Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that limit the amount of air exhaled from the lungs. Emphysema (a progressive disease that damages the lung's air sacs) and chronic bronchitis (an inflammation of the lining of the large air passages in the lungs) are common forms of COPD.


Causes/associated factors
Chronic obstructive pulmonary disease is caused by exposure to noxious particles and gases, which cause the lungs to become inflamed. The inflammation causes many changes in the lungs over time. There's an increased secretion of mucus and thickening of the airways. Eventually, airflow in the lungs becomes obstructed.
Cigarette smoking is the greatest risk factor for developing COPD, accounting for up to 90 percent of all cases. Other risk factors include exposure to occupational dust and chemicals, as well as indoor and outdoor air pollution.

An alpha-1 antitrypsin deficiency, a rare hereditary condition, can cause emphysema in nonsmokers. This increases the risk of developing COPD.


Signs/symptoms
Chronic obstructive pulmonary disease is typically characterized by shortness of breath, a chronic cough or wheezing, which may come and go at first. The cough may produce sputum. Chest tightness may be another symptom.

Diagnosis
The doctor will ask questions about your medical history and do a physical exam. Spirometry, a test used to measure airflow and lung volume, can help the doctor determine the severity and progression of the disease and your response to therapy.
Additional tests may be needed as the disease advances, such as chest X-rays, bronchodilator and steroid reversibility testing, and arterial blood gas measurements.


Treatment
There's no cure for COPD. Treatment is intended to ease symptoms, prevent and treat complications, and improve quality of life.
A healthy lifestyle -- including regular exercise -- can help improve lung function and your overall quality of life.

If you smoke, quit. Ask your doctor about the latest tobacco cessation techniques. It may be helpful to enroll in a smoking cessation program.

Ask your doctor about a yearly flu shot and a pneumococcal vaccine.

Inhaled bronchodilators -- including beta-2 agonists such as albuterol, anticholinergics such as ipratropium, and methylxanthines such as theophylline -- are often prescribed to help control the symptoms of COPD. Sometimes a combination of two or more bronchodilators may be recommended to help control symptoms and decrease the risk of side effects.

Some people who have COPD also respond to inhaled steroids. New inhalation devices can now provide both steroids and bronchodilators in one treatment. Oral steroids (taken by mouth) are another an option, but long-term treatment with oral steroids hasn't been proven beneficial.

In later stages of COPD, oxygen therapy can help relieve symptoms. It may be used as needed for activities involving exertion, during sleep or continuously if necessary. If a severe deficiency of alpha-1 antitrypsin exists, you may need replacement therapy of this particular protein.

Surgery to reduce lung volume may also relieve symptoms, but it's currently considered investigational. As a last resort, a single lung transplant may be possible for patients who meet specific criteria.


Complications
COPD can lead to an enlarged heart or other heart problems. A form of high blood pressure may develop within the lungs and affect heart function. Lung infections can aggravate symptoms, such as difficulty breathing. In some cases, this may lead to hospitalization. Certain respiratory conditions can be life-threatening.

Pregnancy-specific information
Having COPD doesn't have a direct affect on your baby. Your doctor will closely monitor your condition throughout your pregnancy, however.

Senior-specific information
The risk of developing COPD increases with age.

Prevention
The best way to prevent COPD is to stop smoking. It's also helpful to reduce your exposure to secondhand tobacco smoke, other air pollutants and certain occupational hazards, such as dusts and chemicals.