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What is COPD?

Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because your airways have been narrowed.

COPD includes chronic bronchitis and emphysema –

  • In chronic bronchitis, your airways become swollen and can be filled with mucus. People with bronchitis often produce sputum, or phlegm.
  • In emphysema, the air sacs (alveoli) in your lungs are damaged. They break down and the lungs become baggy and full of holes which trap air.

These processes narrow the airways. This makes it harder to move air in and out as you breathe, and your lungs are less able to take in oxygen and get rid of carbon dioxide.

Causes

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution.

Smoking
Majority of COPD cases are caused by cigarette smoking. The toxins in cigarette smoke weaken your lungs’ defense against infections, narrow air passages, cause swelling in air tubes and destroy air sacs—all contributing factors for COPD.

Your Environment
What you breathe every day at work, home and outside can play a role in developing COPD. Long-term exposure to air pollution, secondhand smoke and dust, fumes and chemicals (which are often work-related) can cause COPD.

Alpha-1 Deficiency
This is a rare genetic (inherited) condition that affects the body’s ability to produce a protein (Alpha-1) that protects the lungs. This makes people very susceptible to develop COPD at a young age.

Symptoms

The symptoms of COPD include:

  • getting short of breath easily when you do everyday things such as going for a walk or doing housework
  • having a cough that lasts a long time
  • wheezing in cold weather
  • producing more sputum or phlegm than usual

You might get these symptoms all the time, or they might appear or get worse when you have an infection or breathe in smoke or fumes.

What’s the difference between COPD and asthma?
With COPD, your airways have become narrowed permanently – inhaled medication can help to open them up to some extent.
With asthma, the narrowing of your airways comes and goes, often when you’re exposed to a trigger. Inhaled medication can open your airways fully, prevent symptoms and relieve symptoms by relaxing your airways.
So, if your breathlessness and other symptoms are much better on some days than others, or if you often wake up in the night feeling wheezy, it’s more likely you have asthma.

Remember: Don’t wait for symptoms to become severe because valuable treatment time could be lost. Early detection of COPD is key to successful treatment.

Diagnosis

To diagnose COPD, your doctor will evaluate your symptoms, ask for your complete health history, conduct a health exam and do some tests.

Health History

Your doctor will ask if you:

  • Smoke or have a history of smoking
  • Are exposed to secondhand smoke, air pollution, chemicals or dust
  • Have symptoms such as shortness of breath, chronic cough or lots of mucus
  • Have family members who have had COPD

Testing for COPD

Spirometry: If you are at risk for COPD or have symptoms of COPD, you should be tested through spirometry. Spirometry is a simple test which measures the amount of air you blow out and how fast you can blow it.
Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.

Chest X-Ray: Your doctor may also want you to have a chest X-ray which will help the doctor see if there is damage to your lungs.

Other tests: You may also have to undergo tests to measure the amount of oxygen in your blood such as an arterial blood gas test or pulse oximetry. These tests can show how well your lungs are able to move oxygen into your blood and remove carbon dioxide from your blood.

Treatment

COPD can’t be cured, but it can be treated. Early diagnosis, lifestyle changes and appropriate drug treatments can help you lead a normal and active life, feel better and stay out of hospital.

Don’t smoke

Quitting smoking is the most important step in treating your COPD.
It helps to quit smoking, even if you already have COPD. In fact, quitting smoking is the best thing you can do to feel better. COPD will get worse if you continue to smoke or are around second-hand smoke or air pollution.

Medications

A variety of medicines are used to treat COPD. COPD medicines cannot cure COPD, but they can improve your symptoms. Your doctor will decide which medication is best for you based on the severity of your COPD, how badly it affects your daily life and any adverse effects from the medication.

The different types of COPD medicines include:

  • Bronchodilators
    Bronchodilator medicines open up the airways (breathing tubes) in your lungs. When your airways are more open, it’s easier to breathe.
  • Steroid inhaler
    If you have regular flare-ups or exacerbations of your COPD, you may also be given a steroid inhaler. This can help reduce inflammation and swelling in your airways. This sort of drug is usually given with a long-acting bronchodilator in a combination inhaler
  • Mucolytic
    If you cough up a lot of sputum, you may be given a drug called a mucolytic as a tablet or syrup. This makes your sputum thinner and easier to cough up.

Supplemental Oxygen
Sometimes with COPD, you require extra or supplemental oxygen (also called oxygen therapy). Oxygen is only useful as a treatment for people with a low oxygen level. It’s not a treatment for breathlessness, which in COPD is usually caused by difficulty moving air in and out as you breathe, rather than by a low oxygen level.

Non-invasive ventilation
This involves wearing a nasal cannula (a soft tube inserted into your nose) or face mask connected to a machine that pushes air into your lungs. Non-invasive ventilation supports your breathing to give your muscles a rest and gently helps with each breathe you take. This increases your oxygen level and helps you breathe out more carbon dioxide.

This is generally done when you are hospitalized with a flare up. If you regularly wake up with a headache, tell your doctor. It can be a sign your breathing is shallow at night and you might benefit from non-invasive ventilation at home.

Lung volume reduction surgery (LVRS)
For some people with chronic obstructive pulmonary disease (COPD), lung volume reduction surgery may be recommended. LVRS is an operation which removes the worst affected areas of your lung so that the healthier parts of your lung can work better.

If you have emphysema, this surgery can help to make your breathing more comfortable and improve your quality of life. But it’s a significant operation and does carry risks.

Lung transplant
If you have very severe COPD and have not got better with treatment, you might be a candidate for a lung transplant depending on your age, other illnesses and test findings. In a lung transplant surgeons take out one or two of the lungs and replace them with healthy lungs.

Lung transplants can improve your ability to breathe and be active. However, like any major operation, you should consider the risks and complications, such as organ rejection or needing to take immune-suppressing medications daily.

Management

Exercise and pulmonary rehabilitation
When you have COPD, the right amount and type of exercise has many benefits and is an important part of staying healthy. Don’t avoid activities that make you breathless: you’ll get less fit and out of breath more easily. Regular exercise can help reverse this by strengthening your muscles. Exercise also benefits your heart and blood pressure.

Pulmonary rehabilitation is a specialized exercise program for people with long-term lung disease like COPD. It includes sessions on quitting smoking, breathing control and energy managment as well as education on medicines – when to use them and how to use them properly. Most sessions focus on improving your exercise ability to improve your quality of life.

Controlling your breathing
There are techniques to help you reduce breathlessness. They can also help if you get out of breath suddenly. Being in control of your breathing means breathing gently, using the least effort, with your shoulders supported and relaxed.

Different things work best for different people but these are all techniques to try:

  • relaxed slow deep breathing: breathe in gently through your nose and breathe out through your nose and mouth. Try to feel relaxed and calm each time you breathe out.
  • pursed-lips breathing: breathe in gently through your nose and breathe out with your lips pursed as if you are whistling.
  • blow as you go: use this when you’re doing something that makes you breathless, such as standing up. Breathe in before you make the effort. Then breathe out while making the effort. Try using pursed lips as you breathe out.
  • paced breathing: this is useful when you’re active, such as climbing stairs. You pace your steps to your breathing. For example, breathe in when on the stair, and breathe out as you go up a stair.

Eating well and keeping a healthy weight

It’s important to eat a balanced diet and maintain a healthy weight.

  • If you’re overweight it will be harder for you to breathe and move around.
  • If you’re losing too much weight because eating makes you feel breathless, or find it difficult to shop and prepare meals, try to eat little and often.

Get vaccinated
Infections are a major cause of COPD exacerbations. Make sure you get your flu vaccine every year to protect you against the flu viruses likely to be going round over the winter.
Your doctor should also offer you a vaccination against pneumococcal infection – a bacterial infection that can cause pneumonia and other illnesses. You only need to have this once.

Managing flare-ups
A flare-up – sometimes called an exacerbation – is when your symptoms become particularly severe.
The signs of a flare-up are:

  • your breathlessness gets worse
  • you cough more
  • you produce more sputum
  • a change in the colour and consistency of your sputum

A flare-up might be triggered by an infection or there may be no apparent reason.

Make sure you act very quickly when you have a flare-up. It’s very important that you treat your COPD flare-up as early as possible.
It is best to go to the hospital emergency department.

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