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Chronic Obstructive Pulmonary Disease by Debra Wood, RN

En Español (Spanish Version) More InDepth Information on This Condition

Definition

Chronic obstructive pulmonary disease (COPD) is a long-term lung disease. COPD makes it difficult to move air in and out of the lungs. It will make breathing difficult. COPD includes:

Emphysema—air sacs of lungs are damaged
Chronic bronchitis—airways of lungs are damaged

The changes to lung tissue differ with the two diseases. However, they often occur together. The causes and treatment of each condition are similar.

Normal and Emphysemic Lung

Causes

COPD is caused by damage to the lungs. This damage is caused by:

Cigarette smoking
Inhaling toxins or other irritants
Genetic predisposition that makes the lungs more vulnerable to damage from smoke or pollutants (includes alpha-1-antitrypsin deficiency)

Risk Factors

Factors that increase your chance of developing COPD include:

Smoking cigarettes
Long-term exposure to second-hand or passive smoke
Family members with COPD
Exposure to pollutants
History of frequent childhood lung infections
Age: 40 years or older

Symptoms

Early symptoms of COPD include:

Coughing
Increased sputum production (mucus from deep in the lungs)
Wheezing
Shortness of breath with activity

As the disease progresses, symptoms may include:

Increased shortness of breath
Choking sensation when lying flat
Fatigue
Trouble concentrating
Heart problems
Weight loss
Breathing through pursed lips
Desire to lean forward to improve breathing
More frequent flare-ups (periods of more severe symptoms)

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Your doctor will need to test how impaired your lungs are. This may be done with:

Lung function tests (spirometry)—to test the force of your breath
Blood test—to test oxygen and carbon dioxide levels in the blood

Your doctor may also need detailed pictures of your lungs. This may be done with:

Treatment

There is no cure for COPD. Treatment aims to ease symptoms and improve quality of life.

Treatment includes:

Smoking Cessation

Quitting smoking slows the disease. It is the most important part of treatment. There are many programs to help you quit, including:

Behavior change program
Medication
Combination of behavior program and medication

Environmental Management

Limit the number of irritants in the air you breathe. It may help make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

Medication

Medication for COPD may help by:

Opening the airways
Relaxing the breathing passages
Decreasing inflammation
Treating lung infections (antibiotics)

Some medication may be taken as pills or liquids. Others are inhaled medications that are delivered directly to the lungs.

Vaccines

The flu and pneumonia can make your symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce COPD flare-ups.

Oxygen

Oxygen therapy may be helpful if the oxygen levels in your blood are too low. It can relieve trouble breathing and improve energy. You may only need it for specific activities. It could also be given throughout the day.

Exercise

Special exercises can strengthen chest muscles. This can make it easier to breathe.

Regular physical activity can reduce the workload on your lungs. It helps build their endurance. Physical activity is also associated with improved quality of life. Follow your doctor's recommendations for activity levels and restrictions.

Breathing and Coughing Techniques

Special methods of breathing can help bring more air into your lungs. It can also help force trapped air out of your lungs. Effective coughing techniques can help clear mucus from your lungs. Ask your doctor if these techniques can help you. Some examples include:

Pursed-lip breathing
Controlled coughing technique

Nutrition

Eating habits to consider with COPD:

Eat a healthy diet. It should be low in saturated fat. It should also be rich in fruits, vegetables, and whole grain foods.
Maintain a normal weight. Excess weight causes the lungs and heart to work harder.
It may be hard to eat because you feel full. Try eating several smaller meals during the day. This is better than a few large meals.
Slow down your eating pace. This will make it easier to breathe.
If you need to gain weight, add food or drinks throughout the day. Talk to a dietitian about how many calories you need each day.

Lifestyle Changes

The following may help you manage COPD symptoms and avoid flare-ups:

Pace your activities.
Learn relaxation techniques and other methods to manage stress.
Seek emotional support from professionals, family, and friends. Anxiety can increase the rate of respiration. This makes breathing more strenuous.

Surgery

A small number of patients may benefit from surgery. Surgery options include removing a part of the lung. You could also have a lung transplant.

Prevention

Take these steps to reduce your chance of developing COPD:

If you smoke, quit.
Avoid exposure to second-hand smoke.
Avoid exposure to air pollution or irritants.
Wear protective gear if exposed to irritants or toxins at work.

RESOURCES:

American Lung Association http://www.lung.org
National Lung Health Education Program http://www.nlhep.org

CANADIAN RESOURCES:

Canadian Lung Association http://www.lung.ca
Health Canada http://www.hc-sc.gc.ca

References:

Breathing techniques. Canadian Lung Association website. Available at: http://www.lung.ca/diseases-maladies/copd-mpoc/breathing-respiration/index_e.php. Accessed October 1, 2012.
COPD. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated September 25, 2012. Accessed October 1, 2012.
Eisner MD, Balmes J, et al. Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease. Environmental Health: A Global Access Science Source. 2005;4:7.
Helpful hints for respiratory patients. American Lung Association website. Available at: http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=3004005. Accessed October 1, 2012.
Spirometry. National Lung Health Education Program website. Available at: http://www.nlhep.org. Accessed October 1, 2012.
What is COPD? National Heart Lung and Blood Institute (NHLBI) website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/copd. Accessed October 1, 2012.
What you can do about a lung disease called COPD. Global Initiative for Chronic Obstructive Lung Disease website. Available at: http://www.goldcopd.org/uploads/users/files/GOLD_Patient_RevJan10.pdf. Accessed October 1, 2012.
6/4/2008 DynaMed's Systematic Literature Surveillance. Availalbe at: http://dynamed.ebscohost.com/about/about-us: El Moussaoui R, Roede BM, et al. Abstract Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008;63:415-422.
11/6/2009 DynaMed's Systematic Literature Surveillance. Availalbe at: http://dynamed.ebscohost.com/about/about-us: Poole P, Chacko E, et al. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009;(4):CD002733.
12/14/2009 DynaMed's Systematic Literature Surveillance. http://dynamed.ebscohost.com/about/about-us: Donesky-Cuenco D, Nguyen HQ, et al. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med. 2009;15:225-234.

Last reviewed October 2012 by Brian Randall, MD

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