What is copd?

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. With COPD, the airways that lead to the lungs are narrowed, and the tiny air sacs in the lungs are damaged and lose their stretch. People with COPD have decreased airflow in and out of the lungs, which makes it hard to breathe. The airways also can get clogged with thick mucus. Cigarette smoking is a major cause of COPD.

Although there is no cure for COPD, you can slow its progress. Following your treatment plan and taking care of yourself can help you feel better and live longer.

COPD gradually gets worse over time. As it gets worse, you may be short of breath even when you do things like get dressed, fix a meal, or eat. People often feel weaker and limit activities. And some people may get lung infections and heart problems.

When you have COPD, you have a cough that won't go away, and you're often short of breath. You may also cough up mucus. At times, your symptoms may suddenly flare up and get much worse.

COPD may be treated with medicines and oxygen, along with self-care.

• Medicines called bronchodilators are used to open or relax your airways. They can help you breathe easier. There are two types:
  • Short-acting bronchodilators ease your symptoms. They are considered a good first choice for treating stable COPD in a person whose symptoms come and go (intermittent symptoms).
  • Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away (persistent symptoms).
• Oxygen therapy boosts the amount of oxygen in your blood and helps you breathe easier.
• Self-care means the things you can do for yourself to help manage your COPD. They are things like:
  • Quitting smoking.
  • Eating well.
  • Staying active.
  • Avoiding colds, infections, and other things that may trigger your symptoms.
  • Staying current on vaccines.

A lung (pulmonary) rehab program can help you learn to manage your disease. This program teaches you how to breathe easier, exercise, and eat well.

In lung volume reduction surgery (LVRS), a large area of damaged lung is removed to allow the remaining lung tissue to expand when you breathe in. This surgery is done only for people with severe chronic obstructive pulmonary disease (COPD) or with certain types of emphysema.

The National Emphysema Treatment Trial has examined the results of LVRS. The results of this study report that people not considered good candidates for this surgery include people who have:

• Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysema throughout the lungs.
• Largely non-upper lung emphysema and who are able to exercise for a longer time than other people with COPD.
• Certain other serious medical problems.

For other people LVRS, compared to medical treatment, may provide an increased ability to exercise and may result in fewer symptoms. LVRS also can reduce the number of COPD exacerbations for some people. But it does not improve the survival rate compared to medical treatment, except for people who have emphysema mainly in the upper portion of the lungs and who are not able to exercise well even after pulmonary rehabilitation.

Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRS include people:

• Who have severe emphysema that does not respond to medical therapy.
• Who are younger than 75 to 80 years old.
• Who have not smoked for at least 4 months.
• Who have reasonable expectations of surgery results.
• Who have areas of the lung that can be targeted.
• Who have severe difficulty breathing, as determined by breathing tests.

Decision to have the surgery

The decision to have this surgery is not an easy one. Not all patients who have emphysema or COPD will benefit from this surgery. Detailed testing is needed to find out if a person is likely to be helped by LVRS. Talk with your doctor about all of the treatment options available for COPD.

The best way to keep COPD from starting is to not smoke. And if you smoke, the best way to prevent COPD from getting worse is to quit smoking. There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs.

To find out if you have COPD, your doctor may:

• Do a physical exam and listen to your lungs.
• Ask you questions about your past health and whether you smoke or have been exposed to other things that can irritate your lungs.
• Have you do breathing tests, including spirometry, to find out how well your lungs work.
• Do a chest X-ray to look at your lungs.
• Do a one time test for Alpha-1 antitrypsin (AAT). People who have a low AAT are more likely to get emphysema.
• Do other tests to help rule out other problems that could be causing your symptoms.

Medicines most commonly used for COPD include bronchodilators. They open or relax your airways and help your shortness of breath. Short-acting bronchodilators ease your symptoms. Long-acting bronchodilators help prevent breathing problems. Other medicines may be used for severe symptoms or to treat flare-ups.

Health professionals who can diagnose COPD and provide a basic treatment plan include:

• Family medicine physicians.
• Internists.
• Nurse practitioners.
• Physician assistants.

You may need to see a specialist in lung disease, called a pulmonologist (say "pull-muh-NAWL-uh-jist"), if:

• Your diagnosis of COPD is uncertain or hard to make because you have diseases with similar symptoms.
• You have unusual symptoms that are not usually seen in people with COPD.
• You are younger than 50 and/or have no history or a short history of cigarette smoking.
• You have to go to the hospital often because of sudden increases in shortness of breath.
• You need long-term oxygen therapy.
• You and your doctor are considering surgery, such as a lung transplant or lung volume reduction.

You can't undo the damage to your lungs from COPD. But you can take steps to prevent more damage and to feel better.

Quit smoking

This is the most important thing you can do to slow down the disease and improve your quality of life.

You may think that nothing can help you quit. But there are several treatments shown to be very good at helping people stop smoking. Talk to your doctor if you need help quitting.

Avoid things that can irritate your lungs

These things include smoke and air pollution.

Find ways to make breathing easier

Here are some ways you can make breathing easier.

• Conserve your energy. You may get more tasks done and feel better if you learn to save energy while doing chores and other activities. For instance, take rest breaks and sit down whenever you can while you fold laundry, cook, and do other household tasks. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
• Learn breath-training methods—such as breathing through pursed lips—to improve airflow in and out of your lungs. Learn ways to clear your lungs that can help you save energy and oxygen.
• Discuss pulmonary rehabilitation with your doctor.
• Take the medicines prescribed by your doctor. If you use inhalers, be sure you know how to use each of them properly.

Stay as active as you can

Try to do activities and exercises that build muscle strength and help your heart. If you get out of breath, wait until your breathing is back to normal before you keep going.

Eat well

Getting enough to eat will help you keep up your strength. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

Avoid COVID-19, colds, and the flu

Wash your hands often. Get a flu vaccine every year. Stay up to date on your COVID-19 vaccines. And ask your doctor about getting the pneumococcal and whooping cough (pertussis) shots.

Seek education and support

Treating more than the disease and its symptoms is very important. Here are some things that can help you cope and live better with COPD.

• Educate yourself and your family about COPD and your treatment program. This helps you and your family cope with your lung disease.
• Counseling and support groups can help you learn to live with COPD. You may feel socially isolated because you can't enjoy activities with your family and friends the way you used to. But many people with COPD can lead a full life.
• Ask for help from family, friends, and health professionals. Learning that you have a disease that may shorten or change your life may lead to depression or anxiety. These can make your COPD symptoms worse. But support can make it easier.
• Try to follow your treatment plan. It may make you feel better and less likely to become depressed. A self-reward system—such as a movie night after staying on your medicine and exercise schedule for a week—can help keep you motivated.

Lung surgery is rarely used to treat COPD. Surgery is never the first treatment choice and is only considered for people who have severe COPD that has not improved with other treatment.

Surgery choices include:

Lung volume reduction surgery.

This removes part of one or both lungs. It makes room for the rest of the lung to work better. It is used only for some types of severe emphysema.

Lung transplant.

This surgery replaces a sick lung with a healthy lung from a person who has just died.

Bullectomy.

This removes the part of the lung that has been damaged by the formation of large, air-filled sacs called bullae. This surgery is rarely done.

Other procedures:

Bronchoscopic interventions.

These non-surgical techniques collapse (or close off) diseased parts of the lungs to help the remaining parts work better.

Tobacco smoking is the most important risk factor for COPD. Having asthma can also increase your risk for COPD. Other things that put you at risk include breathing in chemical fumes, industrial dust, or air pollution over a long period of time.

When you have COPD, activity and exercise can:

• Build muscle strength and endurance. This will help you be more active—you will be able to do more activities for longer amounts of time.
• Reduce shortness of breath.

Upper body exercises increase strength in arm and shoulder muscles, which provide support to the rib cage. They help in daily tasks such as carrying groceries and doing housework.

Lower body exercises develop lower body muscles and will help you move around more easily for longer periods of time.

Aerobic exercise gets more oxygen to your muscles. This allows them to work longer.

Exercises for COPD can be done nearly anywhere. They are often done as part of a pulmonary rehabilitation program.

Colds, the flu, and other upper respiratory infections can make COPD symptoms worse. These symptoms include having too much mucus in your lungs, coughing, and being short of breath.

At times, your symptoms may suddenly get much worse. These attacks are called COPD flare-ups, or exacerbations. They may be life-threatening. So it's important to keep track of your symptoms and know what to do if they get worse.

In a COPD flare-up, your usual symptoms suddenly get worse.

• You have more shortness of breath and wheezing.
• You have more coughing, with or without mucus.
• You may cough up more mucus than usual, and it may be a different color.

Your doctor can help you make a plan to manage flare-ups. Quick treatment at home may help prevent serious breathing problems.

COPD slowly damages the lungs and affects how you breathe.

COPD's effect on breathing

In COPD, the airways of the lungs (bronchial tubes) become inflamed and narrowed. They tend to collapse when you breathe out and can become clogged with mucus. This reduces airflow through the bronchial tubes. This is called airway obstruction. It makes it difficult to move air in and out of the lungs.

The inflammation of the bronchial tubes makes the nerves in the lungs very sensitive. In response to irritation, the body forces air through the airways by a rapid and strong contraction of the breathing muscles—a cough. The rapid movement of air in the breathing tubes helps remove mucus from the lungs into the throat. People with COPD often cough a lot in the morning after a large amount of mucus has built up overnight (smoker's cough).

The oxygen and carbon dioxide exchange

The lungs are where the blood picks up oxygen to deliver throughout the body and where it disposes of carbon dioxide that is a by-product of the body processes. COPD affects this process.

Emphysema can lead to destruction of the alveoli. These are the tiny air sacs that allow oxygen to get into the blood. Their destruction leads to the formation of large air pockets in the lung called bullae. These bullae do not exchange oxygen and carbon dioxide like normal lung tissue. Also, the bullae can become very large. Normal lung tissue next to the bullae can't expand as it should, reducing lung function.

Chronic bronchitis affects the oxygen and carbon dioxide exchange because the airway swelling and mucus production can also narrow the airways. This can reduce the flow of oxygen-rich air into the lung and carbon dioxide out of the lung.

The damage to the alveoli and airways makes it harder to exchange carbon dioxide and oxygen during each breath. Decreased levels of oxygen in the blood and increased levels of carbon dioxide cause the breathing muscles to contract harder and faster. The nerves in the muscles and lungs sense this increased activity and report it to the brain. As a result, you feel short of breath.

COPD is a lung disease that makes it hard to breathe. COPD stands for chronic obstructive pulmonary disease. It is caused by damage to the lungs over many years, usually from smoking.

Other things that may put you at risk for COPD include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke is also bad.

Chronic bronchitis and emphysema are two lung problems that are types of COPD. In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes) get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard for you to breathe. It can also make you cough. In emphysema, the air sacs in your lungs are damaged and lose their stretch. Less air gets in and out of your lungs, which makes you feel short of breath.

COPD is almost always caused by smoking. Most people with COPD have smoked for a long time. And research shows that smoking cigarettes puts you at risk for COPD. Over time, breathing tobacco smoke irritates the airways and damages the lungs.

People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. This is a rare condition in which your body may not be able to make enough of a protein (alpha-1 antitrypsin) that helps protect the lungs from damage.