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COPD: Chronic Obstructive Pulmonary Disease
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What is COPD?

COPD

Chronic obstructive pulmonary disease (COPD) is a term referring to a combination of two lung diseases, chronic bronchitis and emphysema. COPD is characterized by obstruction to airflow that interferes with normal breathing.

In COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out because:

  • The airways and air sacs lose their elasticity (like an old rubber band)
  • The walls between many of the air sacs are destroyed
  • The walls of the airways become thick and inflamed (swollen)
  • Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.
  • Lung tissue and the alveoli are damaged which causes air to be trapped in the lungs. This leads to shortness of breath. (1) Illustration and text courtesy of the Nat'l Heart, Lung, and Blood Institute
Causes

Cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or former smokers. Breathing in other kinds of lung irritants, like pollution, dust, or chemicals over a long period of time may also cause or contribute to COPD.(1) COPD typically progresses very slowly, thus it is most often diagnosed in middle-aged or older people. (photo of lungs damaged by long-term cigarette smoking)

Symptoms

COPD develops slowly, and it may be many years before symptoms become noticeable.

  • shortness of breath, especially with exercise
  • chest tightness
  • cough (A cough that doesn't go away and coughing up large amounts of mucus are common signs of COPD)
  • sputum (mucous) production
  • wheezing

The severity of the symptoms depends on how much of the lung has been destroyed. If you continue to smoke, the lung destruction will be more extensive than if you stop smoking.

Diagnosis

Early detection of COPD is very important, because the sooner you quit smoking and avoid other environmental factors that contribute to COPD, the better your chance of slowing damage to your airways and lungs.

Chronic obstructive pulmonary disease (COPD) can usually be diagnosed using a medical history and lung function tests, such as spirometry. Your doctor will also perform a physical examination and may recommend a chest X-ray to rule out other conditions. Some tests are done to rule out other diseases or conditions that may make COPD worse and its treatment more difficult.

A chest X-ray helps ensure that there are no heart or lung problems (such as cancer) causing your symptoms.
A complete blood count (CBC) can reveal information about how well oxygen is getting into the blood and about any possible infection.

Spirometry, a simple and painless breathing test, measures how quickly the lungs can move air in and out. It can also measure how much air the lungs move in and out.

Treatment from the National Lung Health Education Program

There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to feel better and slow the damage to your lungs.(1)

Stop smoking if you smoke. This is the single most important thing you can do for yourself. Otherwise, none of your other efforts will be as effective as they could be, and your COPD will get worse.

Avoid being around smokers and fume-laden air. Polluted air also can irritate your breathing passages. During fog or smog, try to stay indoors with windows closed. Try not to go out when the air quality is rated poor. If you cannot avoid excessive air pollution, protect your mouth and nose with a mask.

Fumeless appliances should be used, if possible, for heating.

See your doctor on a regular basis and especially if you have a chest cold or any time you cough up mucus.

Guard against catching the flu by getting an influenza vaccine each fall, well before winter starts. A pneumonia vaccine should also be given to anyone over age 60, and all persons with COPD.

Coughing has an important "cleaning action" and is something you should do every morning and evening. You must learn to cough in such a way that you can clear your lungs of mucus with two or three coughs. There are many ways to do this; your doctor will teach you the way that is best for your particular problem. As an aid to this cleaning, your doctor might recommend breathing moist or humid air, and drinking plenty of fluids every day. This helps to thin out the mucus so that you can cough it up more easily.

Learning to breathe properly is another very important lesson for people with asthmatic bronchitis, chronic bronchitis, or emphysema. If you have COPD, you usually work very hard to breathe. However, because you are not breathing properly, your hard work does not make you feel better and you become tired easily. There are several things you can do to improve your breathing:

  • First, it is important to relax. You must be relaxed when you breathe.
  • Breathe out against pursed lips, like when whistling. This slows down the number of breaths you take. This allows each breath to do more good for you.
  • Lean forward while exercising. This also helps stop shortness of breath.
  • "Belly breathing" will also help shortness of breath. This is done by allowing your belly to stick out while breathing in and then pulling your belly in while breathing out against pursed lips.
  • Physical Activity

Often people make the mistake of believing that if they try to avoid becoming short of breath, they will protect their lungs and heart. Nothing could be less true. Remaining physically active will improve your breathing ability and help you feel better and enjoy life more.

Exercise regularly: You can learn how to exercise more even if you have COPD. As we all know, muscles will become weak if we don't use them. This is true for the muscles of your chest, which are important in breathing, as well. Strengthening these muscles will help stop shortness of breath.

  • Don't let COPD change your normal attitudes about exercise. You should walk every day, going farther each day than you did the one before. First, walk in your house, then out of doors — walking longer distances each time. You will soon notice that you are breathing better because using the muscles in your chest helps stop shortness of breath.
  • Your doctor will tell you which exercises are best for you and plan an exercise program based upon your ability. Ask about local pulmonary programs.

Oxygen is a very helpful treatment that enables many patients with severe COPD to lead a more normal and productive life. Portable cylinders will allow you to carry oxygen with you, or your doctor might tell you to use it at night during sleep when a lack of oxygen is most severe. Liquid portable oxygen is the most practical ambulatory system. Your doctor must order the proper oxygen system which can benefit you the most. A supplier cannot change your doctor's prescription. Follow the directions you are given carefully, as you would for any medication that is prescribed.

Pulse oximeter This is a small monitoring device which slips onto a finger for a quick and simple measurement of heart rate and the amount of oxygen in the blood. Hospitals and doctors offices have used these devices routinely for years. In hospitals, the pulse oximeter may remain on the finger for continuous monitoring, or they may be used periodically for spot checks. Small, portable pulse oximeters are now available and affordabe for home use. This is relatively new technology that can be extremely helpful, even life-saving, for someone with chronic lung disease. These devices are available for sale to the public (see ads upper right column), but should be used under the direction and supervision of your physician or nurse practitioner.

Medications: Many different medications are used as treatment for asthmatic bronchitis, chronic bronchitis, or emphysema. Your health care provider will decide which medicine is best for you based on your symptoms, medical history, breathing tests, and laboratory tests.

Bronchodilators relax the muscles that surround the breathing tubes and widen them, letting air travel in and out more easily.

Another type of bronchodilator medication (an anticholinergic), is available in metered-dose devices. The other major type of inhaled bronchodilator is called a beta agonist.

Beta agonist medications and anticholinergic medications are also available as solutions for use with pump-driven nebulizers. Both medications can be used together in the same nebulizer. Both are also sold separately in a metered-dose inhaler. Since these bronchodilators work on the respiratory system in different ways, they can be used together to treat COPD.

Expectorants are used to liquefy the mucus in your lungs.

Steroids, are sometimes prescribed to reduce the swelling in your breathing tubes.

Antibiotics are prescribed for infections in the respiratory system such as bronchitis or pneumonia.

Metered-Dose Inhalers Most of these devices, which deliver medication to your lungs as a spray, require a prescription from your doctor. The medication in a metered-dose inhaler that can be bought without a prescription such as Primatine MistTM is adrenaline, a short-acting drug which may be dangerous for persons with heart disease. It is inadequate to treat COPD.

In order to get the maximum benefit from the medication, it is important that the inhaler be used properly. Here are some helpful tips for using a metered-dose inhaler:

  • Remove the cap from the mouthpiece.
  • Shake the inhaler for a few seconds. Breathe out.
  • Hold the inhaler upright and place it in front of your mouth. Keep your mouth slightly open.
  • Breathe in deeply and at the same time press the inhaler between your thumb and forefinger.
  • This will force the medication from the inhaler into your throat and lungs.
  • Remove the inhaler and hold your breath for a few seconds; then resume normal breathing. Wait at least two minutes before repeating the process. (Most inhaler medications specify that two puffs should be taken. Wait at least two minutes between each puff.)
  • Do not exceed the dose prescribed by your doctor. If you continue to have difficulty breathing, contact your doctor immediately.

A device called a spacer or volume chamber should also be used to make it easier to take your medication. This device catches the mist produced by a metered-dose inhaler and holds it so that you can breathe it in at a slower rate.

Nebulizers (Mist-Generating Devices): This type of treatment, which must be prescribed by your doctor, delivers a mist of medication and moisture to your lungs. The device that is most often used to create this mist is a "pump-driven nebulizer." The liquid medication is placed in the nebulizer where it is changed into a mist that you inhale. When taking this treatment, here are some points to remember:

  • Be sure you know the amount of medication and solution to use as well as the length and timing of your treatment.
  • Follow your doctor's or respiratory therapist's instructions carefully about when each treatment should be scheduled and the length of time that it should be done.
  • Relax and sit in a comfortable chair in an upright position.
  • Make sure the tubing is not bent or dented, and that the handhold is at the same level as your mouth.
  • Put the mouthpiece in front of your teeth and keep your mouth slightly open.
  • Take a deep, slow breath and activate the nebulizer control. Let the mist fill your lungs. Hold your breath for about two seconds before exhaling. Remember to exhale slowly and completely each time.
  • If your mouth becomes dry during your treatment, don't be afraid to stop and drink some water.
  • Also -- and this is very important -- if you bring up mucus during the treatment, turn your machine off and stop and cough it up. These treatments are helpful in eliminating mucus.

If you experience any discomfort after treatment, notify your doctor.

Interactive Video Tutorials
  • COPD-Chronic Obstructive Pulmonary Disease from Medline Plus.  Scroll down through "Diseases and Conditions".  Select "COPD" and follow the directions for the interactive video tutorial.  This is an outstanding and interesting video tutorial about the anatomy of the lungs, their function in respiration, and the physiology of disease. This is from Medline Plus, a service of the National Library of Medicine and the National Institute of Health
  • Respiratory System from MerckMedicus. See different layers and angles of the lungs and heart in 3D. This is an excellent and interesting video tutorial that will help the user understand the anatomy of the lungs and heart.
  • Smoking--The Facts from Medline PlusScroll down through "Prevention and Wellness ".  Select "Smoking - The Facts " and follow the directions for the interactive video tutorial.  Medline Plus is a service of the National Library of Medicine and the National Institute of Health

Pulmonary Specialists in Pinellas County, Florida


Bowers, Ron M.D., Diagnostic Clinic, 1551 West Bay Drive, Largo, FL 33770; Phone 727-581-8767

Useful Links:
References:
(1) What is COPD? from the National Heart, Lung, and Blood Institute
(2) Lung: Treatment of COPD and Asthma from the National Lung Health Education Program
--Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Last updated February 2009


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