Chronic Obstructive Pulmonary Disease (COPD)

COPD stands for chronic obstructive pulmonary disease.

• The word chronic, means it won't go away.
• The word obstructive means partly blocked.
• The word pulmonary means in the lungs.
• The word disease means sickness.

What is COPD?

COPD is a lung disease. We all have airways (air tubules) that carry air into the lungs when we breathe. Airways are shaped much like the branches of a tree, they get smaller and smaller as you go further into the lung.  At the end of each tiny branch, there is a small air sac called  an alveolus which looks like a tiny balloon. In healthy people, each airway is clear and open. Each tiny air sac fills up with air which contains oxygen and is necessary to help our bodies function. The air brings in oxygen necessary for our bodies to function when we inhale, and gets rid of carbon dioxide, a waste product when we exhale.

When you have COPD, you have problems with your lungs. The lungs are damaged by COPD. The openings of the airways are smaller.  Less air gets into the lung because:

• The walls of the airway get thick and swollen (inflammation)
• The airways are squeezed by small muscles around them (bronchospasm)
• The airways make mucous which plugs the airways and reduces airflow (mucous plugging). The tiny air sacs at the end of the airways cannot empty and your lungs feel very full.

These abnormalities result in symptoms of shortness of breath at rest, shortness of breath with exertion (dyspnea), cough, and mucous production.

Who Gets COPD?

• Both men and women can develop COPD
• Most people who develop COPD have been exposed to smoke from cigarettes either as the primary inhalation smoke (I am the smoker), secondary smoke inhalation (other people have smoked in my environment), or tertiary smoke inhalation (clothing, furniture, and carpeting contain fumes from other smokers which are slowly released into the environment where I work or live).
• Some people develop COPD because of exposures to occupational exposure to fumes and inhaled particles
• A small percentage of people develop COPD because of genetic abnormalities (Alpha I Antitrypsin Deficiency).

What are the symptoms of COPD?

• Dyspnea (shortness of breath with exertion) which occurs gradually
• Chronic cough (for greater than 2-3 months, for greater than 2-3 years)
• Daily mucous production usually in the early morning then progressing throughout the day
• Wheezing and chest tightness
• Lung infections on a recurrent basis such as bronchitis or pneumonia

COPD encompasses three lung processes:

• Chronic bronchitis which is defined as chronic cough daily for 3 months for two successive years usually productive of mucus
• Emphysema which represents enlargement of the air sacs (alveoli) interfering with the exchange of oxygen in the lung.
• Asthma which is chronic inflammation of the air tubules that leads to wheezing, breathlessness, chest tightness, and shortness of breath. 

In the air sacs, oxygen that we breathe passes through the walls of air sacs into the blood stream and then is distributed throughout our body serving as the fuel that makes our body work. Carbon dioxide, a waste product of our body, passes in the reverse direction out of the blood stream back into the alveoli and is eliminated by breathing out.

In people who develop COPD, irritating gasses and particles are inhaled while smoking or breathing smoke filled air or other fumes or particles.  These gases and particles can injure the airways and lungs and cause swelling (inflammation).  Over time, The inflammation becomes chronic and damages the lung tissue, and may cause scarring. The lung damage makes it more difficult to breathe in and out and makes it harder for oxygen and carbon dioxide to pass across the walls of the air sacs.

How Do I Know If I have COPD?

If you has shortness of breath, a chronic cough, or cough up mucous and have previously smoked, your healthcare provider may recommend an evaluation for COPD  by a board certified Respiratory specialist.  This evaluation would consist of:

• A thorough history and physical examination
• Pulmonary Function Studies: the pulmonary function test measures obstruction or reduced airflow when you breathe out is called spirometry. It is the best test for diagnosing COPD. In addition to spirometry, during the pulmonary function test, lung volumes and a DLCO (test that can measure the ability of lungs to transfer gasses like oxygen and carbon dioxide) will be completed.
• Oximetry: using a finger oximeter clip device measures the saturation of oxygen in your blood by measuring wave lengths. This test does not hurt and can be done at rest, with exertion such as walking on level ground or climbing steps, and during sleep.
• CXR
• Arterial blood gas sample (ABG) may be obtained to determine if you are having problems clearing carbon dioxide from the blood. Arterial blood gas is usually obtained by taking a blood sample from the artery in your wrist.
• Lab testing can also be part of this evaluation and usually includes:
• A CBC (complete blood count) to measure your hemoglobin level since a low hemoglobin level (anemia) can sometimes cause shortness of breath.
• Alpha I Antitrypsin deficiency level. Alpha I Antitrypsin deficiency is a genetic disorder which causes 2-3% of cases of emphysema in the U.S. In general, all adults who have symptoms of COPD should be tested for Alpha I Antitrypsin deficiency.
• Other tests like an exercise test, or a cardiac echo or chest CT might also be necessary and the Respiratory Specialist will let you know why.

What You and Your Family Can Do About COPD

• Stop smoking. Smoking cessation reduces the risk of progression of the COPD.  This includes primary, secondary and tertiary smoke elimination.
• See your family doctor early with any signs of change in your respiratory condition.
• If medications have been prescribed, understand your medications and follow your doctor’s instructions in their use.

Vaccinations: infection is a common cause of COPD. Vaccinations can prevent some infections and should be offered to patients with stable COPD and include

• Pneumococcal Polysaccharide vaccine should be offered to all patients with COPD over the age of 50 and is usually repeated every 5 years up to the age of 65.
• Annual influenza vaccine

Pulmonary Rehab: fitness and weight loss if obesity is a problem vs. good nutrition and weight gain if wasting and significant weight loss are a problem.