What Is COPD
COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time.
COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may contribute to COPD.
Overview
To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways.
Within the lungs, your bronchial tubes branch into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves from the capillaries into the air sacs. This process is called gas exchange.
The airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.
In COPD, less air flows in and out of the airways because of one or more of the following:
- The airways and air sacs lose their elastic quality.
- The walls between many of the air sacs are destroyed.
- The walls of the airways become thick and inflamed.
- The airways make more mucus than usual, which tends to clog them.
Normal Lungs and Lungs with COPD
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.
In the United States, the term “COPD” includes two main conditions—emphysema (em-fi-SE-ma) and chronic bronchitis (bron-KI-tis). (Note: The Diseases and Conditions Index article about bronchitis discusses both acute and chronic bronchitis.)
In emphysema, the walls between many of the air sacs are damaged, causing them to lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.
In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe.
Most people who have COPD have both emphysema and chronic obstructive bronchitis. Thus, the general term “COPD” is more accurate.
Outlook
COPD is a major cause of disability, and it’s the third leading cause of death in the United States. More than 12 million people are currently diagnosed with COPD. Many more people may have the disease and not even know it.
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 people. The disease isn’t passed from person to person—you can’t catch it from someone else.
COPD has no cure yet, and doctors don’t know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
How Is COPD Treated
COPD has no cure yet. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.
Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke. (Secondhand smoke is smoke in the air from other people smoking.)
The Diseases and Conditions Index (DCI) Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart” booklet have more information about how to quit smoking.
Other treatments for COPD may include medicines, vaccines, pulmonary rehabilitation (rehab), oxygen therapy, and surgery. Your doctor also may recommend tips for managing COPD complications.
The goals of COPD treatment include:
- Relieving your symptoms
- Slowing the progress of the disease
- Improving your exercise tolerance (your ability to stay active)
- Preventing and treating complications
- Improving your overall health
Specialists Involved
To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating people who have lung disorders.
Bronchodilators
Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.
Depending on how severe your disease is, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4 to 6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.
Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go right to your lungs. Not all inhalers are used the same way. Ask your health care team to show you the correct way to use your inhaler.
If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may only use the medicine when symptoms occur.
If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.
Inhaled Glucocorticosteroids (Steroids)
Inhaled steroids are used to treat people whose COPD symptoms flare up or worsen. These medicines may reduce airway inflammation.
Your doctor may ask you to try inhaled steroids for a trial period of 6 weeks to 3 months to see whether the medicine helps relieve your breathing problems.
Vaccines
Flu Shots
The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of the flu. Talk with your doctor about getting a yearly flu shot.
Pneumococcal Vaccine
This vaccine lowers your risk of pneumococcal pneumonia (nu-MO-ne-ah) and its complications. People who have COPD are at higher risk of pneumonia than people who don’t have COPD. Talk with your doctor about whether you should get this vaccine.
Pulmonary Rehabilitation
Pulmonary rehabilitation, or rehab, is a medically supervised program that helps improve the health and well-being of people who have lung problems.
Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program’s goal is to help you stay more active and carry out your daily activities.
Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals work together and with you to create a program that meets your needs.
Oxygen Therapy
If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you’re given oxygen through nasal prongs or a mask.
You may need extra oxygen all the time or just sometimes. For some people who have severe COPD, using extra oxygen for most of the day can help them:
- Do tasks or activities, while having fewer symptoms
- Protect their hearts and other organs from damage
- Sleep more during the night and improve alertness during the day
- Live longer
For more information, go to the DCI Oxygen Therapy article.
Surgery
In rare cases, surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.
Surgeries for people who have COPD that’s mainly related to emphysema 
include bullectomy (bul-EK-to-me) and lung volume reduction surgery (LVRS). A lung transplant may be done for people who have very severe COPD.
Bullectomy
When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.
Lung Volume Reduction Surgery
In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.
Lung Transplant
A lung transplant may benefit some people who have very severe COPD. During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.
A lung transplant can improve your lung function and quality of life. However, lung transplants have a high risk of complications. These include infections and death due to the body rejecting the transplanted lung.
If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Discuss with your doctor the benefits and risks of this type of surgery.
For more information, go to the DCI Lung Transplant article.
Managing Complications
COPD symptoms usually slowly worsen over time. However, they can worsen suddenly. For instance, a cold, the flu, or a lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum (spit), and a fever.
Call your doctor right away if this happens. He or she may prescribe antibiotics to treat the infection and other medicines, such as bronchodilators and inhaled steroids, to help you breathe.
Living With COPD
COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:
- Avoid lung irritants
- Get ongoing care
- Manage the disease and its symptoms
- Prepare for emergencies
Avoid Lung Irritants
If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program.
The Diseases and Conditions Index Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart” booklet have more information about how to quit smoking.
Try to avoid other lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)
Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for a while.
Keep your windows closed and stay at home (if possible) when there’s a lot of air pollution or dust outside.
Get Ongoing Care
If you have COPD, it’s important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring all of the medicines you’re taking when you have medical checkups.
Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.
Manage COPD and Its Symptoms
You can do things to help manage your disease and its symptoms. Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks. Do activities slowly. Put items that you need often in one place that’s easy to reach.
Find very simple ways to cook, clean, and do other chores. Some people find it helpful to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help moving things around in your house so that you won’t need to climb stairs as often.
Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.
Prepare for Emergencies
If you have COPD, knowing when and where to seek help for your symptoms is important. You should seek emergency care if you have severe symptoms, such as trouble catching your breath or talking. (For more information on severe symptoms, go to “What Are the Signs and Symptoms of COPD?”)
Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.
Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor’s office and hospital and a list of all the medicines you’re taking.
Emotional Issues and Support
Living with COPD may cause fear, anxiety, depression, and stress. It’s important to talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re feeling very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Source: National Heart, Blood and Lung Institute