COPD

Chronic obstructive pulmonary disease (COPD) refers to a group of lung conditions that interfere with normal breathing, including emphysema, chronic bronchitis, bronchiectasis and alpha 1 antitrypsin deficiency. These diseases cause a chronic, permanent and typically progressive obstruction of airflow in the lungs.

At UCSF, COPD experts specialize in the evaluation, diagnosis and treatment of the disease. In addition to caring for patients, we are at the forefront of basic and clinical research with the goal of better understanding the causes of COPD, as well as improving current treatments and developing new therapies.

COPD is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time.

COPD can cause coughing that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dusts—also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease.

Overview

To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called  bronchial tubes  or airways.

Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli.

Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2.

The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

• The airways and air sacs lose their elastic quality.
• The walls between many of the air sacs are destroyed.
• The walls of the airways become thick and inflamed.
• The airways make more mucus than usual and can become clogged.

Normal Lungs and Lungs With COPD

Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed cross-section of the bronchioles and alveoli. Figure B shows lungs damaged by COPD. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls.

In the United States, the term COPD includes two main conditions—emphysema and  chronic  bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.

In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe.

Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.

Outlook

COPD is a major cause of disability, and it is the third leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it.

COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.

Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person.

COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.

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Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.

In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)—a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly.

Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation  and narrowing that occurs in asthma. 

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The main risk factor for COPD is smoking. Up to 75 percent of people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke.

Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include air pollution, chemical fumes and dusts from the environment or workplace, and secondhand smoke, which is smoke in the air from other people smoking.

Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. This may occur, for example, if a person has a predisposing health issue, such as the genetic condition known as alpha-1 antitrypsin deficiency.

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You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease.

Prevent COPD Before It Starts

The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.

Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

Prevent Complications and Slow the Progression of COPD

If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above.

Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms.

Talk with your doctor about whether and when you should get flu, or influenza, and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.

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At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs  and symptoms  of COPD include:

• An ongoing cough or a cough that produces a lot of mucus; this is often called smoker's cough.
• Shortness of breath, especially with physical activity
• Wheezing or a whistling or squeaky sound when you breathe
• Chest tightness

If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza.

Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD.

If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.

Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion.

The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking.

Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance.

Some severe symptoms may require treatment in a hospital. You—or, if you are unable, family members or friends—should seek emergency care if you are experiencing the following:

• You are having a hard time catching your breath or talking.
• Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood.
• People around you notice that you are not mentally alert.
• Your heartbeat is very fast.
• The recommended treatment for symptoms that are getting worse is not working.

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Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.

Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts.

If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.

Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD.

Pulmonary Function Tests

Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Read Pulmonary Function Tests for more information.

SPIROMETRY

During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer.

The machine measures how much air you breathe out. It also measures how fast you can blow air out.

SPIROMETRY

The image shows how spirometry is done. The patient takes a deep breath and blows as hard as possible into a tube connected to a spirometer. The spirometer measures the amount of air breathed out. It also measures how fast the air was blown out.

Your doctor may have you inhale, or breathe in, medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine.

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.

The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms.

Other Tests

Your doctor may recommend other tests, such as:

• A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
• An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.

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COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease.

The goals of COPD treatment include:

• Relieving your symptoms
• Slowing the progress of the disease
• Improving your exercise tolerance or your ability to stay active
• Preventing and treating complications
• Improving your overall health

To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders.

Lifestyle Changes

QUIT SMOKING AND AVOID LUNG IRRITANTS

Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.

Also, try to avoid secondhand smoke and places with dusts, fumes, or other toxic substances that you may inhale.

For more information about how to quit smoking, read Smoking and Your Heart and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

OTHER LIFESTYLE CHANGES

If you have COPD, especially more severe forms, you may have trouble eating enough because of symptoms such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections.

Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements.

Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Medicines

BRONCHODILATORS

Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.

Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.

Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care providers to show you the correct way to use your inhaler.

If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur.

If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.

COMBINATION BRONCHODILATORS PLUS INHALED GLUCOCORTICOSTEROIDS (STEROIDS)

In general, using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation. 

Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve your breathing problems.

Vaccines

FLU SHOTS

The flu, or influenza, can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot.

PNEUMOCOCCAL VACCINE

This vaccine lowers your risk for pneumococcal pneumonia and its complications. People who have COPD are at higher risk for pneumonia than people who do not have COPD. Talk with your doctor about whether you should get this vaccine.

Pulmonary Rehabilitation

Pulmonary rehabilitation or rehab is a broad program that helps improve the well-being of people who have chronic breathing problems.

Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities.

Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs.

Oxygen Therapy

If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask.

You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them:

• Do tasks or activities while experiencing fewer symptoms
• Protect their hearts and other organs from damage
• Sleep more during the night and improve alertness during the day
• Live longer

Surgery

Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.

Surgeries for people who have COPD that is mainly related to emphysema include bullectomy and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.

BULLECTOMY

When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.

LUNG VOLUME REDUCTION SURGERY

In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.

LUNG TRANSPLANT

During a lung transplant, doctors remove your damaged lung and replace it with a healthy lung from a donor.

A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections and rejection of the transplanted lung.

If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery.

Managing Complications

COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, flu, or lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum or spit, and a fever.

Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection, along with other medicines, such as bronchodilators and inhaled steroids, to help you breathe.

Some severe symptoms may require treatment in a hospital. For more information, read Signs and Symptoms.

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COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progression of the disease.

• Avoid lung irritants.
• Get ongoing care.
• Manage the disease and its symptoms.
• Prepare for emergencies.

Avoid Lung Irritants

If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking.

Keep these irritants out of your home. If you are getting your home painted or sprayed for insects, have it done when you can stay away for a while.

If possible, keep your windows closed and stay at home when there is a lot of air pollution or dusts outside.

Get Ongoing Care

If you have COPD, it is important to get ongoing medical care. Take all your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring a list of all the medicines you are taking when you have medical checkups.

Talk with your doctor about whether and when you should get flu, or influenza, and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.

Manage COPD and Its Symptoms

You can do things to help manage COPD and its symptoms. For example:

• Do activities slowly.
• Put items you use often in one easy-to-reach place. Find simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.
• Ask for help in making things more accessible in your house so that you won't need to climb stairs as often.
• Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks.

Prepare for Emergencies

If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. For more information on severe symptoms of COPD, read Signs and Symptoms.

Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.

Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you are taking.

Emotional Issues and Support

Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also might help. If you are depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

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