In the United States (U.S.), 6.4 percent of people have a COPD diagnosis, and half of the people with breathing difficulties remain undiagnosed, and the figure may be higher.
Contents of this article:
- COPD is a collection of diseases including emphysema and chronic bronchitis.
- It can be fatal and lead to severely reduced quality of life.
- In the United States (U.S.), 6.4 percent of people have a COPD diagnosis.
- Smoking is the main cause of COPD, and quitting can reduce the chances of dying from it. However, 1 in 4 people with COPD has never smoked.
- COPD cannot be cured, only managed through inhaled medicines, an external oxygen supply, and pulmonary rehabilitation.
What is COPD?
COPD is incurable and can affect a person for their entire life.
COPD is a lifelong, incurable respiratory disease. It includes two main conditions:
- Emphysema, in which the air sacs of the lungs are damaged causing the lungs to lose their elastic nature, so the lungs become floppy. This decreases the lungs' efficiency in exchanging gas.
- Chronic bronchitis, a chronic inflammation of the airway lining that causes a thickening and increased production of mucus. Bronchitis becomes chronic when it persists and resists treatment.
Many people with COPD will have both of these, but the severity of each varies between individuals.
Asthma symptoms may overlap as a part of COPD, and a history of asthma can increase the risk of developing the condition. Asthma refers to inflamed airways that spasm and overreact to inhaled substances.
The breathing difficulties and airway obstruction worsen over time. COPD is the third-leading cause of death in the U.S. A person with advanced COPD may be unable to climb the stairs or cook, and they may need breathing assistance with medications and oxygen.
COPD produces some or all of the following symptoms:
- chronic and deteriorating breathlessness, especially after exertion
- persistent cough
- excessive production of sputum
- frequent respiratory infections
In more severe cases, there may be:
- a blue tint of the lips or fingernail beds
- shortness of breath while talking
- lack of mental alertness
- rapid heartbeat
People with mild symptoms may not seek help. The U.S. Department of Health and Human Services estimate that 12 million Americans have undiagnosed COPD.
Complications can include:
- recurrent respiratory infections, such as pneumonia
- heart problems
- lung cancer
- high blood pressure in the lung arteries
- depression, due to the inability to lead an active lifestyle
- weight loss
These complications can be fatal. It is best to take preventive measures against them on receiving a COPD diagnosis. For those who smoke, quitting is essential. Continuing to smoke will worsen symptoms.
Causes and risk factors
Smoking is the main cause and risk factor of COPD in the U.S. and about 8 out of 10 COPD-linked deaths are in smokers.
Smoking is the main cause of COPD. Quitting tobacco can drastically reduce the risk.
However, there are other causes.
- the burning of wood and biomass fuels indoors
- genetic factors, such as a deficiency of alpha-1 antitrypsin, an important lung protectant produced by the liver
- exposure to air pollutants and toxins at home and in the workplace poor indoor air quality
- family history of COPD
Around 1 in 4 people who develop it in the U.S. have never smoked tobacco.
Most people with COPD are over 40 years old when symptoms emerge. However, it may start at a younger age in a person with an underlying health issue, such as alpha-1 antitrypsin deficiency or a history of respiratory infection as a child.
For a diagnosis of COPD, the above symptoms must persist or deteriorate. If a person has the same symptoms but the symptoms go away, they may have another condition.
A doctor will ask about family and medical histories, and any history of smoking.
A lung function test called spirometry can confirm a diagnosis. This measures the amount of air given out in a short breath, and the speed of the air flow as this breath happens. The patient blows hard into a tube attached to the spirometer, which provides the readings.
This test measures how well the lungs work on a variety of levels.
Other lung function tests are available, if spirometry proves inconclusive, such as a lung diffusion capacity test. Blood tests and images of the chest with x-ray or CT scan can also be useful.
Treatment and management
There is no cure for COPD, but management options can ease symptoms, improve quality of life, decrease complications, and reduce the rate of decline in lung function.
Smoking is one of the key causes and agitators of COPD. Quitting smoking can help improve symptoms and slow disease progression.
Supportive medical interventions include:
- individual and group counseling
- nicotine replacement therapy available over the counter, such as nicotine patches
- drugs available on prescription, such as bupropion (Zyban) or varenicline (Chantix)
Quitting smoking can also prevent future development of COPD.
Breathing exercises and self-management
Management of COPD often involves resolving a state of breathlessness. Breathing exercises such as "belly breathing" and "pursed lip breathing" can help reduce the feeling of being out-of-breath.
The American Lung Association has provided some useful videos to assist with learning these breathing techniques.
Drug treatments can help relieve symptoms, but they do not change the natural course of the disease, cure COPD, or reverse damaged lung function. The underlying decline in lung function will likely continue at the same rate.
The following drugs are often prescribed:
- Bronchodilators relax the muscles around the airways so that the airways can open, making breathing easier.
- Glucocorticoids are steroids that can reduce the inflammation of COPD and asthma when combined with bronchodilators.
The drug doses are usually delivered directly to the lungs through inhaler devices, such as metered-dose inhalers (MDIs), dry-powder inhalers (DPIs) or nebulizer machines.
The flu virus can create serious health problems in people with COPD, so they must receive yearly vaccinations.
People with COPD also face a higher risk of pneumonia. The pneumococcal vaccine may be a good preventive measure against complications. Regular tetanus boosters that include protection against whooping cough are also recommended.
Pulmonary rehabilitation is a program organized by a multidisciplinary group of healthcare professionals that helps with daily activities and the quality of life.
The individualized set of interventions may include:
- a physical exercise program
- breathing exercises
- training in disease management
- nutritional and psychological counseling
The program aims to maximize social independence for people with COPD.
The American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) has a directory of certified pulmonary rehabilitation programs .
Oxygen is given via a mask or nasal prongs if blood oxygen is extremely low. The equipment can be used at home, either continuously or at certain times of the day.
This type of therapy may help certain people with COPD live longer, sleep better, perform daily tasks with fewer hindrances, and protect their major organs from damage.
Surgical procedures are considered a last resort in the treatment of COPD.
- a lung transplant
- a bullectomy, which aims to remove the larger air sacs, called bullae, that impact breathing
- lung volume reduction surgery, or the removal of damaged tissue from the lungs to improve function.
Lung operations in COPD patients can lead to fatal and nonfatal complications, including infection and scarring. They can also worsen symptoms.
Life expectancy of a person with COPD depends largely on whether or not they smoke and how severe their lung damage is once diagnosed.
Non-smokers with COPD or people with less severe symptoms are less likely to lose significant years from their life.
Smokers at an enhanced stage of COPD, however, lose around 6 years of life expectancy, apart from the 4 years that smoking itself takes off.
COPD is irreversible, but smokers can reduce their risk by quitting as soon as possible.