Chronic obstructive pulmonary... Health Article

Definition

Chronic obstructive pulmonary disease (COPD) is lung disease that makes it difficult to breathe. Most people with COPD have both emphysema and chronic bronchitis.

Alternative Names

COPD; Chronic obstructive airway disease; Chronic obstructive lung disease; Emphysema; Chronic bronchitis

Causes, incidence, and risk factors

The leading cause of COPD is smoking. Between 15 - 20% of long-term smokers will develop COPD. Using tobacco for a long time causes lung inflammation and destroys air sacs in the lungs. (In rare cases, non-smokers who lack a protein called alpha-1 anti-trypsin can develop emphysema.)

Other risk factors for COPD are:

• Exposure to certain gases or fumes in the workplace
• Exposure to heavy amounts of secondhand smoke and pollution
• Frequent use of cooking gas without proper ventilation

Symptoms

• Cough
• Decreased exercise tolerance
• Shortness of breath (dyspnea) lasting for months to years
• Wheezing

Some people, even those with severe COPD, have few or no symptoms.

Signs and tests

People with COPD may make wheezy air sounds, difficult-to-hear air sounds, or normal sounds when the doctor listens to them during an exam. In severe cases, a person with COPD can seem anxious and may breathe through pursed lips (the shape lips make when you whistle).

During a flare of the disease, the muscles between the ribs contract while the person is breathing in (intercostal retraction) and the person will use other muscles to breathe. The number of breaths per minute (respiratory rate) may be high.

A chest x-ray may show that the lung is expanding too much (hyperinflation). A chest CT scan may show emphysema.

A sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis). The best test for COPD is lung function testing.

Treatment

Treatment for COPD includes inhalers that open the airways (bronchodilators) and sometimes theophylline. Patients with COPD must stop smoking. In some cases inhaled steroids are used to reduce lung inflammation. In severe cases or flare-ups, the health care provider may prescribe steroids through a vein (intravenous) or by mouth (oral).

Antibiotics are used during flare-ups of symptoms, because infections can make COPD worse. Some people may need chronic, low-flow oxygen, non-invasive ventilation, or a tube to get oxygen (intubation). Surgery to remove parts of the diseased lung may be helpful for some patients with COPD.

Lung rehabilitation does not cure the lung disease, but it teaches a patient to breathe in a different way so they can stay active.

Lung transplant is sometimes performed for severe cases.

Support Groups

People often can help ease the stress of illness by joining a support group in which members share common experiences and problems.

See also: Lung disease - support group

Expectations (prognosis)

This condition is a long-term (chronic) illness. The disease will get worse if patients keep using tobacco.

Complications

• Arrhythmias
• Need for breathing machine and oxygen therapy
• Pneumonia
• Pneumothorax
• Right-sided heart failure or cor pulmonale (enlargement of the heart and heart failure from chronic lung disease)

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath or if you develop complications.

Prevention

Not smoking prevents most COPD. In people who smoke, finding and treating small airway disease and taking part in stop-smoking programs may prevent the disease from getting worse.

References

Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007.