Chronic obstructive pulmonary disease explained

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COPD and chronic bronchitis and emphysema, symptoms, causes, diagnosis and treatment.

Chronic obstructive pulmonary disease (COPD) is the name used for a number of progressive lung diseases including emphysema and chronic bronchitis, which can often occur together.

COPD accounts for about seven per cent of all days off work from sickness and the annual NHS workload for COPD exceeds that for asthma.

We look at COPD causes, symptoms, treatment and prevention options:

What is COPD?

COPD is the name for a group of lung conditions that cause breathing difficulties. The name is because there is some restriction or obstruction to airflow in these conditions.

COPD includes chronic bronchitis and emphysema. Most people who have COPD have a combination of both emphysema and chronic obstructive bronchitis.

 • Chronic bronchitis

Chronic bronchitis is a long-term inflammatory condition in the lungs that causes the respiratory passages to be swollen and irritated, increases the mucus production and damages the lungs. This is more common in those in middle age and beyond and mainly seen in smokers. It is defined as a daily productive cough that lasts for three months of the year and for at least two years in a row.

“Most people who develop COPD are smokers, so the most important treatment is to quit smoking”.

This is different to acute bronchitis which is a temporary inflammation of the airways that can occur at any age, commonly in the winter after a cold, the flu or a sore throat or after breathing in irritants. This normally settles after three weeks.

• Emphysema

In emphysema, there is a slightly different problem developing in the lungs as the walls between the tiny grape-shaped air sacs or alveoli are damaged and break down. They then form into much larger airspaces and there is less surface area for gas exchange, so oxygen intake is less and the person feels breathless.

COPD causes

  • Most people who develop chronic bronchitis and emphysema are smokers, so the most important treatment is to quit smoking.
  • The seriousness of the disease depends on how much and for how long a person has been smoking.
  • Other things that can make it worse include air pollution and allergy.
  • Some people may also be more vulnerable than others because of their genetic make-up.

COPD symptoms

The following symptoms may get progressively worse over time and there may be flare-ups or exacerbations:

  • You cough a lot, sometimes every day.
  • You easily get short of breath and feel wheezy.
  • Your cough is productive with phlegm and the sputum may be difficult to cough up.
  • You become much more susceptible to chest infections.

COPD self-help treatment

COPD can often be improved to some extent by avoiding the factors that aggravate the symptoms and carefully following advice about the use of medical treatments. To ease symptoms, try the following:

  • The most important thing you must do is quit smoking. It is never too late. Your doctor or pharmacist can provide advice on smoking cessation products and techniques.
  • Avoid environmental irritants or pollution, such as smoke.
  • Make sure respiratory infections are treated immediately.
  • Avoid passive smoking.
  • Follow good general health advice with a balanced diet and regular exercise.
  • If you live or work in an area with heavy air pollution, you must do everything in your power to avoid or reduce the risk. If necessary, consider getting a new job.
  • Avoid sudden temperature changes or cold, moist weather.
  • You should try and keep active, because this helps to keep your lungs and cardiovascular system healthy.

COPD diagnosis

How can the doctor tell if you have COPD? The history of symptoms is usually a good guide to the diagnosis, especially in a smoker. But some other lung and heart diseases give the same symptoms as COPD.

The National Institute for Health and Care Excellence (NICE) recommend that to make a clear diagnosis and assess the severity of the condition, the following tests may also be helpful:

  • Chest X-ray to exclude other diagnoses (and then a CT scan if necessary to investigate abnormalities).
  • Lung function tests known as spirometry which also look at whether the lung function improves with bronchodilator drugs.
  • A blood test to check for infection, anaemia or other problems.
  • Body mass index (BMI) calculation to check for overweight.

Medication for COPD

People with diagnosed COPD should be looked after by a multi-disciplinary team, including health professionals such as a doctor (who may be a GP or a hospital respiratory consultant) a respiratory nurse specialist, physiotherapist, and occupational therapist. These teams work in the community but if the disease progresses, referral to hospital may be necessary.

It’s important to maintain a positive attitude to treatment of COPD. The condition is not curable but can often be improved, and there are a number of treatments your doctor may recommend.

Can you cure COPD?

The difference between COPD and asthma is that the airway obstruction in asthma is reversible with treatment such as bronchodilator drugs, whereas in COPD it is largely irreversible.

• Bronchodilator agents

There is a small degree of reversibility in COPD, however, and it should be exploited as a proportion of patients with COPD do respond to bronchodilator agents, such as beta-agonists and anticholinergics, with significant changes in lung function. So the first aim of treatment should be to reverse some of the airway obstruction if possible.

Short-acting bronchodilators are used first to open the airways and relieve symptoms as and when they occur. but if a person with stable COPD remains breathless or has exacerbations, either long-acting beta-agonist inhalers or long-acting anticholinergics inhalers should be used as a maintenance therapy (ie long term treatment taken regularly).

• Inhaled anticholinergics

Inhaled anticholinergics are very important in COPD because their unique mode of action targets the major reversible component of airflow obstruction in COPD – cholinergic tone (ie constriction of the muscles in the tiny airways controlled by the nerve transmitter chemical acetylcholine). Anticholinergics drugs are not indicated in asthma, however.

• Inhaled corticosteroid

If the person’s lung function is still poor then an inhaled corticosteroid is added in combination with the bronchodilator. There are several different combination inhalers currently in use.

• Oral treatments

Oral treatments may also be used as well as inhalers in more severe COPD or during an exacerbation (a period when things get worse, for example if a chest infection occurs). These oral treatments include steroids, theophylline, and ‘mucolytic’ drugs which break down the thick sputum that clogs up the airways.

•  Long-term oxygen therapy

Those patients who have become greatly limited by severe COPD should be assessed for long-term oxygen therapy (LTOT) where oxygen is supplied through a mask or nostril tubes, and can significantly improve their quality of life.

•  Pulmonary rehabilitation programme

NICE also recommend that a pulmonary rehabilitation programme should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation.

Managing COPD exacerbations

COPD patients are prone to developing short-term exacerbations of their condition, during which they will feel more breathless. These exacerbations are generally the result of respiratory infections, and so will usually need treatment with antibiotics. But during an exacerbation there is a decline in the patient’s condition and the damage done to the lungs may, in part at least, be permanent.

Frequent exacerbations contribute to a worsening of COPD, so ideally every possible step should be taken to avoid exacerbations or treat them as effectively and swiftly as possible.

COPD patients should take advantage of annual vaccinations against influenza, as well as ensuring they’ve had a vaccination against pnemococcal infection – which is recommended for anyone with COPD aged 65 or over.

COPD surgery

In some people with COPD, large cysts known as bullae can develop in the lung and hinder lung function.

In certain circumstances these can be removed surgically and will allow better inflation of the rest of the lung tissue. But this treatment is suitable for only a minority of patients.

COPD summary

The main drive in COPD treatment has to be one of prevention rather than cure. COPD does occur in non-smokers but the vast majority of sufferers smoke, and their likelihood of developing the disease is related to the amount they smoke.

There is an extra factor – that of individual susceptibility – which cannot be predicted in advance.

Most people with chronic bronchitis caused by smoking do not go to their doctor until they start to become breathless, by which time much irreversible lung damage has already occurred.

Those with known COPD who continue to smoke suffer a more rapid decline in their lung function than those who stop completely.

“The message is clear: smoking is extremely bad for your lungs and health – but it’s never too late to quit smoking, however old you may be”.


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