COPD (Chronic Obstructive Pulmonary Disease)

COPD (chronic obstructive pulmonary disease) is an incurable but treatable and preventable lung disease that tends to develop slowly and worsen gradually. Having COPD means that the lungs have developed permanent changes that affect the body's ability to exhale properly. This can eventually affect the ability to do everyday activities including walking, working, and handling self-care tasks.

Worldwide, COPD ranked as the sixth leading cause of death in 1990. It is projected to be the fourth leading cause of death worldwide by 2030 due to an increase in smoking rates and demographic changes in many countries. COPD is the 4th leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity.

People with COPD tend to get out of breath easily, and they may have to give themselves extra time to breathe out slowly. Due to damage to the lung structure, extra air is often trapped in the lungs, making it difficult both to inhale oxygen and to exhale carbon dioxide as efficiently as a healthy person can.

There are two main types of COPD, affecting slightly different parts of the lungs: chronic bronchitis and emphysema. Typically, people with COPD have both of these diseases, which is why the more general term COPD has become the preferred usage.

COPD isn't reversible, but it is treatable. The purpose of treatment is to slow the disease's progression, and to prevent exacerbations, or flare-ups. For those who smoke, quitting slows the disease process.

COPD Causes

COPD is caused by noxious particles or gas, most commonly from cigarette smoking, which triggers an abnormal inflammatory response in the lung. The inflammatory response in the larger airways is known as chronic bronchitis. Deep inside the lung, the inflammatory response causes destruction of lung tissues, a process known as emphysema.

Symptoms of COPD

The first symptom of COPD is usually coughing that produces phlegm, followed by shortness of breath after activities such as climbing the stairs or walking uphill. Many times a person experiencing difficulty breathing will cut back on activities that cause shortness of breath.

Lying flat forces your lungs to work harder, many people with COPD find they have trouble sleeping deeply but they may not realize it’s the lung condition causing it. Sleep is also hard for people with COPD because they may cough throughout the night, waking themselves up or interrupting deep sleep.

One of the more mysterious symptoms of COPD is waking up after a night’s sleep with a dull, throbbing headache. What’s happening is that you’re not breathing deeply enough at night, and the carbon dioxide builds up while you’re sleeping.

Over time, these breathing difficulties usually get worse, and a person with COPD might eventually have trouble even dressing and bathing himself. He might get tired easily, lose the ability to concentrate, and put strain on his heart because his lungs are not processing enough oxygen. Strain on the heart can lead to swollen feet, ankles, and legs from water retention known as edema.

If your blood doesn’t circulate enough oxygen throughout your body, your lips and fingernails can take on a blue or gray tone. Sometimes the color, known as cyanosis, is most apparent in the nail beds; some people develop an overall grayish-blue tinge to the skin. The cause: Oxygen-rich blood is bright red, while blood with less oxygen turns dark and bluish-colored.

Treatment

Once COPD has been diagnosed, stopping smoking slows down the rate of progression of the disease. Even at a late stage of the disease it can significantly reduce the rate of deterioration in lung function and delay the onset of disability and death.

Asthma-style inhalers are standard treatment for COPD, but researchers are studying new combinations that make them much more effective. So many different studies have come out in the past couple of years that there's no agreed-upon strategy.

However, many experts now believe that patients do best on "triple therapy," taking three different medications: a long-acting beta-agonist, an inhaled corticosteroid, and the anticholinergic Spiriva (generic name tiotropium bromide). A study conducted at Hannover Medical School in Germany found that when patients took all three medications, their severe episodes of breathing difficulty, known as "exacerbations," dropped by 62 percent. They also had fewer emergency room visits and hospitalizations.

Some patients with severe cases of COPD may benefit from lung volume reduction surgery (LVRS), in which the size of the damaged lungs is reduced by removing the damaged parts.

This is considered high-risk surgery. In the National Emphysema Treatment Trial, the first multicenter trial designed to evaluate this surgery in detail, the death rate during surgery was a relatively high 6 percent.

Studies have shown that LVRS is most likely to improve quality of life and decrease mortality in patients with emphysema that mainly affects the upper parts of their lungs, who also have low exercise capacity. In other patients with COPD, LVRS did not improve mortality, and in some cases it increased the risk of dying. For this reason, Medicare and some other insurance companies will only pay for LVRS under certain very specific conditions.

For people with advanced COPD who are not likely to benefit from LVRS, lung transplantation is sometimes considered. This is also a very risky surgery, however. People who have lung transplants are also required to take immunosuppressant drugs indefinitely after their surgery.