Basics of Chronic Obstructive Pulmonary Disease

Also known as emphysema, COPD is an inflammatory disease of the lungs that obstructs the circulation of air and makes breathing difficult. It affects more than 15% of adults over 40 years of age in the United States.

According to information from the U.S Department of Health & Human Services:

“COPD impacts an estimated 251 million people worldwide. While many have been diagnosed with the disease, millions more are believed to have it and not know it. In the United States, 16 million people have COPD, and each year more than 150,000 people die because of it.”¹

As research studies published by the COPD Foundation describes based on the work ‘What is COPD’: “Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.²

“Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.” Information published by the National Heart, Lung and Blood Institute.

“COPD is a major cause of disability, and it is the fourth leading cause of death in the United States.

COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.

Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person.

COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.”³

The National Heart, Lung and Blood Institute explain that: “In COPD, less air flows in and out of the airways because of one or more of the following:

1. The airways and air sacs lose their elastic quality.
2. The walls between many of the air sacs are destroyed.
3. The walls of the airways become thick and inflamed.
4. The airways make more mucus than usual and can become clogged.

Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed cross-section of the bronchioles and alveoli.

Figure B shows lungs damaged by COPD. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls.⁴

Some of the symptoms of chronic obstructive pulmonary disease are:

1. Shortness of breath
2. A whistling sound when breathing (wheezing)
3. Persistent dry cough
4. Lethargy
5. Chest tightness

As specified by the National Heart, Lung and Blood Institute and published by the U.S Department of Health & Human Services: “COPD can cause coughing that produces large amounts of a slimy substance called mucus.

If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza.

Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD.

If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.

Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion.

The severity of your symptoms will depend on how much lung damage you have. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance.

Some severe symptoms may require treatment in a hospital. You—or, if you are unable, family members or friends—should seek emergency care if you are experiencing the following:

1. You are having a hard time catching your breath or talking.
2. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood.
3. People around you notice that you are not mentally alert.
4. Your heartbeat is very fast.
5. The recommended treatment for symptoms that are getting worse is not working.”⁵

While there is no cure for COPD, adopting changes to your daily lifestyle along with taking proper medication helps to prevent further pulmonary damage.

The National Heart, Lung and Blood Institute state that: “COPD Day 2018 state that: “COPD symptoms develop slowly and worsen over time, many who have the disease delay getting diagnosed until they need aggressive treatment or hospitalization.”⁶

Causes

1. Tobacco smoke
2. Air pollution irritates pulmonary tissue, resulting in inflammation.
3. Cold temperatures. The exposure to long periods of cold weather adds extra tension and stress to the lungs.
4. Inhaling chemicals, such as pesticides, harsh cleaning products, and paint.
5. Microbial infections

As you can see, respiratory irritants are the main culprits. It is imperative to know that people who never had exposure to these irritants can also suffer from COPD. However, they carry a much lower risk.

Information published by The National Heart, Lung and Blood Institute shows that: “In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dust from the environment or workplace also can contribute to COPD.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 anti-trypsin (AAT)—a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly.

Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.”⁷

The American Lung Association regarding ‘COPD’ diagnosis and treatment clearly suggests that: “Once COPD has been diagnosed, you and your doctor can select the best treatment options to manage your COPD. These may include medications, rehabilitation or surgery that may improve your quality of life.”⁸

Diagnosis is based on the aforementioned symptoms combined with a spirometry test, which is a pulmonary function test (FEV1 FVC). This is a very severe illness that needs to be taken care of on time to prevent further complications since once pulmonary tissue is lost to fibrosis, it can never be recovered.

Important information to take into consideration regarding ‘Chronic Pulmonary Obstructive Disease’ published in the ‘COPD Foundation’ warns that: “It’s easy to think of shortness of breath and coughing as a normal part of aging, but these could be signs of COPD. That’s why it is important to talk with your healthcare provider as soon as you notice any of these symptoms. COPD can progress for years without noticeable shortness of breath. Ask your healthcare provider about ordering a Spirometry Test.”⁹

There are two breathing techniques that can help you get the air you need without working so hard to breathe: Pursed-lips Breathing and Diaphragmatic (also called Belly or Abdominal) Breathing.

It’s normal to hold your shoulders tense and high. Before starting any breathing technique, take a minute to drop your shoulders down, close your eyes, and relax.”¹¹

Information from The National Heart, Lung and Blood Institute published by the U.S Department of Health & Human Services explain that according to:

“The National Emphysema Treatment Trial lung volume reduction surgery might improve the quality of life in certain groups with severe COPD.”¹²

Medications

There are many medications in a physician’s arsenal that combat certain aspects of COPD. For example, some medications act as bronchodilators and thus increase the airflow to the lungs. A few examples of bronchodilators are formoterol, salmeterol, and glycopyrrolate. Other substances, such as phosphodiesterase-4 (PDE-4) inhibitors, help relieve inflammations.

According to information provided by the American Thoracic Society (ATS) on their publication ‘Medicines Used To Treat COPD’:

“The most common medications for treating Chronic Obstructive Pulmonary Disease (COPD) are Bronchodilators and Steroids. Both make breathing easier.

Bronchodilators

Bronchodilators are medications that relax the muscles that wrap around your breathing tubes, allowing the tubes to become larger and easier to breathe through. Each bronchodilator is different, based on:

1. The chemical make-up,
2. How fast it works and
3. How long it lasts.

Your health care provider will work with you to decide which of these medications or combinations work best for you.

Types of bronchodilators:

1. beta2-agonists
2. Anticholinergics
3. Theophyllines

Steroids

Steroids, also known as corticosteroids, are medications used to reduce swelling in the breathing tubes. These drugs are not the same as anabolic steroids (misused by athletes) to build muscles. Steroids are usually taken by inhaler or pill. The inhaled steroid may be combined with a bronchodilator.

Bronchodilators and steroids are usually taken by inhaling the medicine. These inhaled medicines have recently been developed in a dry powder form as well as a liquid spray. This has resulted in new designs for inhalers.

Other Medications

Antibiotics for bacterial infection, mucolytics to thin mucus (phlegm or sputum), and oxygen to treat low oxygen levels are also used to treat COPD.¹³

For the purposes of breaking down accumulated mucus in the lungs, mucolytic drugs such as carbocysteine and N-acetylcysteine are used. One of the most anxiety-causing symptoms of COPD is the sense of heaviness in the chest. This is due to the resistance encountered by incoming air against thick mucus. Mucolytic medication mitigates this obstruction by liquefying mucus, clearing air passages.

As the Cochrane Airways publication regarding pulmonary rehabilitation for chronic obstructive pulmonary disease states: “Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity.”¹⁴

If you suffer from COPD, it is essential to continuously visit a specialist, since they will prescribe medication according to the severity of the condition and the needs of the patient.

The ‘American Lung Association’ affirms that: “Like aerobic exercise improves your heart function and strengthens your muscles, breathing exercises can make your lungs more efficient.⁷

“COPD is a progressive and (currently) incurable disease, but with the right diagnosis and treatment, there are many things you can do to manage your COPD and breathe better. People can live for many years with COPD and enjoy life.”¹⁵

References:

(1, 5, 12) U.S Department of Health & Human Services. NHLBI NEWS. NIH statement on World COPD Day 2018 https://www.nhlbi.nih.gov/news/2018/nih-statement-world-copd-day-2018

(2, 9) COPD Foundation. What is COPD? https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx

(3, 4, 6, 7) National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health-topics/copd

(8, 15) American Lung Association. Diagnosing and Treating COPD https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/

(10) Medical news today. What tests are used to diagnose COPD? MaryAnn de Pietro (licensed respiratory therapist). https://www.medicalnewstoday.com/articles/323344.php 

(11) Chronic Obstructive Pulmonary Disease Foundation. Breathing Techniques https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Breathing-Techniques

(13) American Thoracic Society (ATS). Medicines Used To Treat COPD. https://www.thoracic.org/patients/patient-resources/resources/copd-medicines.pdf

(14) Cochrane Airways Editorial Group. 2015. Pulmonary rehabilitation for chronic obstructive pulmonary disease. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2015, Issue 2.  Art.  No.:  CD003793.  DOI: 10.1002/14651858.CD003793.pub3.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003793.pub3/epdf/full