COPD (chronic inflammatory lung disease - causes obstructed airflow from the lungs. Most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

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Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production.

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Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

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Symptoms:

COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues.

 

Main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years.

Other signs and symptoms of COPD may include:

• Shortness of breath, especially during physical activities

• Wheezing

• Chest tightness

• Having to clear your throat first thing in the morning, due to excess mucus in your lungs

• A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish

• Blueness of the lips or fingernail beds (cyanosis)

• Frequent respiratory infections

• Lack of energy

• Unintended weight loss (in later stages)

• Swelling in ankles, feet or legs

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Causes:

- The main cause of COPD is tobacco smoking.

- In the developing world, COPD can occur secondary to fumes exposure such as that from burning fuel for cooking and heating in poorly ventilated homes.

- Alpha-1-antitrypsin deficiency - genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs.

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Complications:

COPD can cause many complications, including:

• Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.

• Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk.

• Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk.

• High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

• Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.

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Treatment:

Smoking cessation

The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse — which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful.

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Medications:

Bronchodilators

These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both.

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Inhaled steroids

Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. 

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Combination inhalers

Some medications combine bronchodilators and inhaled steroids. 

 

Oral steroids

For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

 

Phosphodiesterase-4 inhibitors

A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss.

 

Theophylline

This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended.

 

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties.

 

Lung therapies:

Doctors often use these additional therapies for people with moderate or severe COPD:

• Oxygen therapy

  • ​ If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town.

    Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options.

• Pulmonary rehabilitation program

  • ​ These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs.

    Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program.

 

Managing exacerbation:

Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment.

Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing.

When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible.