Lung conditions - chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is an umbrella term for a number of lung diseases that prevent proper breathing. Three of the most common are emphysema, chronic bronchitis and chronic asthma that is not fully reversible. These conditions can occur on their own or together.

The main symptoms of COPD are breathlessness, a chronic cough and the production of sputum (mucus or phlegm). Cigarette smokers and ex-smokers are most at risk.

There is no cure for COPD, and the damaged airways do not regenerate. However, there are things you can do to slow the progress of the disease, improve your symptoms, stay out of hospital and live longer.

Symptoms of COPD#

Symptoms can include:

• Breathlessness after exertion and, in severe cases, on minimal exertion or even at rest
• Wheezing
• Coughing, often bringing up sputum (mucus or phlegm)
• Fatigue
• Cyanosis – a blue tinge to the skin caused by insufficient oxygen
• Increased susceptibility to chest infections

COPD often develops so slowly that you may not notice your breathing gradually becoming impaired. The damage to the lungs can be considerable before symptoms are severe enough to be obvious.

How the lungs work#

The lungs are spongy lobes inside the chest, protected by the ribcage. Inhaled air travels down the trachea (windpipe) into two tubes (bronchi), one to each lung. The bronchi divide into smaller tubes called bronchioles, and these branch further into tiny air sacs called alveoli. Each alveolus is wrapped in a fine mesh of capillaries where oxygen and carbon dioxide are exchanged.

Oxygen dissolves and moves across a thin film of moisture from the air sac into the bloodstream. The oxygen-rich blood travels to the heart and is then pumped around the body. At the same time, carbon dioxide passes from the capillaries into the air sacs and is breathed out.

How COPD affects the lungs#

In emphysema, the alveoli and bronchi are damaged. The weakened and ruptured air sacs cannot move oxygen into the blood efficiently. As more air sacs are damaged, you may eventually feel breathless even at rest.

Bronchitis means inflammation of the bronchi. The lungs normally make a small amount of fluid to stay healthy, but chronic bronchitis causes too much fluid to be produced. This leads to frequent, productive coughing that brings up mucus or phlegm.

Complications of COPD#

If you have COPD you are at increased risk of a number of complications, including:

• Collapsed lung – the lung may develop an air pocket, and if this bursts during a coughing fit the lung can deflate.
• Osteoporosis – bones become thin and break more easily; steroid use in COPD is thought to contribute.
• Anxiety and depression – breathlessness, or the fear of it, can lead to these feelings.
• Low blood oxygen (hypoxaemia) – a lack of oxygen reaching the brain can cause cognitive difficulties such as confusion, memory lapses and depression.
• Pneumonia and other chest infections – even a common cold can lead to a severe infection.
• Heart problems – the heart has to work very hard to pump blood through the damaged lungs.
• Fluid retention (oedema) – circulation problems can cause fluid to pool, particularly in the feet and ankles.

As symptoms progress, many people reduce their physical activity to avoid breathlessness. They then become less fit and more breathless on exertion. This downward spiral of inactivity makes a range of further problems more likely, such as obesity and cardiovascular disease.

Causes and risk factors#

The main causes and risk factors include:

• Cigarette smoking – the most significant risk factor. Around 20 to 25 per cent of smokers will develop COPD. Ex-smokers remain at risk and should watch for breathlessness.
• Long-term exposure to lung irritants – such as chemical vapours or dust from grain or wood. Severe air pollution can make COPD worse.
• Genetic factors – a disorder known as alpha-1-antitrypsin deficiency can trigger emphysema even when no other risk factors are present.

Diagnosis#

COPD is diagnosed mainly with a breathing test called spirometry, which can be done in a general practice, a specialised laboratory or by a specialist. Other tests may include a physical examination, a review of your medical history, gas transfer and lung volume tests, blood tests, sputum analysis, a chest x-ray and a computed tomography (CT) scan.

Treatment for COPD#

There is no cure, and damaged lung tissue does not repair itself, but treatment can slow the disease, ease symptoms and help you live longer. Options may include:

• Bronchodilator medication to open the airways, usually given by a puffer
• Corticosteroids to reduce inflammation and swelling of lung tissue, usually given by a puffer to minimise side effects
• Expectorants to loosen phlegm and make it easier to cough up
• Oxygen therapy for people with low blood oxygen levels. The body can tolerate low oxygen for short periods, but low oxygen over long periods can harm vital organs. Home oxygen therapy helps return blood oxygen to normal, may prolong life and can improve quality of life, although it does not always relieve shortness of breath.
• Treatment for chest infections, such as antibiotics for current infections, plus pneumonia and influenza vaccinations to reduce future infections
• Pulmonary rehabilitation – an individual assessment followed by supervised exercise training and education, usually run over about eight weeks, with re-assessment and referral to an ongoing maintenance exercise program at the end
• Surgery – lung volume reduction surgery is an option for a small number of people, in which diseased portions of lung are removed so healthier tissue can expand and contract better. Endobronchial valves can also be used to reduce lung volume.
• Ongoing monitoring – regular medical check-ups

Lifestyle changes#

Helpful lifestyle changes include:

• Quitting smoking – approaches include stopping abruptly, counselling, nicotine replacement therapy and medicines that act on brain receptors. Evidence shows that counselling together with medical therapy is most effective.
• Being as physically active as possible and, where you can, attending pulmonary rehabilitation
• Following a COPD action plan
• Eating a healthy diet and making sure you get plenty of rest
• Staying well hydrated to help keep the mucus in your lungs runny and easier to cough up
• Avoiding smoky or dusty environments
• Joining a support group

Key points#

• The main symptoms of COPD are breathlessness, a chronic cough and sputum (mucus or phlegm) production.
• Cigarette smokers and ex-smokers are most at risk of COPD.
• Symptoms include an increased susceptibility to chest infections.
• The damage to the lungs can be considerable before symptoms are severe enough to notice.
• Smoking is the most significant cause and risk factor for COPD.

Where to get help#