What is COPD?
Chronic obstructive pulmonary disease (COPD) refers to a general grouping of respiratory conditions, most often characterized by difficulty breathing, coughing, and limited airflow in the lungs, among other symptoms. COPD is commonly associated with smoking cigarettes; however, it can be caused by a variety of environmental and genetic factors.
COPD, which includes chronic bronchitis and emphysema, is a progressive lung disease that makes it hard to breathe. It results from inflammation in the lungs that gets worse with time. Inflammation produces large amounts of mucus and damages lung tissue, which then traps air in the lungs. This makes it difficult to exhale completely and causes shortness of breath. Eventually, the symptoms of COPD will affect your ability to do basic activities, such as walking or housework.
Fortunately, COPD is highly preventable. Smoking is the number one cause of the disease. Therefore, stopping smoking—or never starting—is the best way to avoid COPD. However, up to 20% of the 24 to 30 million Americans with COPD have never smoked.
Currently, there is no way to reverse COPD lung damage and cure the disease. COPD treatment aims to control symptoms, improve disability, and prevent flares, which can lead to hospitalization. Doctors accomplish this with oral and inhaled medications. If you smoke, you can best support your treatment by quitting smoking.
Unfortunately, COPD is the third leading cause of death in the United States after heart disease and cancer. Although it may take years, COPD can ultimately lead to respiratory failure. The lungs will no longer be able to exchange oxygen and carbon dioxide efficiently. Respiratory failure can develop gradually or happen suddenly (acutely).
Seek immediate medical care (call 911) if you have symptoms of acute respiratory failure including:
- Air hunger, which is the feeling of not being able to get enough air when you breathe
- Bluish lips, skin or fingernails
- Confusion, sleepiness, or loss of consciousness
What are the different types of COPD?
The respiratory conditions that can fall under a COPD diagnosis include:
- Emphysema—permanent structural changes and damage to the air sacs in the lungs
- Chronic bronchitis—recurrent, mucus-producing cough that lasts for at least three months at a time
- Refractory asthma—irreversible, chronic inflammation of the airways that can lead to breathlessness, wheezing, chest tightness, and coughing
What are the symptoms of COPD?
COPD symptoms tend to start gradually. You may not even notice them at first. Many people blame aging for the initial mild symptoms of slight shortness of breath or not having the energy for usual activities. However, the symptoms will get progressively worse with time if they are due to COPD.
Common symptoms of COPD
Common symptoms of COPD include:
- Chest tightness
- Chronic cough that may produce lots of mucus
- Frequent chest infections
- Shortness of breath, especially with physical activity
As the disease progresses, additional symptoms can develop. This includes weight loss, poor appetite, shortness of breath even at rest, and swelling in the feet, ankles or legs.
Serious symptoms that might indicate a life-threatening condition
In some cases, COPD leads to acute respiratory failure and becomes life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Feeling unable to get enough air when you breathe
- Blue tinge to lips, skin or fingernails
- Confusion, drowsiness, or passing out
- Shortness of breath
Regular follow-up care with your doctor can help identify worsening COPD symptoms before they become a problem. Talk with your doctor and find out when to call and what to do if you notice your symptoms getting worse.
What causes COPD?
Most cases of COPD are the result of inhaling irritants or pollutants over a long period of time. In the United States, the most common cause is smoking. The smoke or other irritant causes chronic inflammation in the lungs.
Inflammation can narrow the airways in the lungs and trigger an overproduction of mucus. It can also damage the air sacs—or alveoli—where the lungs exchange the gases oxygen and carbon dioxide. The alveoli lose their elasticity, trapping air in them instead of allowing normal gas exchange. The symptoms of COPD are the result.
What are the risk factors for COPD?
The single greatest risk factor for COPD is a history of smoking cigarettes. Secondhand smoke and passive inhalation of fumes or particulate matter can also contribute to lung damage, leading to airway obstruction and a possible COPD diagnosis. About 80 to 90% of COPD cases are related to smoking. Any type of smoke, such as pipe, cigar or marijuana, can increase the risk of COPD if you inhale it. However, not all smokers will get COPD. It affects approximately 20 to 30% of smokers and the risk increases with the amount you smoke. Most people are 40 years of age or older when they notice symptoms.
Other risk factors for COPD include:
- Family history of COPD. People who smoke and have a family history of COPD are more likely to develop it.
- Genetics, including having the inherited disorder alpha-1-antitrypsin deficiency. In this disorder, the body can’t produce enough of a protein that helps protect the lungs.
- Long-term exposure to other inhaled irritants, such as dust, soot, fumes or chemicals
- Other lung diseases, such as bronchitis and asthma
- Secondhand smoke
What are some conditions related to COPD?
Chronic bronchitis, emphysema, and asthma are all related to COPD because certain signs and symptoms of each condition can be diagnosed as COPD. Airflow obstruction is the most significant factor in making a COPD diagnosis out of these respiratory conditions. Other conditions with symptoms similar to COPD include:
- Central airway obstruction—slow progression of breathing difficulty, first during physical exertion, then during minimal activity
- Bronchiectasis—collapse of small airways due to chronic inflammation or chronic infection
- Constrictive bronchiolitis—also called “bronchiolitis obliterans”—small airway obstruction, which leads to inflammation and scarring
How do doctors diagnose COPD?
To diagnose your condition, your doctor will ask you about your family medical history and your medical history including childhood respiratory illness. Your doctor will also ask several questions related to your symptoms including:
- What symptoms are you experiencing? Shortness of breath? Coughing? Other symptoms?
- How often are you out of breath? Does this occur when you are at rest or at exercising?
- Is your shortness of breath getting worse?
- How far can you walk or how many steps can you climb before you become short of breath?
- How often do you cough?
- Do you cough up mucus? If so, what color is it?
- Do you ever cough up blood?
- Do you smoke? If so, how many cigarettes a day, for how many years? If you have quit, how long ago? Does anyone in your household smoke?
- Are you exposed to dust, chemicals, or other airborne irritants on the job or at home?
During your visit, your doctor will perform a physical exam, including checking your ears, nose and throat, listening to your heart and lungs, checking your temperature, weight and body mass, and examining your skin, fingers, legs and feet for other systems that may provide clues.
Pulmonary function testing for COPD
If your doctor suspects COPD, he or she will likely recommend pulmonary function testing. The primary method of diagnosing COPD is through spirometry, which tests lung function and capacity. By performing spirometry before and after administering a bronchodilator, such as albuterol, doctors can determine the presence and severity of airflow restrictions in the lungs.
Your doctor may order additional diagnostic imaging—chest X-ray and CT scan—to confirm or rule out underlying causes and complications of COPD.
Diagnosis is confirmed through spirometry findings and lack of alternative explanations for airflow limitation. There are several systems for classifying the stage and severity of COPD. While each staging system accounts for slightly different variables, they all rely predominantly on the spirometry findings for each patient.
Genetic testing for COPD
The most common inherited disorder linked to COPD is a deficiency of alpha-1 antitrypsin (AAT). It is estimated that as many as 100,000 people in the United States have a severe AAT deficiency, which poses a significant risk for early onset of COPD and related lung disorders, especially among people who smoke. Testing for alpha-1 antitrypsin deficiency is recommended for the following:
- Nonsmokers who have been diagnosed with emphysema or COPD
- People under the age of 45 diagnosed with emphysema or COPD
- People with a family history of emphysema and/or liver disease
How is COPD treated?
The single most important way to slow or stop the progression of COPD and improve your breathing is to quit smoking, if you smoke, and limit your exposure to other irritants, such as dusts, fumes and gases. Treatment for COPD is based on your specific symptoms and diagnosis. Common treatment options include:
- Medication, such as bronchodilators and glucocorticoids
- Supplemental oxygen
- Pulmonary rehabilitation
- Lung volume reduction surgery
- Lung transplant
- Palliative care
Medications for COPD
Your doctor will prescribe medications to help relieve your symptoms and prevent COPD flares. There are two main categories of medicines for COPD—maintenance drugs and quick-relief drugs. Maintenance medicines are for regular use to control symptoms and prevent flares. Quick-relief medicines are for when symptoms are worsening.
Types of maintenance COPD drugs include:
- Inhaled corticosteroids, such as budesonide (Pulmicort, Pulmicort Flexhaler)
- Inhaled long-acting beta agonists (LABAs), such as salmeterol (Serevent)
- Inhaled long-acting muscarinic antagonists (LAMAs), such as tiotropium (Spiriva)
- Oral PDE4 inhibitors, such as roflumilast (Daliresp)
Several combination products are available that contain two or more maintenance drugs in one inhaler. This means more convenient dosing for these inhaled medicines.
Types of quick-relief COPD inhaled drugs include:
- Short-acting anticholinergics, such as ipratropium (Atrovent, Atrovent HFA)
- Short-acting beta agonists (SABAs), such as albuterol (Accuneb, Proventil HFA, Ventolin HFA, and others)
Finding the right combination of drugs and dosages can take some trial and error. Your doctor will monitor your disease to decide how well your treatment is working. Talk with your doctor if you feel your treatment is not controlling your COPD symptoms. You may get better results with a different drug.
Because COPD is progressive, symptoms will worsen and can become constant. For moderate to severe COPD, additional therapies are often necessary. This includes oxygen therapy and pulmonary rehabilitation. Surgery is sometimes a last resort treatment for some forms of severe COPD.
How does COPD affect quality of life?
COPD can impact quality of life in several ways, increasing financial burdens, limiting physical activity, and even interfering with the ability to work. Additional burdens of living with COPD include:
- Higher likelihood of emergency room visits and hospitalization
- Needing to carry and use special equipment, such as inhalers or portable oxygen tanks
- Difficulty climbing stairs
- Disrupted sleeping patterns
- Increased confusion or memory loss
- Days off from work or unemployment
The economic burden of COPD varies for each person, but generally rises as the stage and severity of the disease increase. Hospitalization accounts for approximately half of total direct costs, while inability to work contributes the most to indirect costs of COPD in the United States.
What are the potential complications of COPD?
Despite treatment, complications can occur. A main complication of COPD is a flare—or exacerbation—requiring hospitalization. It’s common for this to occur with respiratory infections, such as cold, flu, bronchitis or pneumonia. On average, a hospital stay for a COPD flare lasts four days and about 20% of patients return within 30 days. Getting an annual flu shot, a pneumococcal vaccine, and a COVID-19 vaccine are important strategies for preventing flares and hospitalizations. Talk with your doctor about these vaccines to see if you could benefit from them.
Other COPD complications include heart disease, lung cancer, high blood pressure in the blood vessels of the lungs, depression, and anxiety. Anxiety is problematic for people with COPD because difficulty breathing can trigger anxiety and vice versa. As the two build, it can cause a flare.
Ultimately, COPD can lead to respiratory failure and death. Early diagnosis is an important way to limit the effects of COPD. Controlling the disease in its early stages can extend your life and help you maintain your quality of life and activity levels.
Does COPD shorten life expectancy?
As the third-highest cause of death in the United States, COPD is responsible for killing more than 120,000 people each year. While there is no cure for COPD, the frequency and severity of COPD exacerbations can be reduced through smoking cessation and a variety of treatment options.
While not all COPD patients will die of the disease, it is a serious chronic illness with life-threatening implications, so it is important to appoint a medical decision maker (MDPOA) in advance.