65.
  • Have been exposed to air pollution.
  • Have worked with chemicals, dust, or fumes.
  • Have alpha-1 antitrypsin deficiency.
  • Had many respiratory infections during childhood.
What are the complications of COPD?

COPD can trap bacteria in your lungs, leading to infections . It can also prevent oxygen from getting into your body and carbon dioxide from getting out. This can lead to serious complications, including:

  • Pneumonia.
  • High levels of carbon dioxide in your blood (hypercapnia).
  • Low levels of oxygen in your blood (hypoxemia).
  • Respiratory failure.
  • Pulmonary hypertension.
  • Right-sided heart failure (cor pulmonale).
  • Collapsed lung (pneumothorax).
  • Polycythemia (making too many red blood cells).

Diagnosis and Tests

How is chronic obstructive pulmonary disease (COPD) diagnosed?

To diagnose COPD, a provider will perform an exam and ask you about your health history. They’ll test how well your lungs work and might get images of your lungs.

They may ask you questions like:

  • Do you smoke or have you ever smoked?
  • Have you had long-term exposure to dust or air pollutants?
  • Do other members of your family have COPD, other lung conditions, or liver disease?
  • Do you get short of breath with exercise? When resting?
  • Have you been coughing or wheezing for a long time?
  • Do you cough up phlegm?
What tests do healthcare providers use to diagnose COPD?

Your provider might use the following tests to help diagnose COPD:

  • Pulmonary function tests. Providers can use spirometry and other tests to see how well your lungs are working.
  • Pulse oximetry. This test uses a device on your finger to measure oxygen levels in your blood.
  • Imaging tests. Chest X-rays or CT scans can look for lung changes caused by COPD.
  • Arterial blood gas test. This is a blood test that checks your oxygen and carbon dioxide levels.
  • Exercise testing. Your provider uses this to determine if the oxygen level in your blood drops when you exercise.
  • Electrocardiogram (ECG or EKG). This test checks heart function and rules out heart disease as a cause of shortness of breath.
  • Blood tests. Your provider may check your levels of the protein AAT to see if you might have Alpha-1 antitrypsin deficiency.
  • Genetic testing. If your provider thinks a genetic condition could be causing your lung issues, they may check for genetic changes with a blood test.

Management and Treatment

How is COPD treated?

There’s no cure for COPD. Treatment focuses on improving your symptoms and reducing and treating exacerbations. Your provider may recommend:

  • Smoking cessation programs. If you smoke, quitting can slow down the progression of COPD.
  • Inhaled medications. Bronchodilators and steroids can reduce inflammation and open your airways. These might come in an inhaler or as a liquid you put in a nebulizer.
  • Oxygen therapy. You may need supplemental oxygen to improve your oxygen levels.
  • Pulmonary rehabilitation. This is an exercise and education program that can strengthen your lungs and help you manage COPD.
  • Corticosteroids. You might need a course of steroids to reduce inflammation during an exacerbation.
  • Positive airway pressure. Your provider might have you use a BiPAP machine to help you breathe, especially during an exacerbation.
  • Antibiotics. If you have frequent bacterial infections in your lungs, your provider may prescribe antibiotics to prevent infections and exacerbations.
  • Lung volume reduction (LVR). If you have severe COPD and you’re a good candidate, your provider may suggest surgery or a valve procedure that reduces the trapped air in your lungs.
  • Clinical trials. Clinical trials are tests of new treatments to see if they’re safe and effective. Your provider might recommend one if a new treatment could be a good fit.