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Finding out that you or a loved one has chronic obstructive pulmonary disease (COPD) can be alarming and may leave you with a lot of questions.
Though COPD has no cure, it's a condition that can be managed with the right treatments and medications, according to the American Lung Association (ALA).
Here's what you need to know about COPD, including what it is, its causes, symptoms, stages and risk factors, plus the many treatment options available to those living with the condition.
What is COPD?
COPD is a group of progressive, chronic diseases that constrict airflow in and out of the lungs so that less oxygen moves through the body.
“It's three different illnesses, all of which create the same fundamental problem, which is you can't blow out as fast as you should,” explained Dr. Scott Eisman, a pulmonary disease and critical care medicine specialist at Scripps Memorial Hospital Encinitas in California.
“And those three illnesses are asthma and chronic bronchitis and emphysema -- and they're all different,” he noted.
Causes and risk factors
According to the U.S. Centers for Disease Control and Prevention, the cause of most cases of COPD is smoking. However, as many as 25% of people in the United States with the disease have never smoked cigarettes.
“If you talk about chronic bronchitis and emphysema, the most common cause is cigarette smoking,” Eisman said. However, he explained that asthma-related COPD could have various causes, such as environmental toxins or certain preexisting conditions such as gastroesophageal reflux disease.
Scripps Health states that chronic lung infections that damage lung tissues and some cases of chronic asthma where lung tissues fail to relax after an asthma attack can also cause COPD.
The risk factors for developing COPD outlined by the ALA include:
- Secondhand smoke exposure, including smoke from a coal or wood-burning stove
- Aging, which leads to declining lung function, particularly for those over 40
- Childhood respiratory infections
- A history of asthma
- Underdeveloped lungs.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) takes into account your lung test assessments, symptoms and COPD exacerbations (flare-ups) when assessing your COPD stage, according to the COPD Foundation.
It mostly focuses on two lung function readings:
- How much air you can exhale in one second, known as FEV1 (forced expiratory volume in the first second)
- How much air you can exhale in one total breath, known as FVC (forced vital capacity).
If your ratio of FEV1 to FVC is less than 0.7, you may be diagnosed with one of four stages of COPD:
- GOLD stage I: FEV1 is greater than or equal to 80%, indicating mild airflow limitations
- GOLD stage 2: FEV1 is 50% to 79%, indicating moderate airflow limitations
- GOLD stage 3: FEV1 is 30% to 49%, indicating severe airflow limitations
- GOLD stage 4: FEV1 is less than 30%, indicating very severe airflow limitations.
Different people may experience different symptoms, depending on the type and severity of COPD they have. The ALA notes that common symptoms of COPD include:
- Coughing up mucus
- Shortness of breath during daily activities
- Tightness in the chest
- Coughing continuously
- An inability to breathe deeply.
“A lot of people [with COPD] will complain of the inability to do things with their arms,” Eisman said. “So, like carrying groceries, for example, becomes much more challenging because it changes the way that your chest is configured, which changes the way your lungs work.”
Since COPD may have a number of different underlying causes, the ALA says treatment options are diverse and include:
- A plan to stop smoking
- COPD medications such as bronchodilators and anti-inflammatories delivered via inhaler or nebulizer
- Pulmonary rehabilitation programs that include exercise training; social support, and nutritional and disease management education
- Oxygen therapy to increase the oxygen flow in your body
- Noninvasive ventilation therapy to reduce carbon dioxide levels in your body
- Complementary therapies such as massage, meditation and reflexology
- Lung surgeries such as lung volume reductions, lung transplants and bullectomies, which remove damaged air sacs in the lungs.
Endobronchial valve therapy such as Zephyr valve therapy is another COPD treatment, particularly for people with severe COPD. During this procedure, Eisman said, doctors place valves into your lungs using a small tube with a camera called an endoscope. These valves help optimize your lung volume for better oxygen flow.
“By doing it this way, we're able to accomplish that same optimization of your lung volume … without surgery," Eisman said. "And it's been done now about in 50,000 or so patients worldwide, over the last five or seven years, maybe a little longer, and there's new literature out about it just now that it improves survival.”
Proper COPD treatments can have a major effect on peoples' lives, Eisman said. "You can improve their exercise tolerance, their ability to do what we would call the activities of daily living, their ability to have a productive life [and] to live longer,” he said.
SOURCE: Scott Eisman, MD, pulmonary disease/critical care medicine, Scripps Memorial Hospital Encinitas, Encinitas, Calif.
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