Chronic obstructive pulmonary disease (COPD) is an umbrella term for conditions that obstruct the air passages (bronchi) or damage the small air sacs (alveoli) in the lungs, resulting in progressively impaired breathing. Two primary disorders that constitute COPD are emphysema and chronic bronchitis; many patients with COPD exhibit a combination of both.
Chronic bronchitis is a persistent inflammation of the bronchial tubes in the lungs, producing a recurrent cough with large amounts of mucus. When the cells lining the airways are irritated beyond a certain point, the tiny cilia (hairlike projections) that normally trap and eliminate foreign matter cease to function properly. The buildup of irritants leads to the production of excess mucus, which clogs air passages and produces the characteristic heavy cough of bronchitis. Bronchitis is classified as chronic when the patient coughs up sputum most of the days of a three-month period, two consecutive years in a row.
Emphysema is progressive damage to the lungs, resulting from destruction of tissue and loss of elasticity in the alveoli, where oxygen enters and carbon dioxide exits the bloodstream. If the lungs are damaged by the chemicals in cigarette smoke or by the persistent inflammation and coughing of chronic bronchitis, the delicate walls of the alveoli may become progressively enlarged, inelastic, and far less functional.
The loss of elasticity, often combined with narrowing of the small airways in the lungs (sometimes to the point of collapse), traps stale air instead of allowing it to be exhaled. The affected air sacs are thus unable to deliver oxygen to the bloodstream or to remove carbon dioxide—contributing to the characteristic shortness of breath of emphysema.
Lung damage may progress until breathing is severely impaired, at which time the condition is potentially life-threatening. Low blood-oxygen levels may cause the pressure in the pulmonary arteries to become elevated (pulmonary hypertension), which in turn may prevent the right side of the heart from adequately pumping blood through the lungs.
The onset of COPD is usually very gradual. It develops over a number of years, and symptoms may not appear until COPD has already progressed quite far. Lung damage is permanent, but it is preventable in many cases by avoiding smoking. COPD is two to three times more common in men than in women.
Symptoms of COPD
- Shortness of breath, worse with exertion.
- Wheezing.
- A persistent, mucus-producing cough, especially in the morning (a symptom of chronic bronchitis).
- A chronic dry cough (a symptom of emphysema).
- In severe cases, symptoms of COPD may include coughing up blood, chest pain, and blue-purple complexion.
- Swollen legs and ankles from right-sided heart failure (cor pulmonale).
- Difficulty in exhaling.
What Causes COPD?
- Smoking is the most common cause of COPD.
- Air pollution may be a contributing factor in developing COPD.
- Industrial or chemical fumes can damage the airways.
- Repeated viral or bacterial lung infections may thicken the lining of the bronchial walls, narrow the airways, and stimulate excessive mucus production in the lungs.
- A hereditary deficiency of the enzyme alpha-1-antitrypsin may cause the walls of the alveoli to break down.
- People with occupations that require constant exposure to dust, chemicals, or other lung irritants or that require heavy use of the lungs, such as glass-blowing or playing a wind musical instrument, may be more susceptible to emphysema.
- Young children living with heavy smokers are more susceptible to chronic respiratory inflammation.
Prevention of COPD
- Don’t smoke (smoking is the primary cause of COPD).
- Avoid spending long periods outside on days when the air quality is poor.
Diagnosis of COPD
- Patient history and physical examination are needed.
- A sputum sample may be taken for analysis.
- Blood samples will be taken from both an artery and a vein (to measure oxygen and carbon dioxide levels).
- A chest x-ray will be performed.
- Spirometry and various other pulmonary-function tests that measure breathing capacity and efficiency will be done.
- Tests that measure the strength and efficiency of the heart muscle may be ordered.
How To Treat COPD
- Don’t smoke; avoid smoke-filled rooms.
- Drink plenty of fluids to loosen mucus secretions. Avoid caffeine and alcohol, however, since they have a diuretic effect and may lead to dehydration.
- Moisten indoor air with a cool-mist humidifier.
- Try to avoid going outside on cold days or days when the air quality is poor, and avoid exposure to cold, wet weather. If bronchitis is advanced and unrelenting, you may want to consider moving to a warmer and drier climate.
- Don’t use cough suppressants. Coughing is necessary to clear accumulated mucus from the lungs, and suppressing it may potentially lead to serious complications.
- A viral respiratory tract infection may trigger a flare-up of symptoms; decrease the risk of catching one by minimizing contact with people suffering from respiratory infections and washing your hands often. Get vaccinated for influenza (annually) and pneumonia (a one-time inoculation).
- A bronchodilator may be prescribed to widen the bronchial passages. Oxygen may be administered in more severe cases of COPD.
- Your doctor may prescribe antibiotics to treat or to prevent bacterial lung infections, since patients with COPD are more susceptible to these. Antibiotics should be taken for the full term prescribed.
- Your doctor may instruct you on how to drain mucus from your lungs by assuming various positions that lower your head below your torso (a technique known as postural drainage).
- Breathing exercises (as instructed by your doctor) may prove beneficial in treating COPD.
- In very severe cases of emphysema with extensive lung damage, a lung transplant may be advised (heart-and-lung transplants are advised if progressive lung disease has weakened the heart).
When To Call A Doctor
- Call a doctor if symptoms of COPD become severe; for example, if shortness of breath or chest pain becomes more intense, your cough worsens or you cough up blood, you develop a fever, you begin to vomit, or your legs and ankles swell more than usual.
- Make an appointment with a doctor if you have experienced a recurrent, persistent, mucus-producing cough for parts of the last two years, or if you experience persistent shortness of breath.
- Emergency: Get medical assistance immediately if your lips or complexion turn bluish or purplish.
For more information o COPD and related lung diseases, click on this link -- Johns Hopkins Health Alerts: Lung Diseases
