Chronic obstructive pulmonary disease (COPD) causes permanent damage to the lungs and narrows the airways (bronchi). This makes breathing difficult once the disease has reached an advanced stage. At that point even everyday activities such as climbing stairs, gardening, or taking a walk can leave you out of breath.
COPD does not arise overnight. Instead, it develops gradually over the course of many years. Symptoms like a persistent cough are often initially mistaken for "normal" smoker's cough or asthma. People often first find out that they have COPD when it has already progressed to a more advanced stage and their symptoms get worse. By that time many of them are already over 60. COPD treatments aim to stop or at least slow down the progression of the disease. The most important thing to do is quit smoking. Medicine can relieve symptoms and prevent shortness of breath. Education programs designed for COPD patients can help them cope with the disease.
The potential capacity of your lungs is very large. When relaxed, your body only needs less than a tenth of the amount of air your lungs can handle during strenuous exercise. This flexibility is the reason why lung function can gradually worsen over many years without noticeably affecting your day-to-day life. Shortness of breath caused by COPD only becomes apparent once the capacity of your lungs has already decreased a lot. The typical symptoms of COPD include the following:
- Breathing difficulties during physical exercise; also while at rest in advanced COPD
- Daily cough over a longer period of time
- Sputum (coughed-up phlegm)
- Breathing sounds such as wheezing
- Symptoms that get worse when you have a cold or flu
Phases in which the disease suddenly gets much worse, known as flare-ups or exacerbations, are also typical and are usually marked by acute episodes of shortness of breath and more coughing with sputum.
Several factors play a role in the development of COPD. One is persistent inflammation of the bronchi. Also, the air sacs (alveoli) in the lungs may become over-inflated. This condition is called pulmonary emphysema.
Chronic bronchitis may develop if the airways are frequently exposed to harmful substances such as tobacco smoke, dust, or gases. This inflammation destroys the cilia – the tiny, hairs that line the inside of the bronchi like a carpet. The cilia can move and are covered by a thin layer of mucus. Dust and germs from the outside air usually become trapped in this mucus layer, which prevents them from reaching the lungs. The cilia then transport the mucus out of the bronchi. This self-cleaning function is very important for healthy lungs. Damaged cilia are not able to move the mucus, leaving the bronchi clogged.
In pulmonary emphysema, the walls of the air sacs are damaged. Instead of there being many small air sacs, large air sacs develop. This decreases the surface area of the lungs, and less oxygen can enter the bloodstream. If someone has both narrow, inflamed bronchi and pulmonary emphysema at the same time, each can make the other get worse.
Air sacs and constricted airway (bronchus)
Other kinds of regular lung irritation, such as exposure to dust particles in the workplace, can also increase your risk of developing the disease.
It is thought that certain factors already present at birth may make some people more likely to develop COPD later on. Examples include problems with lung development in the womb and the rare “alpha-1 antitrypsin deficiency (AATD),” which affects about 1 to 2 out of 100 people.
The symptoms are not obvious at first, but even people with mild COPD often have a cough with sputum. Their airways are only slightly constricted in the early stages of the disease, so they hardly notice the gradual loss in lung function. Over time, though, they start having more problems breathing during physical exercise. They also start coughing more, with more sputum.
Advanced COPD greatly affects your quality of life. Your airways become so narrow that you get out of breath during everyday activities or even while resting.
At advanced stages of COPD, the lungs can no longer provide the body with enough oxygen. This also affects other organs such as the heart, which now has to pump more blood through the lungs. The increased workload causes part of the muscle on the right side of the heart to grow. The medical term for this is pulmonary heart disease or “cor pulmonale.” The heart becomes weaker as a result, which can cause water retention in the legs and the rest of the body, among other things.
Because of the problems caused by physical exertion, people with COPD exercise less. This means that they lose muscle mass, which makes them even less physically fit.
In people with COPD, respiratory infections that would otherwise be harmless can cause their lung function to suddenly decline and make their symptoms a lot worse. These attacks, called flare-ups or exacerbations, often need to be treated in the hospital. Flare-ups may also be caused by smoke, exhaust fumes or certain weather-related conditions such as heat, cold or high humidity. The following are typical signs of a flare-up:
- More sputum
- Colored sputum, sputum with pus, or sputum that is thicker and stickier than usual
- More shortness of breath than usual
- More coughing than usual
- Increased need for medication
- Fever, decreased physical fitness, more severe fatigue or other nonspecific symptoms
Suddenly finding it harder to breathe usually makes people feel anxious, which can lead to even more trouble breathing. It is helpful to know how to react in these kinds of situations. An emergency plan of action can be useful here: it describes the typical symptoms and provides information on things like when it might be a good idea to change your medication schedule or dose, and when to see a doctor or go to hospital.
COPD often goes undetected at first. Smokers in particular often think it is simply a harmless “smoker’s cough.” But symptoms like a persistent cough and frequent shortness of breath can be signs of COPD.
Initial tests can often be done by a family doctor. Any additional examinations need to be done by a lung specialist (a pulmonologist).
Your doctor will first do a general physical examination, ask about any other conditions you have, and take a blood sample. This is followed by tests that measure the performance of your lungs (lung function tests, spirometry). Depending on the results, further tests may be done to rule out other conditions such as asthma, heart failure, or lung cancer.
Besides confirming the diagnosis, these tests can be used to help see how advanced the disease is and determine your risk of complications. A treatment plan can then be drawn up based on the results.
The most effective way to prevent COPD is to not smoke or to quit smoking. This is often easier said than done. Strategies for quitting include combining a support program and nicotine replacement therapy.
Harmful substances in the environment or at the workplace can also increase your risk of developing COPD and should be avoided as much as possible. Protective measures at work can help avoid constant exposure to these substances.
Flare-ups are often triggered by respiratory infections, which are a further attack on the bronchi. Typical symptoms of the common cold and flu, such as a sore throat, sweats and fever, can weaken your body even more. Because of this, people with COPD should take special care to avoid infection during the cold and flu season. This includes avoiding contact with people who have colds and large crowds. It may also be a good idea to have a flu vaccine.
One aim of COPD treatment is to relieve symptoms, making everyday life easier and improving quality of life. A further aim is to slow down the progression of the disease and prevent exacerbations.
Medication is an essential part of daily COPD treatment. Depending on how far the disease has progressed, combinations of various drugs are commonly used. These are usually drugs called bronchodilators that can widen the airways and make it easier to breathe. There are also drugs called corticosteroids that can be taken to reduce inflammation in the airways, but they are more commonly used to treat asthma. At more advanced stages of COPD, oxygen therapy is often used as well. Different types of oxygen therapy are used depending on how severe the disease is.
Supportive measures include physical exercise, breathing exercises, inhalation, or changes in diet. In Germany, statutory health insurers also offer disease management programs (DMPs) for people with COPD. The aim of these programs is to provide consistent and well-planned treatment in close cooperation with medical professionals, reducing the number of flare-ups and slowing down the progression of the disease.
Pulmonary rehabilitation helps people with chronic obstructive pulmonary disease (COPD) to better cope with their disease and to live as normal a life as possible. A treatment plan based on individual needs is created to help reach this goal. The treatment plan includes a combination of physical exercise, an educational program on dealing with the disease and the therapy, and social and emotional support.
Pulmonary rehabilitation is an important part of the COPD disease management program (DMP). Rehabilitation can either be done on an inpatient or outpatient basis.
The impact COPD has on everyday life depends mostly on the stage of the disease. For years it may only cause minor problems, but the symptoms get worse as time goes by. In advanced COPD it is no longer possible to live a normal life, and eventually people will usually need extensive support and nursing care.
Many people find it helpful to adjust their lifestyle and daily routine according to their body's needs and responses as much as possible. Some focus more on things that are especially important to them. Some find specialized breathing and relaxation exercises helpful, allow themselves lots of rest and do low-impact sports when they feel up to it.
The more the disease progresses, the greater the need for practical and emotional support from family and friends.
In addition to disease management programs (DMPs), a wide range of different services for individual counseling and support is available if you are ill. In Germany, there are regional differences in how these services are organized and they are not always easy to find. A list of points of contact can help you to locate and make use of these services.
Bundesärztekammer, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Kassenärztliche Bundesvereinigung: Bundesärztekammer. Nationale Versorgungsleitlinie COPD. Berlin: Ärztliches Zentrum für Qualität in der Medizin. January 2012.
Calverley PM, Walker P. Chronic obstructive pulmonary disease. Lancet 2003; 362(9389): 1053-1061.
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Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. (Updated 2015).
Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004; 364(9434): 613-620.
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