COPD

Overview of COPD

Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that affect airflow and breathing. Two of the most common COPD conditions are chronic bronchitis and emphysema. Chronic bronchitis is persistent and long-standing inflammation of the lining of the bronchial tubes in the lungs. Emphysema is a chronic condition where the lung alveoli (air sacs) are gradually destroyed.

Lung Damage

Damage to the lungs from COPD cannot be reversed, but treatment can minimize future damage and relieve symptoms. The main cause of COPD is tobacco smoking, but it can occur from exposure to fuel fumes with cooking and heating. The trachea divides into two tubes called bronchi. Each of these tubes branch off in the lungs into smaller tubes called bronchioles. At the end of these bronchioles are clusters of tiny air sacs called alveoli. The oxygen a person inhales passes through the tiny blood vessels in these air sacs, and carbon dioxide is exchanged and exhaled. Chronic inflammation from tobacco smoke causes the alveoli to lose their elasticity, leaving some air trapped.

Alpha-1-Antitrypsin Deficiency

Alpha-1-antitrypsin (AAt) is a protein made in the liver, secreted in the bloodstream, and circulated to the lungs. This substance protects the lungs from damage. Approximately one percent of people with COPD have a genetic disorder that causes low levels of AAt. Alpha-1-antitrypsin deficiency can occur in infants, children, and young adults who do not smoke.

Symptoms

The symptoms of COPD include:

  • Shortness of breath
  • Chest tightness
  • Wheezing
  • Productive cough
  • Discoloration of the nailbeds (cyanosis)
  • Lack of energy
  • Weight loss
  • Frequent lung infections

Risk Factors for COPD

  • Exposure to tobacco smoke – The main risk factor for COPD is long-term cigarette smoking. The risk increases as the years and packs per day increase.
  • Occupational exposure to chemicals and dusts – Persistent exposure to vapors, dusts, and chemical fumes increases the risk for developing COPD.
  • Genetics – Aat deficiency is a genetic condition that causes COPD.
  • Age – COPD is a gradually occurring condition, with symptoms presenting around the age of 40 years.
  • Complications of COPD
  • Respiratory infections – People with chronic lung inflammation are more prone to the flu, colds, bronchitis, and pneumonia. A respiratory infection makes it hard to breathe and can further damage the lung tissue.
  • Heart problems – COPD increases the risk of heart attack and other forms of heart disease.
  • Lung cancer – People with COPD are at a greater risk for developing lung cancer.
  • High blood pressure – COPD can lead to pulmonary hypertension.
  • Depression – COPD causes breathing difficulty which contributes to development of depression.
  • Treatment
  • Effective therapy for COPD involves reducing the risk of complications, controlling symptoms, and improving quality of life. Treatment involves:
  • Smoking cessation – The main thing a smoker with COPD can do to alleviate symptoms and prevent exacerbations is to stop smoking. Nicotine replacement products and medications can help with smoking cessation.
  • Bronchodilators – These medications relax the muscles around the airways to relieve coughing and shortness of breath. Examples include levalbuterol, ipratropium, and albuterol.
  • Inhaled steroids – Corticosteroids reduce airway inflammation and prevent lung infections. Examples include fluticasone and budesonide.
  • Phosphodiesterase-4 inhibitors – This is a fairly new medication used for severe COPD. Roflumilast (Daliresp) decreases airway inflammation by relaxing the airways.
  • Theophylline – This is an inexpensive bronchodilator that can be taken by mouth or given intravenously.
  • Antibiotics – When respiratory infections occur, they can aggravate COPD symptoms. Antibiotics are used to eradicate bacterial infections that affect the lungs.
  • Oxygen therapy – Supplemental oxygen is used when there is not enough oxygen getting into the bloodstream.