Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that makes it difficult to breathe. The condition causes damage to the airways and air sacs in your lungs, often as a result of long-term exposure to irritants like tobacco smoke. The two main conditions that fall under the umbrella of COPD are emphysema and chronic bronchitis, and most people with COPD have some combination of both. 

Signs and symptoms

In its early stages, COPD may not cause noticeable symptoms, and many people mistake a persistent cough for a "normal smoker's cough". As the disease progresses, symptoms become more severe and can interfere with daily life. 

Common symptoms:

  • Shortness of breath (dyspnea): A feeling of being unable to catch your breath, especially during physical activity like walking or climbing stairs. In advanced COPD, this can happen even while resting.

  • Chronic cough: An ongoing cough that is often the first symptom to appear.

  • Sputum (phlegm) production: A cough that brings up mucus that can be clear, white, yellow, or greenish.

  • Wheezing: A whistling or squeaky sound when you breathe.

  • Chest tightness: A feeling of pressure or heaviness in the chest.

  • Fatigue: Feeling unusually tired or having a lack of energy.

  • Frequent respiratory infections: People with COPD are more prone to colds, the flu, and pneumonia.

  • Swelling: As COPD progresses, swelling in the ankles, feet, or legs can occur. 

Flare-ups (exacerbations)

People with COPD can experience sudden and severe worsening of their symptoms, known as a flare-up or exacerbation. These can be triggered by infections, cold air, or pollution and may require additional medication or hospitalization. 

Diagnosis

To diagnose COPD, a doctor will consider your symptoms, medical history, and risk factors.

  • Medical and smoking history: Your doctor will ask about any history of smoking, exposure to secondhand smoke, or workplace irritants like dust or chemical fumes.

  • Physical exam: The doctor will listen to your lungs with a stethoscope to check for abnormal sounds.

  • Spirometry(one of the tests considered “pulmonary function test”-PFT): This is the most important and common test for COPD diagnosis. You will blow into a tube connected to a machine called a spirometer. The test measures how much air you can breathe out and how fast you can do it, which helps determine the severity of any airflow obstruction.

  • Imaging tests: A chest X-ray can rule out other conditions with similar symptoms, like heart failure or lung cancer. A CT scan provides more detailed images of the lungs and can help assess the type and extent of lung damage.

  • Blood tests: An arterial blood gas test can measure oxygen and carbon dioxide levels in your blood to check for a gas exchange problem. 

Treatment

There is no cure for the lung damage caused by COPD, but effective treatments are available to manage symptoms, improve quality of life, and slow the disease's progression. 

Medical treatment

  • Smoking cessation: If you smoke, quitting is the most important thing you can do to prevent further lung damage.

  • Inhalers: Medications delivered through an inhaler can relax the airway muscles to make breathing easier.

  • Oral medications: Tablets, such as steroids or mucolytics, can be used to reduce inflammation or thin mucus.

  • Oxygen therapy: For advanced COPD, supplemental oxygen may be needed to ensure you get enough oxygen, especially during activity or while sleeping.

  • Pulmonary rehabilitation: A program that combines exercise, education, and breathing techniques to improve your strength, endurance, and quality of life. 

Surgical procedures

In severe cases, surgery may be an option for certain patients.

  • Bullectomy: Surgery to remove large, damaged air sacs (bullae) from the lungs.

  • Lung volume reduction surgery: A procedure to remove the most damaged sections of the lung to allow healthier tissue to work better.

  • Lung transplant: In very advanced cases, a lung transplant may be considered. 

Managing flare-ups

If you experience a COPD flare-up, you should contact your doctor immediately. Treatment for an exacerbation may involve:

  • Antibiotics to treat a lung infection.

  • Higher doses of bronchodilator inhalers.

  • Oral or inhaled steroids to reduce inflammation.

  • Non-invasive ventilation (NIV) or other hospital care for severe cases.

 

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