About Chronic
Obstructive Pulmonary Disease
(COPD)
Chronic
obstructive pulmonary disease (COPD) is a lung disease in which
the lung is damaged, making it hard to breathe. In COPD, the
airways-the tubes that carry air in and out of your lungs-are
partly obstructed, making it difficult to get air in and
out.
Cigarette smoking is the most
common cause of COPD. Most people with COPD are smokers or
former smokers. Breathing in other kinds of lung irritants,
like pollution, dust, or chemicals over a long period of time
may also cause or contribute to COPD.
The airways branch out like an
upside-down tree, and at the end of each branch are many small,
balloon-like air sacs. In healthy people, each airway is clear
and open, the air sacs are small and dainty, and both are
elastic and springy. When you breathe in, each air sac fills up
with air, like a small balloon, and when you breathe out, the
balloon deflates and the air goes out.
In COPD,
the airways and air sacs lose their shape and become floppy.
Less air gets in and less air goes out
because:
- The
airways and air sacs lose their elasticity (like an old
rubber band)
- The
walls between many of the air sacs are
destroyed
- The
walls of the airways become thick and inflamed
(swollen)
- Cells
in the airways make more mucus (sputum) than usual, which
tends to clog the airways.
COPD
develops slowly, and it may be many years before you notice
symptoms like feeling short of breath. Most of the time, COPD
is diagnosed in middle-aged or older people.
There is no cure for COPD. The
damage to your airways and lungs cannot be reversed, but there
are things you can do to feel better and slow the damage to
your lungs.COPD is not contagious-you cannot catch it from
someone else.
Symptoms
The symptoms
of COPD include:
- Cough
- Sputum (mucus) production
- Shortness of breath, especially with
exercise
- Wheezing (a whistling or
squeaky sound when you breathe)
- Chest
tightness.
A cough
that doesn't go away and coughing up lots of mucus are common
symptoms of COPD. These often occur years before the flow of
air in and out of the lungs is reduced. However, not everyone
with a cough and sputum production goes on to develop COPD, and
not everyone with COPD has a cough.
The severity of the symptoms
depends on how much of the lung has been destroyed. If you
continue to smoke, the lung destruction is faster than if you
stop smoking.
Causes
Smoking is
the most common cause of COPD
Most cases of COPD develop after
repeatedly breathing in fumes and other things that irritate
and damage the lung and airways. Cigarette smoking is the most
common irritant that causes COPD. Pipe, cigar, and other types
of tobacco smoking can also cause COPD, especially if the smoke
is inhaled. Breathing in other fumes and dusts over a long
period of time may also cause COPD.
The lungs
and airways are highly sensitive to these irritants. They cause
the airways to become inflamed, narrowed, and destroy the
elastic fibers that allow the lung to stretch, then come back
to its resting shape. This makes breathing air in and out of
the lungs more difficult.
Other things that may irritate
the lungs and contribute to COPD include:
- Working around certain kinds of chemicals and
breathing in the fumes for many years
- Working in a dusty area over many
years
- Heavy
exposure to air pollution.
Being
around secondhand smoke (smoke in the air from other people
smoking cigarettes) also plays a role in causing
COPD.
Treatment
Quitting
smoking is the single most important thing you can do to reduce
your risk of developing COPD and slow the progress of the
disease.
Your doctor will recommend
treatments that help relieve your symptoms and help you breathe
easier. However, COPD cannot be cured.
The goals of COPD treatment are
to:
- Relieve your symptoms with no or minimal side
effects of treatment
- Slow
the progress of the disease
- Improve exercise tolerance (your ability to stay
active)
- Prevent and treat complications and sudden onset of
problems
- Improve your overall health.
The
treatment for COPD is different for each person. Your family
doctor may recommend that you see a lung specialist called a
pulmonologist (pull-mon-OL-o-gist).
Medications
Bronchodilators
Your doctor may recommend
medications called bronchodilators that work by relaxing the
muscles around your airways. They help open your airways
quickly and make breathing easier. Bronchodilators can be
either short-acting or long-acting.
- Short-acting bronchodilators last about 4 to 6
hours and are used only when needed.
- Long-acting bronchodilators last about 12 hours or
more and are used every day.
Most
bronchodilator medications are inhaled, so they go directly
into your lungs where they are needed. There are many kinds of
inhalers, and it is important to know how to use your inhaler
correctly.
Inhaled Glucocorticosteroids
(Steroids)
Inhaled steroids are used for
some people with moderate or severe COPD. Inhaled steroids work
to reduce airway inflammation. Your doctor may recommend that
you try inhaled steroids for 6 weeks to 3 months to see if the
medication is helping with your breathing problems.
Flu Shots
The flu (influenza) can cause
serious problems in people with COPD. Flu shots can reduce the
chance of getting the flu. You should get a flu shot every
year.
Pneumococcal Vaccine
This vaccine should be
administered to those with COPD to prevent a common cause of
pneumonia. Revaccination may be necessary after 5 years in
those over 65 years old.
Pulmonary Rehabilitation
(Pulmonary Rehab)
Pulmonary rehab is a coordinated
program of exercise, disease management training, and
counseling that can help you stay more active and carry out
your day-to-day activities. What is included in your pulmonary
rehab program will depend on what you and your doctor think you
need.
It may
include exercise training, nutrition advice, education about
your disease and how to manage it, and counseling.
Oxygen Treatment
If you have severe COPD and low
levels of oxygen in your blood, your doctor may recommend
oxygen therapy to help with your shortness of
breath.
This means
you are not getting enough oxygen on your own. You may need
extra oxygen all the time or some of the time. For some people
with severe COPD, using extra oxygen for more than 15 hours a
day can help them:
- Do
tasks or activities with less shortness of
breath
- Protect the heart and other organs from
damage
- Sleep
more during the night and improve alertness during the
day
- Live
longer.
Natural
Remedies
N-acetyl
cysteine(NAC) helps break down mucus. For that reason, inhaled
NAC is used in hospitals to treat bronchitis. NAC may also
protect lung tissue through its antioxidant activity. Oral NAC,
200 mg taken three times per day, is also effective and
improved symptoms in people with bronchitis in double-blind
research. Results may take six months.
References for COPD
Article
- Van Schayck CP, Dekhuijzen PN, Gorgels WJ,
et al. Are anti-oxidant and anti-inflammatory treatments
effective in different subgroups of COPD? A
hypothesis. Respir
Med 1998;92:1259–64.
- Boman G, Bäcker U, Larsson S, et al. Oral
acetylcysteine reduces exacerbation rate in chronic
bronchitis: a report of a trial organized by the Swedish
Society for Pulmonary Diseases.
Eur J Respir
Dis 1983;64:405–15.
- Multicenter Study Group. Long-term oral
acetylcysteine in chronic bronchitis. A double-blind
controlled study. Eur J Respir
Dis 1980;61:111:93–108.
- Dal Negro R, Pomari G, Zoccatelli O, Turco
P. L-carnitine and rehabilitative respiratory
physiokinesitherapy: metabolic and ventilatory response in
chronic respiratory insufficiency.
Int J Clin Pharmacol
Ther Toxicol 1986;24:453–6.
- Dal Negro R, Turco P, Pomari C, De Conti
F. Effects of L-carnitine on physical performance in
chronic respiratory insufficiency.
Int J Clin Pharmacol
Ther Toxicol 1988;26:269–72.
- Sridhar MK. Nutrition and lung
health. BMJ 1995;310:75–6.
- Shahar E, Folsom AR, Melnick SL, et al.
Dietary n-3 polyunsaturated fatty acids and smoking-related
chronic obstructive pulmonary disease. Atherosclerosis Risk
in Communities Study Investigators.
N Engl J
Med 1994;331:228–33.
- National Institutes of
Health
| 
Medical Research