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Penn State General Internal Medicine

Penn State Respiratory Care

Chronic Obstructive Pulmonary Disease (COPD)

What is it?

Chronic obstructive pulmonary disease (COPD) is a condition in which airflow in and out of the lungs is obstructed, which causes breathing difficulties. The cause of this obstruction in patients with COPD is chronic bronchitis or emphysema. Bronchitis is an inflammation of the bronchi, which are the airways that connect the windpipe (trachea) to the lungs. Chronic means it happens frequently, over a long period of time. Emphysema is an enlargement of the alveoli, the tiny air sacs in the lungs, and the rupture of the alveola walls, which narrows the airways.

Who gets it?

Chronic bronchitis and emphysema often occur together in cigarette smokers. This means almost 16 million people in the United have COPD. It is the fourth leading cause of death in the United States. It is also a common cause of disability that prevents people from working, and is more often fatal in men than women. Some families have an inherited form of emphysema called "early onset emphysema" because it can appear as early as 30 to 40 years of age. This type of emphysema is caused by low levels of an enzyme inhibitor called alpha-1-antitrypsin (AAT). Approximately 75,000 to 150,000 Americans have an AAT-deficiency, but not all develop emphysema. Smokers with AAT-deficiency are at a greater risk of developing COPD. People who die from COPD are more likely to be white blue-collar workers.

What causes it?

Cigarette smoking accounts for the cause of 80% of all cases of COPD. However, pipe, cigar, and marijuana smoking can also damage the lungs. Frequent exposure to air pollution and industrial fumes and dusts, as well as frequent bacterial infections of the upper respiratory system can also cause COPD. With chronic bronchitis, the airways become irritated by smoke or other pollutants in the air, then swell and produce a large amount of mucus. The swelling and irritation can scar the walls of the bronchial airways and cause the smooth muscles in the airways to spasm, which stimulates coughing. The mucus clogs the airways and makes it difficult to breathe. In normal lungs, tiny air sacs called alveoli support the small airways, called the bronchioles, and hold the airways open. With emphysema, smoke causes an overproduction of an enzyme that destroys the walls of the alveoli, so the bronchioles no longer have any support. When the bronchioles collapse, the airway becomes permanently narrowed.

What are the symptoms?

Chronic bronchitis usually begins as a mild cough, sometimes called a smoker's cough. The cough may be deeper in the morning and cause the patient to bring up a yellowish mucus called phlegm or sputum. The patient may wheeze and feel short of breath. With time, the symptoms can become so severe that breathing becomes difficult and normal activities are restricted. Chronic bronchitis can lead to emphysema. The first symptom of emphysema is usually shortness of breath during exertion. There is little coughing and no sputum. As the disease progresses, and with age, the shortness of breath occurs more often, until it even occurs when the patient is at rest. A sputum-producing cough may occur at this point. The strain of breathing can also cause the heart to weaken. Leg swelling is an early sign of heart failure. COPD can lead to acute respiratory failure, usually when a respiratory illness such as a cold places too much of a strain on the lungs. Acute respiratory failure occurs when there are low levels of oxygen or high levels of carbon dioxide in the blood. The quality of life for a person with COPD becomes increasingly lower as the disease progresses.

How is it diagnosed?

To diagnose COPD, the doctor will perform a complete physical exam and take a medical history. If the COPD is mild, the doctor may only hear some wheezes upon listening to the chest with a stethoscope. Doctors commonly use an instrument called a spirometer to measure the air taken into and exhaled from the lungs. In patients with COPD, this test will show a reduced amount of airflow when the patient exhales forcefully. Other diagnostic tests for COPD include an arterial blood gas, which measures the amounts of oxygen and carbon dioxide levels in the blood; blood and sputum tests to look for the cause of any infections; and an electrocardiogram (ECG), which measures the electrical activity of the heart to determine whether the lung disease has caused any heart problems. A chest x-ray may be ordered to diagnose emphysema or to look for signs of pneumonia. Because early-onset emphysema can be caused by low levels of the alpha-1-antitrypsin protein, the doctor may also order a blood test to check for this condition, especially if the patient has emphysema at a young age and no other risk factors.

What is the treatment?

While there is no treatment that will slow the progress of COPD, good respiratory care can improve quality of life. Survival rates depend upon the amount of damage to the lungs, and the only way to increase the patient's rate of survival is with oxygen therapy. It is also important to remove the irritation that is causing the damage. That means avoiding irritants such as cigarette smoke and polluted air. Commonly used medications include bronchodilators, which relax the bronchial muscles so the airways are widened and it's easier to breathe. This drug is available in inhaled, injected, and oral forms. The doctor may also prescribe antibiotics if chronic bronchitis is accompanied by a bacterial infection. Steroids called corticosteroids also can help relax the airways so breathing is easier in patients with chronic bronchitis. However, these types of drugs usually aren't prescribed for long-term use because of their side effects. Drinking plenty of fluids can help prevent thick mucus, as well as taking a drug to help reduce secretions. In severe cases, patients need to breathe oxygen from a portable cylinder 24 hours a day to keep the blood oxygen at normal levels. Yearly flu vaccinations and a one-time pneumonia vaccine are recommended to prevent pulmonary infections for all patients with COPD. Antibiotics are given at the first sign of any infection. Patients showing signs of heart failure are given diuretics to prevent fluid retention. In cases of early-onset emphysema, patients receive augmentation therapy in which replacement alpha-1-antitrypsin protein is injected every one to two weeks for life. Some patients with COPD benefit from an outpatient pulmonary rehabilitation program in which trained healthcare professionals instruct the patient in exercise, breathing, and relaxation techniques, and provide respiratory therapy, such as oxygen, mechanical ventilation, continuous positive airway pressure, and removal of secretions. While surgery is rarely used, available surgical techniques include lung transplants and removal of diseased lung tissue, called lung volume reduction. Alternative treatments include diet and nutritional supplements; herbal medicines; water, or hydrotherapy; acupressure and acupuncture; aromatherapy; and yoga. Consult your doctor before using any alternative therapies.

Self-care tips

You can reduce your chances of developing COPD if you make certain lifestyle changes. Follow a healthy diet and get plenty of exercise; don't smoke; avoid secondhand smoke; and avoid spending prolonged periods of time in damp, cold areas or areas high in air or industrial pollution. If you have COPD, get regular physical exams to monitor your condition. Ask your doctor about flu and pneumonia shots because these illnesses can become life-threatening to someone with existing respiratory problems.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers.  The health information written by our authors is intended to be a supplement to the care provided by your physician.  It is not intended nor implied to be a substitute for professional medical advice.