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What is Chronic obstructive pulmonary disease (COPD) ?

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

What are the symptoms of chronic obstructive pulmonary disease ?

COPD symptoms often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. Signs and symptoms of COPD may include :

Shortness of breath, especially during physical activities
 Wheezing
 Chest tightness
 Having to clear your throat first thing in the morning, due to excess mucus in your lungs
 A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
 Blueness of the lips or fingernail beds (cyanosis)
 Frequent respiratory infections
 Lack of energy
 Unintended weight loss (in later stages)
 Swelling in ankles, feet or legs

People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.

What are some causes of Chronic obstructive pulmonary disease (COPD) ?

It’s caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.

In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin.

What are some types of Chronic obstructive pulmonary disease (COPD) ?

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

What are some risk factors for COPD ?

Risk factors for COPD include :

– Exposure to tobacco smoke : The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.
– People with asthma who smoke : The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more.
– Occupational exposure to dusts and chemicals : Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
– Exposure to fumes from burning fuel : In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.
COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. 

What are some complications of COPD ?

COPD can cause many complications, including :

– Respiratory infections : People with COPD are more likely to catch respiratory infection. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.
– Heart problems : COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk.
– Lung cancer : People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk.
– High blood pressure in lung arteries : COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

How is COPD diagnosed ?

To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you’ve had to lung irritants such as cigarette smoke. Your doctor may order several tests to diagnose your condition.

Tests may include :

– Lung function tests : Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood.
– Spirometry : It is the most common lung function test. During this test, you’ll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration.
– Chest X-ray : A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.
– CT scan : A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer.
– Arterial blood gas analysis : This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.
– Laboratory tests : Laboratory tests aren’t used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. An  alpha-1-antitrypsin (AAt) deficiency test test may be done if you have a family history of COPD and develop COPD at a young age.

How is COPD treated ?

Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Smoking cessation

The most essential step in any treatment plan for COPD is to stop all smoking. It’s the only way to keep COPD from getting worse. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. It’s also a good idea to avoid secondhand smoke exposure whenever possible.

Medications

Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed.

Bronchodilators

These medications relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both.

Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA), levalbuterol (Xopenex HFA), and ipratropium (Atrovent).

long-acting bronchodilators include tiotropium (Spiriva), salmeterol and, formoterol.

Inhaled steroids

Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent HFA) and budesonide (Pulmicort) are examples of inhaled steroids.

Oral steroids

For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

Theophylline

This may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended.

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren’t generally recommended for prevention.

Lung therapies

These additional therapies for people with moderate or severe COPD:

– Oxygen therapy : If there isn’t enough oxygen in your blood, you may need supplemental oxygen. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time.
– Pulmonary rehabilitation program : These programs generally combine education, exercise training, nutrition advice and counseling.
– Lung volume reduction surgery : Surgery is an option for some people with some forms of severe emphysema who aren’t helped sufficiently by medications alone. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently.
– Lung transplant : Lung transplantation may be an option for certain people who meet specific criteria. Transplantation is a major operation that has significant risks, such as organ rejection, and it’s necessary to take lifelong immune-suppressing medications.
Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve air flow.