Chronic Obstructive Pulmonary Disease (COPD)
What is COPD?
COPD, or Chronic Obstructive Pulmonary Disease, is a chronic inflammatory lung disorder. It is not a single disorder but a collection of lung diseases that obstruct the flow of air to the lungs and create breathing problems.
Diseases associated with COPD can include but are not limited to chronic bronchitis, emphysema, and refractory asthma, a severe form of asthma. Emphysema and bronchitis occur most often together, but the severity of either condition can vary from patient to patient.
People living with COPD are at a higher risk of developing severe conditions, including heart disease and lung cancer.
Symptoms and Causes
Common symptoms of COPD include:
- Shortness of breath, most commonly during physical exertion
- Wheezing when breathing
- Chest tightness
- A chronic cough that may produce clear, white, yellow or greenish sputum
- Recurring respiratory infections
- Depleted energy
- Unexpected weight loss
- Swelling in the ankles, feet or legs
Most patients do not experience severe symptoms until after significant damage to the lungs has already occurred. Those with COPD may experience acute episodes of increased symptoms known as ‘exacerbations.’
What Causes COPD?
The most common cause of COPD in developed countries such as the United States is smoking.
COPD can also develop as a result of exposure to fumes from burnt fuel in poorly ventilated homes. Since not all smokers develop COPD, there may be a genetic component involved as well. In 1 percent of COPD cases, the condition has been caused by a genetic disorder that causes low levels of the AAt protein in the blood.
Patients with asthma are also at risk of developing COPD. Asthma patients who smoke are at an even higher risk of developing the condition. Patients with asthma and COPD have what is known as Asthma COPD Overlap Syndrome, or ACO.
Additional risk factors for developing COPD include:
- Exposure to cigarette smoke and secondhand smoke
- Occupational exposure to fumes, dust and vapors
- Exposure to air pollution
How is COPD Diagnosed?
Diagnosing COPD begins with your doctor taking a detailed medical history and conducting a physical exam. The medical history will include questions about any exposure the patient has had to airborne irritants, such as cigarette smoke or occupational toxins.
The diagnostic process may also include a number of tests, including:
- Pulmonary function tests that test how much air your lungs inhale or exhale
- Chest x-rays, which can spot emphysema
- CT scans of the lungs, which can identify emphysema or screen for lung cancer
- Arterial blood gas analysis, which assesses how efficiently lungs deliver oxygen to the blood or remove carbon dioxide from the blood
- Lab tests, which can rule out genetic disorders
Stages of COPD
There are several different ways of grading COPD. One of the most common is the GOLD system, which is done via spirometry testing. Spirometry testing divides COPD into four stages:
- Grade 1 – Mild
- Grade 2 – Moderate
- Grade 3 – Severe
- Grade 4 – Very Severe
Patients are placed into one of these four categories based on how much air is expelled in the first second of a forced exhalation during spirometry testing. The less air the patient produces, the higher the grade.
Patients may also be grouped in letter grades based on the amount of symptoms they experience and their number of risk factors. These letter grades run as follows:
- Group A: Low risk, fewer symptoms
- Group B: Low risk, more symptoms
- Group C: High risk, fewer symptoms
- Group D: High risk, more symptoms
How is COPD Treated?
There are a range of treatments available to those with COPD that can help reduce symptoms, manage exacerbations, and reduce the risk of complications from COPD. These include medications, at-home therapies, and lung therapies.
First and foremost, any patient with COPD who smokes should quit smoking as soon as possible. Prescribing nicotine patches and similar interventions can help with this process. Medications used to treat COPD include but are not limited to:
- Oral Steroids
- Inhaled Steroids
Lung therapies used to treat COPD include oxygen therapy administered when sleeping or during physical activity, as well as a pulmonary rehabilitation program that can include education, exercise, and nutritional counseling.
Patients may also use bilevel positive airway pressure (BiPAP) either at home or in the doctor’s office.
Is There a Connection Between COPD and Lung Cancer?
Patients with COPD are at a high risk of developing lung cancer. Both conditions share many common causes, including tobacco smoking. While not every COPD patient develops lung cancer, receiving a COPD diagnosis does increase the risk of eventually developing lung cancer.
What’s the Outlook for People With COPD?
The outlook for those with COPD varies widely from patient to patient, and there is no one life expectancy for patients with the condition. In general, those with lower grade COPD have a longer life expectancy than those with higher grade COPD. Any patient with COPD should work in close consultation with their doctor to manage symptoms and improve quality of life. Adhering to all treatment protocols is the best way to optimize the outlook for those with COPD.