Chronic Obstructive Pulmonary Disease (COPD)

What Is It?
Chronic obstructive pulmonary disease (COPD) refers to a group of disorders that damage the lungs. These disorders make
breathing increasingly difficult over time.
The most common forms of COPD are chronic bronchitis and emphysema. Both are chronic illnesses that impair airflow in the
lungs. Most cases of COPD are related to cigarette smoking.

Chronic Bronchitis
In this disorder, the air passages in the lungs are inflamed. And the mucus-producing glands in the lung's larger air passages
(bronchi) are enlarged. These enlarged glands produce too much mucus. This triggers a cough. In chronic bronchitis, this cough
is present for at least three months out of the year for two or more consecutive years.

You are more likely to develop chronic bronchitis if you:
Smoke tobacco
Are exposed to air pollution
Are exposed to airborne organic dusts or toxic gases in the workplace. Cotton mills and plastic manufacturing plants
carry particularly high risk.
Have a history of frequent respiratory illnesses
Live with a smoker
Have an identical twin with chronic bronchitis
Emphysema
In this disorder, the tiny air sacs in the lungs (alveoli) are destroyed. The lungs are unable to contract fully. They gradually lose
elasticity. Holes develop in the lung tissue. This reduces the lungs' ability to exchange oxygen for carbon dioxide.
Your breathing may become labored and inefficient. You may feel breathless most of the time.

You are more likely to develop emphysema if you:
Smoke
Are exposed to secondhand smoke
Are exposed to airborne irritants or noxious chemicals:
o Lead
o Mercury
o Coal dust
o Hydrogen sulfide
Live in an area with significant air pollution
Some people have an inherited form of emphysema. The lungs lack a protective protein called alpha-1 antitrypsin. In people
with alpha-1 antitrypsin deficiency, lung damage can appear as early as age 30.
Symptoms
People with COPD commonly have symptoms of both chronic bronchitis and emphysema.
Chronic Bronchitis
Chronic bronchitis may have different symptoms in different people.
Your first symptom may be a morning cough that brings up mucus. At first it may only occur during the winter months. In
milder cases, a cough produces only a small amount of thin, clear mucus. In other people, the mucus is thick and discolored.
As the illness progresses, the cough begins to last throughout the day and year. It produces more mucus. Symptoms similar to
asthma may develop. These include wheezing and shortness of breath.
Eventually, you may develop:
A continuous cough
Breathlessness
Rapid breathing
A bluish tint to the skin from lack of oxygen
Over time, the airways narrow. Blood pressure increases in the arteries that feed the lungs. This strains the right side of the heart.
Eventually, heart failure may develop. Blood backs up in the liver, abdomen and legs.
Chronic bronchitis also makes you prone to frequent respiratory infections. It increases the risk of potentially life-threatening
breathing difficulties. These often require hospitalization.
Emphysema
If you have emphysema, you may first feel short of breath during activities such as walking or vacuuming. Lung function
decreases slowly in emphysema. You may hardly notice the change as breathing becomes more and more difficult.
With time, you may develop:
Increased shortness of breath
Wheezing
Coughing
Tightness in the chest
A barrel-like distended chest
Constant fatigue
Difficulty sleeping
Weight loss
Diagnosis
Your doctor will examine you. He or she will look for evidence of COPD, including:
Rapid breathing
A bluish tint to your skin, lips or fingernails
A distended, barrel-shaped chest
Use of neck muscles to breathe
Abnormal breath sounds
Signs of heart failure (swelling in the ankle and legs)
The evaluation of COPD often includes some of the following tests:
Blood oxygen level The medical assistant puts a clip on your finger for less than a minute. It is painless. The device
measures the oxygen level in your blood (called the oxygen saturation level).
Pulmonary function test You will breathe into a special mouthpiece. A machine will measure how much your
airways are blocked and how much your lungs inflate.
Blood tests Blood tests measure the different types of blood cells. They also measure the amount of oxygen and
carbon dioxide in the blood.
If your doctor suspects inherited emphysema, blood tests can check for low alpha-1-antitrypsin levels.
Chest X-rays and CT chest scans The images provide a baseline, showing the extent of damage. They can very
helpful in the future if you develop new symptoms. Comparing new X-rays or CT scans to the old images makes it
easier for your doctor to diagnose a new pneumonia or a possible lung cancer. They also show whether your heart is
enlarged.
Electrocardiogram Measures the electric activity of the heart. It is usually done to make sure your symptoms are not
caused by a heart problem rather than a complication of COPD.
Sputum analysis If you have symptoms suggestive of bronchitis or pneumonia, you may be asked to cough up a
sample of sputum (mucus). The sample is sent to the lab to look for bacteria.
If you are diagnosed with inherited emphysema, family members should be tested for alpha-1-antitrypsin deficiency.
Expected Duration
Symptoms of chronic bronchitis tend to begin in smokers after age 50. These symptoms gradually worsen for the rest of the
smoker's life unless he or she quits smoking.
Most cases of emphysema are diagnosed in smokers in their 50s or 60s. People with the inherited form can show symptoms as
early as age 30. Regardless of the cause, emphysema has no cure and lasts a lifetime.
Prevention
The majority of cases of COPD are related to smoking You can drastically reduce your risk of COPD by avoiding cigarettes.
If you smoke, get the help you need to stop.
If you don't smoke, don't start.
Limit your exposure to secondhand smoke.
In addition, avoid outdoor activities when air pollution levels are high.
If you have chronic bronchitis, avoid contact with anyone with an upper respiratory tract infection. Even a mild cold can trigger
a flare-up of bronchitis symptoms.
During cold and flu season:
Wash your hands frequently
Avoid touching your face with your hands
Anyone with COPD should be vaccinated against influenza and pneumococcal pneumonia.
Treatment
No treatment can fully reverse or stop COPD.
Treatment aims to:
Relieve symptoms
Treat complications
Minimize disability
The first step in treatment is to quit smoking. This is the most critical factor for maintaining healthy lungs.
Quitting smoking is most effective during the early stages of COPD. Doing so can reverse some early changes. And it can also
slow the rate of decline of lung function in later stages.
Other COPD treatments may include:
Environmental changes Your COPD may be caused by work-related exposure to dusts or chemicals. You and your
doctor should discuss how to change your work environment.
People with COPD should avoid exposure to outdoor air pollution and secondhand smoke. Also avoid other airborne toxins,
such as deodorants, hair sprays and insecticides.
Medications Doctors generally prescribe bronchodilators. These medications open up the airways. They may be
taken as an inhaled spray or in pill form.
Antibiotics may be necessary to treat acute respiratory infections.
Daily inhaled corticosteroids can reduce airway inflammation. For flare-ups, an oral corticosteroid called prednisone often is
prescribed.
Exercise programs Regular exercise builds stamina. It will improve your quality of life, even if it does not directly
improve lung function. Pulmonary rehabilitation programs can reduce the need for hospitalization.
Good nutrition A balanced diet can help maintain stamina and improve resistance against infection. Drinking
enough fluids can help keep mucus watery and easy to drain.
Supplemental oxygen Your lungs may not be getting enough oxygen into your blood. Oxygen therapy can:
o Improve your quality of life
o Increase your ability to exercise
o Help to relieve heart failure
o Prolong life
o Improve mental function
o Lift your spirits
Lung volume-reduction surgery An option for some carefully selected patients with emphysema. This surgery
removes the most severely diseased portions of the lungs. This allows the less damaged areas to expand better. The long-
term value of this procedure is unknown.
Lung transplants or heart-lung transplants Transplants are rarely an option, except in very selected cases of early
onset, severe COPD.
When To Call A Professional
See your doctor annually to check for early signs of lung disease if you:
Smoke
Work in a job that carries a high risk of COPD
You should be tested for alpha-1 antitrypsin deficiency if you have family members with the problem. If you have alpha-1
antitrypsin deficiency, have your breathing monitored regularly for early signs of emphysema.
Call your doctor whenever you have:
Shortness of breath
A chronic cough with or without phlegm
A significant decrease in your usual ability to exercise
Prognosis
There is no cure for COPD. Do the following to improve your function and sense of well-being:
Quit smoking
Stick to your treatment program
Exercise daily
People with COPD who continue to smoke can expect progressive deterioration of lung function. Quitting completely is the best
chance of stopping or slowing down the process.
It is never too late to quit. Even with severe chronic bronchitis, symptoms can improve.
The lung damage from emphysema cannot be reversed. However, quitting smoking can decrease the risk of additional harm to
the lungs.
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is
often the first sign of COPD. Chronic bronchitis andemphysema are common COPDs.
Your airways branch out inside your lungs like an upside-down tree. At the end of each branch are
small, balloon-like air sacs. In healthy people, both the airways and air sacs are springy and elastic.
When you breathe in, each air sac fills with air like a small balloon. The balloon deflates when you
exhale. In COPD, your airways and air sacs lose their shape and become floppy, like a stretched-out
rubber band.
Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like
pollution, dust or chemicals, may also cause or contribute to COPD. Quitting smoking is the best way to
avoid developing COPD.
Diagnosis
The first step in diagnosing emphysema and chronic bronchitis is a good physical evaluation. Following
the evaluation may be a number of tests to evaluate your breathing and other aspects of your health.
These tests may be necessary because other diseases and/or disorders can be confused with COPD.
Detailed Medical History and Physical Exam
This is an important first step in the diagnosis of COPD. A doctor will conduct a complete physical exam
and ask you questions about your lifestyle including your family, your job, your habits, your hobbies,
your current medications, and your symptoms.
Breathing, Exercise, and Oxygen Tests (Pulmonary Function Tests)
Pulmonary function testing measures how well you are breathing. There are different types of
breathing tests that can be done during pulmonary function testing. They include spirometry, lung
volumes and diffusing capacity. Spirometry can show how much air you can breathe in and out. It also
shows how fast you can breathe in and out. Lung volumes can provide further information about how
your lungs are functioning. Diffusing capacity can show how well your lungs move oxygen from the
lungs to the blood. The results of pulmonary function testing can help your doctor find the best
treatment plan for you.
Spirometry
This simple test, called spirometry, measures airflow into and out of the lungs. This indicates whether
or not there is airway obstruction. Spirometry test results are useful in making the diagnosis of a
specific lung disorder. Even more important, yearly spirometry measurements help to detect lung
disease at an early stage when lifestyle changes and treatment may help forestall future problems.


Arterial Gas Testing
Arterial blood gas is a blood sample test ordered by your physician to evaluate measurements of
oxygen level, carbon dioxide (effectiveness of respiration), and several other parameters. Generally, it
is indicated when your physician needs to evaluate the effectiveness of your breathing.
Bronchial Provocation Test
The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry
breathing test is done before and after you inhale a spray such as methacholine. The spirometry results
are compared before and after you inhale the spray to see what changes there are in your breathing.
You will be given additional information in the Pulmonary Physiology Unit (PPU) at the time of the test.

Exercise Tolerance Test
The exercise tolerance test evaluates the ability of your heart and lungs to provide oxygen and remove
carbon dioxide from the bloodstream before, during and after you exercise.
Exercise For Desaturation Test
The exercise for desaturation test evaluates your oxygen needs at rest and during exercise.
X-Rays and CT (CAT) Scans
X-rays
X-rays can show irregularities or damage in the lungs caused by COPD and other chronic lung diseases.
CT or CAT Scan
A CT or CAT scan is a shortened name for computerized tomography. A CT scan takes pictures of the
inside of the body. The pictures are more detailed than a typical x-ray. During a CT scan of the chest
pictures are taken of cross sections or slices of the thoracic structures in your body. Thoracic structures
include your lungs, heart and the bones around these areas.
A CT or CAT scan is a shortened name for computerized tomography. A CT scan takes pictures of the
inside of the body. The pictures are more detailed than a typical x-ray. During a CT scan of the sinuses
pictures are taken of cross sections or slices of the sinuses. The sinuses are air-filled cavities in your
head. CT scans can identify problems with your sinuses. Your doctor will use this information to
determine the best treatment for you.
Bronchoscopy
A bronchoscopy allows the doctor to look inside the airways in the lungs. The bronchoscopy can be
videotaped to look at later. Your doctor may also do a lavage, which involves putting a small amount of
fluid into the airways. The fluid is then pulled out. The fluid contains cells from the airways of your
lungs. A biopsy of the airway may also be done. During a biopsy a small amount of the tissue is taken
from the lining of the lung. The cells and tissue can be studied closely to help determine your diagnosis
and the best treatment for you/your child.
Mucus Test
Some kinds of bacteria like to live in the mucus produced in the sinuses and airways of the lungs. A
culture of this mucus can help identify an infection. Lung and/or sinus infections can complicate and/or
mimic some symptoms of COPD.

Bone Scan Test
A bone scan is a test that can identify bone that is diseased or injured. Normally, bone absorbs
nutrients that are the building blocks of bone formation. If bone is diseased or injured nutrients are
absorbed differently. The bone scan takes pictures of this process. A bone scan can pick up on bone
disease or injury that may not be seen with a traditional x-ray.

pH Probe Study
A pH probe study measures the amount of gastroesophageal reflux you/your child has.
Gastroesophageal reflux is the backward flow or reflux of food and acid from the stomach into the
esophagus. The esophagus is the tube that takes food from your mouth into your stomach. A pH probe
will help identify if you have increased amounts of reflux and if it is causing you to have trouble
breathing or other symptom