Chronic obstructive pulmonary disease

Medically reviewed: 24, January 2024

What is Chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) encompasses a group of respiratory conditions, such as chronic bronchitis, emphysema, and chronic obstructive airways disease, which can coexist and affect the lungs.

COPD is one of the most common respiratory diseases in the United States. It causes 300, 000 deaths a year, which is about 20 times more than asthma. Chronic obstructive pulmonary disease occurs as a result of damage to the lungs.

The main result of having damaged lungs, usually through smoking, is difficulty with breathing.

These breathing problems gradually get worse and worse, resulting in decreased quality of life and even heart failure.

The symptoms of chronic obstructive pulmonary disease can appear similar to those of asthma. However, whereas asthma can be controlled with treatment, chronic obstructive pulmonary disease causes permanent damage to the lungs, from which they cannot recover.

Symptoms of Chronic obstructive pulmonary disease

People who smoke are at much higher risk of COPD. The condition builds up over a number of years, as the lungs are gradually being damaged more and more by smoking, and does not usually become noticeable after the age of 40.

Symptoms include:

• recurring lung and chest infections
• exacerbation (flare-ups) of breathlessness and phlegm/mucus.

In the early hours of the morning, when the sun is barely rising and the air is still crisp, a smoker’s cough emerges, echoing through the silence. It is a persistent cough that lingers, refusing to be silenced. Alongside this cough comes the presence of mucus and phlegm, a thick and sticky substance that clings to the throat, causing discomfort and irritation.

As the cough persists, wheezing can be heard, a sound resembling a strained whistle struggling to escape from within. The chest tightens, constricting like a vice grip, making it difficult to take in a full and satisfying breath.

Every inhalation becomes a struggle, as if one is fighting against an invisible force that seeks to limit their oxygen supply. The simple act of breathing becomes a challenge, leaving one feeling a sense of panic and helplessness. It is as if the air is being stolen away, leaving only a sense of shortness of breath that lingers, a constant reminder of the body’s struggle to find relief.

These symptoms are often worse in the winter and it is common for people with chronic obstructive pulmonary disease to have two or more acute attacks a year.

People who live with chronic obstructive pulmonary disease are often anxious about their condition and can feel depressed and isolated. chronic obstructive pulmonary disease can affect work, hobbies, exercise and socializing as well as impacting on relationships, particularly physical ones.

COPD can lead to significant weight loss and muscle wasting, which can eventually result in heart failure. The amount of exertion it takes to breathe and keep up with normal daily activities often means an inadequate oxygen supply to the heart and other muscles.

Causes of Chronic obstructive pulmonary disease

The primary factor influencing the development of COPD is smoking, with the risk of developing the condition escalating in correlation to the amount and duration of smoking. Additionally, although less prevalent, passive smoking, environmental pollution, exposure to fumes, and inhalation of dust particles are also recognized as contributing factors to chronic obstructive pulmonary disease.

If the airways of the lungs (bronchi) are inflamed or the air sacs (alveoli) are damaged and the airways narrowed, you will have difficulty breathing in and out.

Diagnosis of Chronic obstructive pulmonary disease

People who live with COPD are often short of breath, have a persistent cough and a build up of phlegm.

The following tests can be carried out to eliminate other conditions, such as asthma:

• Spirometry (breathing test)

This is the usual test to diagnose chronic obstructive pulmonary disease. The doctor will ask you to breathe in and out of a tube that is connected to a machine, to see if your airways are narrowed. You may have your ‘peak respiratory flow’ measured or have to expel air from your lungs after using an inhaler. If there is no improvement after using the inhaler, it is more likely that you have chronic obstructive pulmonary disease than asthma.

• Chest Radiography

This is an x-ray that will show any hyperinflation (excessive growth) of the lungs.

• CT scan

This is more sensitive than a chest radiography and is particularly useful in diagnosing another lung disease called emphysema.

Treatment of Chronic obstructive pulmonary disease

The best way to prevent COPD is not to smoke cigarettes or if you already smoke, to give up as soon as possible, as the progress of the disease can be slowed. It is also important to avoid other people’s smoke and smoky environments.

As there is no cure for chronic obstructive pulmonary disease, treatment is mainly used to treat and relieve symptoms:

• Regular exercise will help to strengthen the heart and lungs and improve breathing.
• A balanced diet, including vitamin C and zinc, is very important for keeping the immune system healthy.
• Drinking lots of fluids, especially water will help to reduce phlegm and mucus.

Symptoms of chronic obstructive pulmonary disease such as mucus and generally feeling ‘blocked up’ and unable to breathe properly can be relieved with steam inhalation or a humidifier in the home.

Physiotherapy can helps to clear mucus and phlegm.

The physiotherapist will be able to teach you exercises to do at home. Arm exercises can improve symptoms and are not as tiring as leg exercises.

People living with COPD are at risk of catching other illnesses so it is important to have the flu vaccine every year and the pneumonia vaccine every 5-10 years.

Medical therapy

Bronchodilators are the main treatment for relieving symptoms of chronic obstructive pulmonary disease. They widen the airways and are usually taken by inhaler (but can be taken in tablet form). They are also used for asthma.

Corticosteroids / steroids make the airways less inflamed and are also taken by inhaler or in tablet form. Antibiotics can be taken in conjunction with steroids when the condition flares up.

Mucolytics are taken in capsules or tablets and make the phlegm and mucous thinner. They are only available on prescription. Mucolytics are especially beneficial for flare-ups or irregular worsening of your condition.

A nebuliser can be used for very severe chronic obstructive pulmonary disease. A fine mist is sprayed in liquid form, which means that a larger dose of medication can be taken at one time. Before starting this treatment, your GP or specialist will test to make sure the nebuliser is suitable for you.

Long-term oxygen therapy

In extreme cases, when the oxygen in the blood is low, oxygen may be taken from an electronically operated ‘oxygen concentrator’ through nasal tubes or a mask.

In order to ensure optimal usage, the machine necessitates a minimum duration of 15 hours per day.

However, fret not as the tubes connecting you to the machine are designed to be exceptionally lengthy, granting you the freedom to roam and explore your humble abode while remaining seamlessly connected. In addition to portable oxygen tanks, there is the possibility of liquid oxygen becoming available in the near future.

It is vital not to smoke whilst you are taking oxygen, not only because it will affect your treatment, but also because of the fire risk.

Pulmonary Rehabilitation programs

This is a tailored form of therapy that improves respiratory symptoms and sleep, and increases exercise capacity, mobility and self-confidence. The program involves education, exercise, psychological support, smoking cessation advice and nutritional assessment. It takes place in a group setting and lasts about six weeks.

Patients learn more about their disease and how to control their symptoms. Pulmonary rehabilitation can greatly improve your quality of life.

Hospitalization

This may be necessary if you have lost a lot of weight or are finding it very difficult to breathe. A stay in hospital is nearly always more effective than resting at home as your respiration levels can be constantly monitored.

Lung transplantation

This is rare and usually only suggested for patients with a life expectancy of less than two years. The operation can be very successful, but the patient will need to take anti-rejection drugs for the rest of their life (these help the body accept a new organ but can have unpleasant side effects).

LVRS (Lung Volume Reduction Surgery)

Damaged parts of the lung are removed during surgery. This can help symptoms, but patients are at risk from catching pneumonia or developing an air leak where the lung is re-sealed.

Prevention of Chronic obstructive pulmonary disease

The only way to really prevent COPD is not to smoke. Once diagnosed, giving up smoking may help slow the progress of the disease and increase life expectancy, but symptoms may not improve as the damage to the lungs has already been done.