Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow.

The main symptoms include shortness of breath and cough with sputum production.

COPD is a progressive disease, meaning it typically worsens over time.

Eventually, everyday activities such as walking or getting dressed become difficult.

Chronic bronchitis and emphysema are older terms used for different types of COPD.

The term “chronic bronchitis” is still used to define a productive cough that is present for at least three months each year for two years.

Those with such a cough are at a greater risk of developing COPD. The term “emphysema” is also used for the abnormal presence of air or other gas within tissues.

Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.

Most cases of COPD can be prevented by reducing exposure to risk factors.

This includes decreasing rates of smoking and improving indoor and outdoor air quality.

While treatment can slow worsening, no cure is known.

COPD treatments include smoking cessation, vaccinations, respiratory rehabilitation, and often inhaled bronchodilators and steroids.

Some people may benefit from long-term oxygen therapy or lung transplantation.

In those who have periods of acute worsening, increased use of medications and hospitalization may be needed.

Signs and symptoms

Wheezing

The sound of wheezing as heard with a stethoscope.

The most common symptoms of COPD are sputum production, shortness of breath, and a productive cough.

These symptoms are present for a prolonged period of time and typically worsen over time.

Cough

A chronic cough is often the first symptom to develop.

Early on it may just occur occasionally or may not result in sputum.

When a cough persists for more than three months each year for at least two years, in combination with sputum production and without another explanation, it is by definition chronic bronchitis.

Chronic bronchitis can occur before the restricted airflow and thus COPD fully develops.

The amount of sputum produced can change over hours to days. In some cases, the cough may not be present or may only occur occasionally and may not be productive.

Vigorous coughing may lead to rib fractures or a brief loss of consciousness.

Those with COPD often have a history of “common colds” that last a long time.

Shortness of breath

Shortness of breath is often the most common symptom that bothers most people. It is commonly described as: “my breathing requires effort,” “I feel out of breath,” or “I can’t get enough air in”.

Typically, the shortness of breath is worse on exertion of a prolonged duration and worsens over time.

In the advanced stages or end-stage pulmonary disease, it occurs during rest and maybe always present. It is a source of both anxiety and a poor quality of life in those with COPD.

Many people with more advanced COPD breathe through pursed lips and this action can improve shortness of breath in some.

Other symptoms

In COPD, breathing out may take longer than breathing in. Chest tightness may occur, but is not common and may be caused by another problem.

Advanced COPD leads to high pressure on the lung arteries, which strains the right ventricle of the heart.

This situation is referred to as cor pulmonale, and leads to symptoms of leg swelling and bulging neck veins.

COPD often occurs along with a number of other conditions, due in part to shared risk factors.

These conditions include ischemic heart disease, high blood pressure, diabetes mellitus, muscle wasting, osteoporosis, lung cancer, anxiety disorder, sexual dysfunction, and depression.

Exacerbation

An acute exacerbation of COPD is defined as increased shortness of breath, increased sputum production, a change in the color of the sputum from clear to green or yellow, or an increase in cough.

Cause

The primary cause of COPD is tobacco smoke, with occupational exposure and pollution from indoor fires being significant causes in some countries. Typically, these must occur over several decades before symptoms develop.

Smoking

The primary risk factor for COPD globally is tobacco smoking.

Air pollution

People who live in large cities have a higher rate of COPD compared to people who live in rural areas.

Occupational exposure

Intense and prolonged exposure to workplace dust, chemicals, and fumes increase the risk of COPD in both smokers and nonsmokers.

COPD is a type of obstructive lung disease in which chronic, incompletely reversible poor airflow (airflow limitation) and inability to breathe out fully (air trapping) exist.

The poor airflow is the result of breakdown of lung tissue (known as emphysema), and small airways disease known as obstructive bronchiolitis.

Severe destruction of small airways can lead to the formation of large focal lung pneumatoses, known as bullae, that replace lung tissue. This form of disease is called bullous emphysema.

Narrowing of the airways occurs due to inflammation and scarring within them. This contributes to the inability to breathe out fully.

The greatest reduction in air flow occurs when breathing out, as the pressure in the chest is compressing the airways at this time.

This can result in more air from the previous breath remaining within the lungs when the next breath is started, resulting in an increase in the total volume of air in the lungs at any given time, a process called hyperinflation or air trapping.

Low oxygen levels, and eventually, high carbon dioxide levels in the blood, can occur from poor gas exchange due to decreased ventilation from airway obstruction, hyperinflation, and a reduced desire to breathe.

During exacerbations, airway inflammation is also increased, resulting in increased hyperinflation, reduced expiratory airflow, and worsening of gas transfer. This can also lead to insufficient ventilation, and eventually low blood oxygen levels.

Diagnosis

The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath, a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease.

Spirometry is then used to confirm the diagnosis.

Spirometry

Spirometry measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator, a medication to open up the airways.

Two main components are measured to make the diagnosis.\

!. The forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in the first second of a breath

2. The forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a single large breath.

Other tests

A chest X-ray and complete blood count may be useful to exclude other conditions at the time of diagnosis.

Characteristic signs on X-ray are overinflated lungs, a flattened diaphragm, increased retrosternal airspace, and bullae, while it can help exclude other lung diseases, such as pneumonia, pulmonary edema, or a pneumothorax.

A high-resolution computed tomography scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.

Differential diagnosis

COPD may need to be differentiated from other causes of shortness of breath such as congestive heart failure, pulmonary embolism, pneumonia, or pneumothorax.

Many people with COPD mistakenly think they have asthma.

The distinction between asthma and COPD is made on the basis of the symptoms, smoking history, and whether airflow limitation is reversible with bronchodilators at spirometry.

Prevention

Most cases of COPD are potentially preventable through decreasing exposure to smoke and improving air quality.

Management

No cure for COPD is known, but the symptoms are treatable and its progression can be delayed.

Bronchodilators

Inhaled bronchodilators are the primary medications used, and result in a small overall benefit. The two major types, both exist in long-acting and short-acting forms.

Corticosteroids

Corticosteroids are usually used in inhaled form, but may also be used as tablets to treat and prevent acute exacerbations.

While inhaled corticosteroids (ICSs) have not shown benefit for people with mild COPD, they decrease acute exacerbations in those with either moderate or severe disease.

Oxygen

Supplemental oxygen is recommended in those with low oxygen levels.

Surgery

For those with very severe disease, surgery is sometimes helpful and may include lung transplantation or lung volume reduction surgery, which involves removing the parts of the lung most damaged by emphysema, allowing the remaining, relatively good lung to expand and work better.

COPD usually gets gradually worse over time and can ultimately result in death.

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