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Chronic Obstructive Pulmonary Disease
(COPD)
Key points
- Chronic obstructive pulmonary disease (COPD) prevents airflow to the
lungs, causing breathing problems.
- It is a leading cause of death in the United States.
- Smoking is the main cause of COPD, but nonsmokers can get it.
- Talk with your doctor if you have COPD symptoms or previously
smoked.
What it is?
Chronic obstructive pulmonary disease (COPD) is an ongoing
lung condition caused by damage to the lungs. The damage
results in swelling and irritation, also called
inflammation, inside the airways that limit airflow into and
out of the lungs. This limited airflow is known as
obstruction. Symptoms include trouble breathing, a daily
cough that brings up mucus and a tight, whistling sound in
the lungs called wheezing.
COPD is most often caused by long-term exposure to
irritating smoke, fumes, dust or chemicals. The most common
cause is cigarette smoke.
Chronic bronchitis is inflammation of the lining of the
tubes that bring air into the lungs. These tubes are called
bronchi. The inflammation prevents good airflow into and out
of the lungs and makes extra mucus. In emphysema, the small
air sacs of the lungs, called alveoli, are damaged. The
damaged alveoli can't pass enough oxygen into the
bloodstream.
Although COPD is a condition that can get worse over time,
COPD is treatable. With proper management, most people with
COPD can control symptoms and improve their quality of life.
Proper management also can lower the risk of other
conditions linked to COPD, such as heart disease and lung
cancer.
Changes in your lungs and airways in COPD include:
- Loss of elasticity in your airways and air sacs in your lungs
(alveoli).
- Inflammation, scarring (fibrosis) and narrowing of your airways.
- Thick mucus in your airways.
- Destruction of the walls between your alveoli. This enlarges them
and traps air.
People with COPD often get exacerbations, or worsening of symptoms, like
severe difficulty breathing, thicker mucus, wheezing and
cough. You might need to go to the hospital for severe exacerbations.
COPD gets progressively worse over time. Flare-ups get more severe and
happen more often. This usually takes years or decades, though some
people get worse faster.
Types of COPD
COPD includes both emphysema and chronic bronchitis. People with COPD
often have features of both.
-
Emphysema:
This lung condition causes destruction of the fragile
walls and elastic fibers of the alveoli. The damaged
inner walls of the alveoli may be destroyed, creating
one large air space that is hard to empty compared with
the many healthy small ones. The alveoli now have less
surface area that can be used to exchange oxygen and
carbon dioxide. Also, old air gets trapped in the large
alveoli so there isn't room for enough new air to get
in.
-
Chronic bronchitis. In this condition, the bronchial tubes become inflamed
and narrowed. As a result, the tubes thicken, making
less room for air to pass through. Extra mucus caused by
the irritation blocks the narrowed tubes even more. An
ongoing cough results from trying to clear mucus from
the airways.
Symptoms
Common signs and symptoms include:
- Cough with mucus that you’ve had for a long time (for
three months or longer at a time for at least two
years).
- Shortness of breath doing everyday activities.
- Trouble taking deep breaths.
- Wheezing or other lung sounds
- Barrel-shaped chest.
- Excess phlegm or mucus.
- Bluish skin (cyanosis).
Complications
COPD is 1 of the top 10 causes of death in the U.S.
COPD can trap bacteria in
your lungs, leading to infections. It can also prevent oxygen from
getting into your body and carbon dioxide from getting out. This can
lead to serious complications, including:
- Pneumonia.
- High levels of carbon dioxide in your blood (hypercapnia).
- Low levels of oxygen in your blood (hypoxemia).
- Respiratory failure.
- Pulmonary hypertension.
- Right-sided heart failure (cor
pulmonale).
- Collapsed lung (pneumothorax).
- Polycythemia (making too many red blood cells).
Causes and risk factors
Damage to your lungs from smoking is
the most common cause of COPD. Other causes include:
- Alpha-1 antitrypsin deficiency (“alpha-1”), a genetic disorder
that can lead to lung damage.
- Secondhand smoke.
- Air pollution.
- Exposure to dust and fumes from your job or hobbies.
What are the risk factors for this condition?
While smoking is the biggest risk factor for COPD, not everyone who
smokes will develop it.
You may be at higher risk for COPD if you:
- Are female.
- Are over the age of 65.
- Have been exposed to air pollution.
- Have worked with chemicals, dust or fumes.
- Have alpha-1 antitrypsin deficiency.
- Had many respiratory infections during childhood.
Who is at risk
Some people are more likely to have COPD, including:
- Current or former smokers.
- People with a history of asthma.
- Women.
- Adults 65 and older.
- American Indian or Alaska Native populations and people of more than
one race.
- People who are unemployed, unable to work, retired, a homemaker or a
student.
- People with less than a high school education.
Diagnosis
To diagnose COPD, a provider will perform an
exam and ask you about your health history. They’ll test
how well your lungs work and might get images of your lungs.
They may ask you questions like:
- Do you smoke or have you ever smoked?
- Have you had long-term exposure to dust or air
pollutants?
- Do other members of your family have COPD, other lung
conditions or liver disease?
- Do you get short of breath with exercise? When resting?
- Have you been coughing or wheezing for a long time?
- Do you cough up phlegm?
What tests do healthcare providers use to diagnose COPD?
Your provider might use the following tests to help diagnose
COPD:
-
Lung diffusion test. This test shows how well the
body moves oxygen and carbon dioxide between the lungs
and the blood.
-
Spirometry. In this test, you breathe out quickly
and forcefully through a tube connected to a machine.
The machine measures how much air the lungs can hold and
how quickly air moves in and out of the lungs.
Spirometry diagnoses COPD and tells how much airflow is
limited.
-
Lung volume test. This test measures the amount
of air the lungs hold at different times when breathing
in and out.
-
Pulse oximetry. This simple test uses a small
device placed on one of your fingers to measure how much
oxygen is in your blood. The percentage of oxygen in the
blood is called oxygen saturation. You also may have a
six-minute walking test with a check of your oxygen
saturation.
-
Chest X-ray. A chest X-ray may show some lung
changes from COPD. An X-ray also can rule out other lung
problems or heart failure.
-
CT scan. A CT scan combines X-ray images taken
from different angles to create images of structures
inside the body. A CT scan gives much greater detail of
changes in your lungs than a chest X-ray does. A CT scan
of your lungs can show emphysema and chronic bronchitis.
A CT scan also can help tell if you might benefit from
surgery for COPD. CT scans can be used to check for lung
cancer.
-
Arterial blood gas analysis. This blood test
measures how well your lungs are bringing oxygen into
your blood and removing carbon dioxide.
-
Exercise stress test. An exercise test on a
treadmill or stationary bike may be used to monitor
heart and lung function during activity
-
Electrocardiogram (ECG
or EKG). This test checks heart function
and rules out heart disease as a cause of shortness of
breath.
-
Blood tests. Blood tests aren't used to diagnose
COPD, but they may be used to find the cause of your
symptoms or rule out other conditions.
-
Testing for AAT deficiency. Blood tests can tell
if you have the genetic condition called
alpha-1-antitrypsin deficiency.
What are the stages of COPD?
Your provider can stage COPD based on your forced expiratory
volume in one second (FEV1)
results. FEV1 is
the amount of air you can breathe out in one second, and it
can tell your provider how blocked your airways are. Your
provider measures FEV1 with Spirometry.
COPD stages based on severity are:
-
Stage 1: FEV1 is
80 or above.
-
Stage 2: FEV1 is
between 50 and 79.
-
Stage 3: FEV1 is
between 30 and 49.
-
Stage 4: FEV1 is
less than 30.
Your provider can also evaluate your symptoms and your risk
for exacerbation using groupings with the letters A, B and
E:
-
A: You have mild symptoms and a low risk for
exacerbations.
-
B: You have more severe symptoms and a low risk
for exacerbations.
-
E: You have a high risk for exacerbations.
Your stage isn’t directly related to your symptoms — for
instance, you could be in stage 3 or 4 but still have mild
symptoms. Your provider can use your stage, symptoms and
number of exacerbations to guide your treatment.
How is COPD treated?
There’s no cure for COPD. Treatment focuses on improving
your symptoms and reducing and treating exacerbations. Your
provider may recommend:
-
Smoking cessation programs. If you smoke,
quitting can slow down the progression of COPD.
-
Inhaled medications. Bronchodilators and
steroids can reduce inflammation and open your airways.
These might come in an inhaler or
as a liquid you put in a nebulizer.
-
Oxygen therapy. You may need supplemental
oxygen to improve your oxygen levels.
-
Pulmonary rehabilitation. This is an
exercise and education program that can strengthen your
lungs and help you manage COPD.
-
Corticosteroids. You might need a course of
steroids to reduce inflammation during an exacerbation.
-
Positive airway pressure. Your provider might
have you use a BiPAP
machine to help you breathe, especially during an
exacerbation.
-
Antibiotics. If you have frequent bacterial
infections in your lungs, your provider may prescribe
antibiotics to prevent infections and exacerbations.
-
Lung volume reduction (LVR). If you have severe
COPD and you’re a good candidate, your provider may
suggest surgery or
a valve
procedure that reduces the trapped air in your
lungs.
-
Clinical trials. Clinical trials are tests of
new treatments to see if they’re safe and effective.
Your provider might recommend one if a new treatment
could be a good fit.
Medications for COPD
The medications listed below are related to or used in the treatment of
this condition.
Drug name |
Rating |
Rx/OTC |
Preg |
CSA |
Alcohol |
Symbicort |
7.3 |
Rx |
C |
N |
|
Trelegy Ellipta
|
6.9 |
Rx |
|
N |
|
prednisone
|
7.5 |
Rx |
C |
N |
|
montelukast
|
7.6 |
Rx |
B |
N |
|
Breztri Aerosphere
|
7.4 |
Rx |
|
N |
X |
Anoro Ellipta
|
6.9 |
Rx |
C |
N |
|
budesonide / formoterol / glycopyrrolate
|
7.4 |
Rx |
|
N |
X |
dupilumab
|
5.0 |
Rx |
|
N |
|
Dupixent
|
5.0 |
Rx |
|
N |
|
Ohtuvayre
|
10 |
Rx |
|
N |
|
Breo Ellipta
|
6.7 |
Rx |
C |
N |
|
albuterol
|
9.0 |
Rx |
C |
N |
|
Daliresp
|
7.8 |
Rx |
C |
N |
|
Stiolto Respimat
|
6.8 |
Rx |
C |
N |
|
budesonide / formoterol
|
7.3 |
Rx |
C |
N |
|
Incruse Ellipta
|
3.7 |
Rx |
C |
N |
|
Tudorza Pressair
|
8.9 |
Rx |
C |
N |
|
levalbuterol
|
8.6 |
Rx |
C |
N |
|
Rayos
|
10 |
Rx |
C |
N |
|
fluticasone / vilanterol
|
6.7 |
Rx |
C |
N |
|
roflumilast
|
7.8 |
Rx |
C |
N |
|
aclidinium
|
8.9 |
Rx |
C |
N |
|
fluticasone / umeclidinium / vilanterol
|
6.8 |
Rx |
|
N |
|
Xopenex
|
10 |
Rx |
C |
N |
|
Bevespi Aerosphere
|
7.8 |
Rx |
|
N |
X |
olodaterol / tiotropium
|
6.7 |
Rx |
C |
N |
|
umeclidinium / vilanterol
|
6.8 |
Rx |
C |
N |
|
albuterol / ipratropium
|
|
Rx |
C |
N |
|
fluticasone / salmeterol
|
|
Rx |
C |
N |
|
ipratropium
|
|
Rx |
B |
N |
|
Striverdi Respimat
|
4.6 |
Rx |
C |
N |
|
umeclidinium
|
3.6 |
Rx |
C |
N |
|
Xopenex HFA
|
|
Rx |
C |
N |
|
Yupelri
|
10 |
Rx |
|
N |
|
Breyna
|
|
Rx |
C |
N |
|
formoterol / glycopyrrolate
|
7.8 |
Rx |
|
N |
X |
olodaterol
|
4.6 |
Rx |
C |
N |
|
revefenacin
|
8.7 |
Rx |
|
N |
|
tiotropium
|
|
Rx |
C |
N |
|
Xopenex Concentrate
|
|
Rx |
C |
N |
|
aclidinium / formoterol
|
4.0 |
Rx |
|
N |
|
Duaklir Pressair
|
|
Rx |
|
N |
|
ensifentrine
|
10 |
Rx |
|
N |
|
formoterol
|
|
Rx |
C |
N |
|
salmeterol
|
|
Rx |
C |
N |
|
Legend |
Rating | For ratings, users
were asked how effective they found the medicine while
considering positive/adverse effects and ease of use (1 =
not effective, 10 = most effective). |
Rx
| Prescription only. |
OTC
| Over-the-counter. |
Rx/OTC
| Prescription or Over-the-counter. |
Pregnancy Category |
Controlled Substances Act (CSA) Schedule |
Alcohol |
B | Animal reproduction studies have failed to demonstrate a
risk to the fetus and there are no adequate and
well-controlled studies in pregnant women.
| U |
CSA Schedule is unknown. |
X |
Interacts with Alcohol. |
C |
Animal reproduction studies have shown an adverse effect on
the fetus and there are no adequate and well-controlled
studies in humans, but potential benefits may warrant use in
pregnant women despite potential risks. |
N |
Is not subject to the Controlled Substances Act. |
Can COPD be prevented?
Unlike some other medical conditions, COPD often has a clear
cause and a clear way to prevent it. Most of the time, COPD
is directly linked to cigarette smoking. The best way to
prevent COPD is to never smoke. If you smoke and have COPD,
stopping now can slow how fast the condition worsens.
If you've smoked for a long time, quitting can be hard,
especially if you've tried quitting once, twice or many
times before. But keep trying to quit. It's critical to find
a stop-smoking program that can help you quit for good. It's
your best chance for lessening damage to your lungs. Talk
with your healthcare professional about options that might
work best for you.
Workplace exposure to chemical fumes, vapors and dusts is
another risk factor for COPD. If you work with these types
of lung irritants, talk with your supervisor about the best
ways to protect yourself. This may include wearing equipment
that prevents you from breathing in these substances.
Here are some steps you can take to help prevent
complications linked with COPD:
- Quit smoking to help lower your risk of heart disease
and lung cancer.
- Get an annual flu vaccination and vaccination against
pneumococcal pneumonia to lower your risk of or prevent
some infections. Also talk with your doctor or other
healthcare professional about when you need the COVID-19
vaccine and the RSV vaccine.
- Talk with your healthcare professional or a mental
health professional if you feel sad or hopeless or think
that you may have depression.
Prognosis
Can a person with COPD get better?
The damage to your lungs from COPD is permanent and doesn’t
get better. But there are ways to manage your symptoms for a
long time, and sometimes even improve them. Following your
healthcare provider’s recommendation and a pulmonary
rehabilitation program can help improve your symptoms and
your quality of life.
Can you live a long life with COPD?
How long you live with COPD depends on how severe it is and
how quickly it’s progressing. Many people can live for
decades after diagnosis, especially with early treatment.
People in stage 3 or 4 have a life expectancy that’s six
to nine years shorter than average.
Is COPD a terminal illness?
COPD gets progressively worse over time, but it’s not always
a terminal illness. How quickly it progresses varies from
person to person. Over time (usually years or even decades)
many people with COPD won’t be able to breathe on their own.
But others can live a long time without having severe
symptoms.
Living With COPD
How do I take care of myself with COPD?
If you have COPD, some tips to take care of yourself
include:
-
Avoid lung irritants and anything that makes your
symptoms worse. This includes smoking,
secondhand smoke, dust, air pollution and strong
fragrances.
-
Attend pulmonary rehabilitation sessions. This
includes physical and occupational
therapy and education sessions. Keep up with the
plan they outline even after your sessions have ended.
-
Talk to a registered dietitian. They can
tell you if there are specific foods to eat or avoid
that can help keep you healthy.
-
Take all of your medications as prescribed. Make
sure you have daily medications on hand before you run
out.
-
Make a plan for flare-ups. Work with your
provider on a plan for what to do if you have an
exacerbation. This might include having certain
medications on hand and knowing when to go to the
hospital.
-
Know how to use your medical devices. This can
include inhalers, nebulizers, a CPAP machine and other
devices. Ask your provider to demonstrate correct usage.
-
Take care of your mental health. Having a
chronic illness can take a toll on your mental health. A
mental health provider like a psychiatrist, psychologist or
counselor can help you manage social, emotional and
other mental health issues.
When should I see my healthcare provider?
If you think you could have COPD, don’t wait to see a
healthcare provider. Early diagnosis and treatment can
reduce your risk of your symptoms progressing.
If you have COPD, see your healthcare provider if you have
signs of an infection or other changes in your symptoms,
including:
-
Worsening shortness of breath. You may notice
that you can’t walk as far as you used to, you’re having
more breathing difficulty at night, or you’re using your
breathing treatments or inhalers more often than usual.
-
Mucus (sputum) changes. This could include
changes in color, bloody mucus, a foul smell, more mucus
or thicker mucus than usual.
-
Increased coughing or wheezing.
-
New or worsening swelling in your ankles, feet
or legs. Contact
your provider if it doesn’t go away after a night’s
sleep with your feet up.
-
Unexplained weight loss or gain.
-
Frequent morning headaches or dizziness.
-
Unexplained, extreme fatigue or weakness. Contact
your provider if it lasts for more than a day.
-
Fever or chills.
-
Other signs of infection. These could include
sore throat, unusual sinus drainage, nasal congestion, headaches or
tenderness along your upper cheekbones.
When should I go to the ER?
Go to the emergency room if you experience:
- High fever (over 103 degrees Fahrenheit/40 degrees
Celsius).
- Sudden or severe difficulty breathing.
- Restlessness, confusion, forgetfulness or irritability.
- Slurred speech.
What questions should I ask my healthcare provider?
It might be helpful to ask your healthcare provider:
- What are the best ways to take care of myself?
- Can I improve my symptoms?
- How do I take this medication?
- How do I use my inhaler, nebulizer or other medical
devices?
- When should I follow up with you?
- When should I go to the ER?
One Final Note..
Living with chronic lung disease like COPD might feel overwhelming,
scary, frustrating or even lonely at times. But there are ways to
keep your lung muscles strong for as long as possible and even
improve your symptoms. Making a plan with your healthcare team that
will keep you healthy and reduce exacerbations can help it feel more
manageable. Talk to your loved ones about how they can help, and
what to do if you have a flare-up.
If you feel out of breath frequently, have a chronic cough or feel
tired easily, don’t wait to talk to a healthcare provider. Early
diagnosis can improve your quality of life and help keep you healthy
for the years ahead.
Resources for Patients and Their Families
At a glance
Several organizations offer information and resources about chronic obstructive
pulmonary disease (COPD) for patients and their families.
Resources
Awareness and EducationPeople with COPD, their families, caregivers, and communities can be empowered
to recognize, understand and reduce the impact of COPD.
Pulmonary (Lung) RehabilitationPulmonary rehabilitation teaches you how to manage your COPD symptoms and
improve your quality of life. Tailored programs show you how to breathe better
and conserve your energy. They also provide advice on diet and exercise.
Smoking Cessation
Cigarette smoking is the most common cause of
COPD in the United States. Information to help
you stop smoking can be found
here
How the COPD Community is Working to
Reduce the Impact of COPD
The COPD National Action Plan is the
first-ever blueprint for how we can all work
together—across communities and sectors—to raise
awareness of COPD and reduce its impact. The
Plan was developed at the request of Congress,
with input from the broad COPD community. This
included patients, caregivers, federal agencies,
nonprofits, researchers, policymakers, industry
representatives, and advocates.
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