Chronic Obstructive Pulmonary Disease (COPD): Signs, Symptoms, Treatment

4. CHRONIC BRONCHITIS: A common lung disease characterized by increased mucus in the windpipe

and bronchi (see above). The bronchi become inflamed, clogged, and narrow, making it more difficult for

air to pass through. Chronic bronchitis is also caused by coughing and spitting up of mucus for at least

three months of the year or for two straight years.

5. EMPHYSEMA: An abnormality characterized by enlargement and damage of the walls of tiny balloon-

like sacs in the lungs that air travels to. These tiny sacs (known as alveoli) are where gases are

exchanged in the lungs so that breathing can take place. The enlargement and damage of these tiny air

sacs makes it more difficult for oxygen to move from the lungs to the blood.

6. CHRONIC BRONCHIECTASIS: An abnormal condition characterized by irreversible stretching open

and destruction of the bronchi walls.

WHAT CAUSES COPD?

About 80% to 90% of COPD cases are caused by smoking. Air pollution is another cause of COPD.

Thus, COPD is more common in cities that have many people and many businesses that people work in.

In such cities, there are more people that smoke and more businesses that produce air pollution. People

who work in jobs where they are exposed to dust, poisonous gases, and other substances are also at

risk for developing COPD. Frequent lung infections are another possible cause of COPD. In rare cases,

emphysema can be caused by a severe deficiency of alpha 1-antitrypsin, a type protein that helps

protect the body from an enzyme (protein that helps produce chemical reactiosn) known as neutrophil

elastase. Without this protection, elastase can accumulate in the lung tissue and damage the tissue that

helps absorb oxygen.

CAN COPD BE INHERITED FROM PARENTS?

COPD is rarely caused by inheriting an abnormal gene from both parents. Genes are units of material

contained in a person's cells that contain coded instructions as for how certain bodily characteristics

(such as eye color) will develop. A cell is the smallest, most basic unit of life, that is capable of existing by

itself. All of a person's genes come from his/her parents. This is why people have physical characteristic

of their parents.

When COPD is inherited, it is due to a condition known as alpha1-antitrypsin deficiency. In this rare

condition (it occurs in 2 out of 1000 people), people are missing a natural substance in the body, known

as alpha1-antitrypsin. This substance prevents other substances in the body from destroying tissues in

the lungs and liver. If someone is missing alpha1-antitrypsin, then tissues in the lungs and liver will be

destroyed because the substance is not there to prevent it. Unfortunately, this means that whether or not

people with this condition smoke, the lungs will become damaged. However, smoking will make this

damage worse.

TELL ME MORE ABOUT THE CHRONIC BRONCHITIS ASPECT OF COPD?

In chronic bronchitis, the linings of the airways in the lungs respond to irritation from smoke by

developing thicker and narrower air passages into and out of the lungs. Groups of specialized cells,

known as mucus glands, multiply in the linings of the bronchi. This leads to more mucus production. To

clear the airways, coughing occurs so that the person can spit the extra mucus out. However, even

coughing becomes difficult over time in chronic bronchitis and the airways cannot be cleared out as

effectively. This leads mucus to buildup in the airway passages, which can easily lead to infections. The

infections, in turn, can lead to further damage. For example, repeated infections will eventually cause the

linings of the airways to be permanently damaged, thickened, and scarred.

TELL ME MORE ABOUT THE EMPHYSEMA ASPECT OF COPD?

In emphysema, smoke from cigarettes and pollution in the air damage the tissues in the air sacs (known

as alveoli). This leads the air sacs to open up because they are not as stretchy as they used to be.

Picture the damaged air sacs being like small rubber bands that are stretched out but cannot return to

their normal state. The air sacs eventually tear and clump together. This reduces the amount of space in

the lungs and air becomes trapped in the widened air sacs. Since the air is trapped, the amount of

oxygen that enters the blood is reduced. It is in these air sacs where oxygen normally moves from the

lungs to the blood.

WHAT ARE THE SIGNS AND SYMPOMS OF COPD?

The signs and symptoms may take years to develop, but usually develop in this order:

1. Coughing up of material from the lungs in the morning.

2. Coughing throughout the day.

3. Increased production of materials coughed up from the lungs.

4. Frequent chest infections. These infections especially occur in the winter months and produce green

or yellow material that is coughed

up from the lungs.

5. Wheezing (abnormal breathing sounds), especially after coughing.

6. Shortness of breath when performing activities in which one does not have to put forth much physical

effort. The shortness of breath can become so bad that it can occur even when the person is resting.

The symptoms mentioned above get worse in the cold weather and when infections occur. Other signs of

COPD include breathing failure, which causes the fingers, lips, toes, and tongue to turn blue. In fact, the

entire body can take on a blue appearance from not getting enough oxygen in the blood. Swelling in the

ankles, feet, and legs can occur due to long-term heart failure. The chest of some people with

emphysema can become barrel-shaped as the lungs expand. The skin of some people with COPD may

appear red because they unknowingly breathe faster to get more oxygen into their blood. People with the

symptoms listed above should call their doctor as soon as possible.

HOW IS COPD DIAGNOSED?

To begin with, the doctor examining a patient with suspected COPD will want to know if he/she has a

history of smoking. Since most cases of COPD are due to smoking, such information is very important to

making a diagnosis of COPD. The doctor will also ask the patient if he/she is experiencing any of the

signs and symptoms mentioned above. If anyone in the patient's family has developed COPD before age

50, blood tests may be done to check for the amount of alpha1-antitrypsin in the blood to see if enough

of it is present. See the section above on whether COPD can be inherited, to read about alpha1-

antitrypsin deficiency.

Blood tests may also be done to measure the amount of gases in the blood such as oxygen and carbon

dioxide. The doctor may want to test any material coughed up from the lungs. He/she may perform tests

known as electrocardiography or echocardiography to assess if the heart is working properly. These

heart tests will be able to tell the doctor if the heart is working too hard to pump blood through the lungs.

The doctor may also perform tests that measure lung functioning by having the patient breath into

special machines. The patient may be given tests such as X-rays or computerized axial tomography (CT)

scans, to produce pictures of the chest. These pictures can be used to look for damage of lung tissue

and to make sure the problems that the patient is reporting are not due something other than COPD.

Compared to X-rays, CT scanning is a more advanced imaging technique and produces much clearer

pictures.

WHAT CAN I DO IF I HAVE COPD?

As was mentioned earlier, the damage due to the lungs from COPD is mostly irreversible. However,

there are some things that can be done to reduce symptoms. If the COPD occurred from smoking, giving

up smoking forever is the only thing that can be done to prevent COPD from getting worse. Simply

reducing the number of cigarettes smoked will have little or no effect on improving the disorder. The

environment that the patient lives in should be kept clear of smoke, dust, dirt, dampness, cold, and any

form of pollution.

The doctor may prescribe an inhaler (a device that you breathe in from) that contains a medication that

widens walls of the bronchi (air passages). This will help more air get through the bronchi and will

decrease shortness of breath. Also, home oxygen therapy can be used to provide oxygen rich air to the

body. Home oxygen therapy requires placing a tube in the nose that delivers the oxygen. The tube is

hooked up to a special machine that can be taken home. Low doses of oxygen may be given to a patient

with COPD for at least 15 hours a day to prevent heart failure and death.

Swollen ankles or other swollen body parts can be treated with medications known as diuretics that

reduce fluid buildup in the body. Infections in the chest can be treated with antibiotics, which are

medicines that fight infections. Vaccines, which are substances injected into the body to prevent against

certain types of infection (such as the flu and Streptococcus pneumoniae) should be administered.

A procedure known as lung volume reduction surgery is sometimes used to help the lungs move inwards

and outwards more easily. This procedure involves removing some of the lung tissue and is used in

people whose lungs are stretched out very wide. The procedure can help increase the amount of oxygen

that gets to the blood.

WILL EXERCISE HELP MY LUNGS IMPROVE IF I HAVE COPD?

No. Exercise will not help the lungs function better in patients with COPD. However, gentle exercise,

such as walking, may help build up tolerance to exercise.

WHAT IS THE PROGNOSIS FOR PEOPLE WITH COPD?

The answer to this question depends on the severity of the COPD. If the COPD is mild and detected

early, it may be possible to prevent severe, worsening lung damage by immediately stopping smoking.

Unfortunately, many people do not realize they have COPD until it is too late. These people often need to

stop working due to shortness of breath and are forced to stay at home most of the time.

Three out of four people with COPD will survive for one year after being diagnosed with it. However, only

1 out of 20 people will survive for longer than 10 years after being diagnosed with COPD. Between

85,000 and 120,000 people a year die from COPD. Smokers are 10 times more likely to develop COPD

than non-smokers. It is the 4th most common cause of death in the United States.

HOW MANY PEOPLE HAVE COPD?

About 15 million people in the United States have COPD, making it a very common condition.

HOW MANY PEOPLE HAVE COPD?

About 15 million people in the United States have COPD, making it a very common condition.

CAN PEOPLE BECOME DISABLED FROM COPD?

Yes. People can become seriously disabled from COPD due to severe shortness of breath, preventing

them from carrying out simple daily tasks.

WHAT AGE DO PEOPLE USUALLY GET COPD?

COPD is more common after age 40.

ARE MALES OR FEMALES MORE LIKELY TO HAVE COPD?

Males are twice as likely as females to have COPD. However, COPD is becoming increasingly common

in older women.

WHAT ELSE IS COPD KNOWN AS?

Chronic obstructive pulmonary disease is also known as chronic obstructive lung disease.

WHAT IS THE ORIGIN OF THE TERM COPD?

Chronic comes from the Greek word "chronos" meaning "time." Obstructive comes from the Latin word

"obstruere" meaning "to build against." Pulmonary comes from the Latin word "pulmo" meaning "lung."

Disease comes from the Latin word "dis" meaning "separation," and the French word "aise" meaning

"ease." Dis-, in the case of disease, means "bad."