What is COPD?
Chronic Obstructive Pulmonary Disease, also known as COPD, is classified as a group of progressive lung conditions or diseases and takes a long time to develop. The two conditions which fall into this group are chronic bronchitis and emphysema. Many diagnosed with COPD are also being treated for both of these conditions.
A lung disease, sufferers of COPD struggle with breathing, typically as a result of smoking or prolonged exposure to chemical irritants or fumes. Chronic bronchitis is a condition whereby the lining of the bronchial tubes (airways that carry air to the lungs) become inflamed and produce excess mucus, causing a narrowing or blockage.
Emphysema is characterised by damaged air sacs (alveoli) that have lost their stretch (normally air sacs are capable of inflating and deflating with breath). This means that a sufferer struggles with getting enough air in and out of the lungs, causing severe shortness of breath.
Once these types of conditions reach the stage of COPD, there’s very little you can do. Damage to the lungs can’t be reversed and the condition typically worsens over time.
Signs of COPD may initially be mild (coughing and shortness of breath), but progressively worsen where it becomes increasingly difficult to breathe. Flare-ups of severe symptoms are common as the disease reaches more advanced stages.
There is currently no cure for COPD, and if left untreated it can result in other worsening respiratory infections, including lung cancer and heart problems. Treatment will involve steps to curb the development of further damage and manage symptoms, as well as reduce the chance of complications. Treatment typically involves medications, oxygen therapy and even surgery.
What causes COPD?
The vast majority of diagnosed COPD individuals are smokers or former smokers. As such, cigarette (tobacco) smoking is one of the main underlying causes for the development of this condition, as well as chronic bronchitis and emphysema. Cigar smoke, second-hand smoke and pipe smoke, as well as long-term exposure to chemicals and fumes (such as burning fuel for cooking and heating) affecting normal lung function are also contributing culprits to COPD.
Long-term exposure to dust and air pollution can also significantly impair lung function, making a person more susceptible to COPD. Conditions such as asthma can also place a person at greater risk.
Genetics can play a role whereby a deficiency in AAt / alpha-1-antitrypsin (a protein) can eventually cause deterioration of the lungs, and also affect normal liver function. AAt is produced in the liver and secreted into the bloodstream. This protein helps to protect the normal function of the lungs. As a cause, this is fairly rare.
The condition takes a long time to develop and typically sees individuals well into their middle age (40 years and older) being diagnosed. A person’s airways become severely irritated and the natural stretchy fibres in the lungs progressively become destroyed.
Lung function and COPD
How do the lungs normally function?
When air is inhaled, it travels down the trachea (windpipe) and passes through the bronchi (two large tubes) into the lungs. The tubes are much like the branches of a tree and divide several times into smaller ones, known as bronchioles. These end in clusters of small alveoli (air sacs).
The air sacs contain tiny capillaries (blood vessels) within their walls. As we breathe (inhale), air passes into these capillaries and enters the bloodstream. The air sacs process out carbon dioxide (a waste product of metabolism) through exhaling (breathing out).
How does COPD affect the lungs?
The bronchial tubes and air sacs are naturally elastic and function in such a way that allows inflation and deflation as air is inhaled, processed and exhaled. COPD progressively destroys the natural flow of this function. Elasticity is lost and both the tubes and air sacs begin to over-expand. When this happens, air becomes trapped in the lungs, making it difficult for a person to breathe when they try to exhale.
What are the signs and symptoms of COPD?
Many dismiss the first signs of COPD as they can be mild and similar to that of the common cold or even flu. Early signs include:
- A mild (but recurrent) cough
- A feeling of needing to clear your throat (especially first thing in the morning)
- Occasional shortness of breath (particularly during or after exercise activity)
General signs and symptoms
A typical reaction to persistent early signs and flags to your doctor are subtle change in habits. These can include avoidance behaviour when it comes to taking the stairs or reducing physical activity (mild exercise).
COPD symptoms progressively worsen and as such, a person finds it increasingly difficult to ignore physical signs. Damage to the lungs typically causes:
- Noisy breathing and wheezing
- Shortness of breath
- Tightness in the chest
- Chronic cough (with or without mucus / sputum)
- Frequent respiratory infections, such as colds and flu
- Lethargy and an increasing lack of energy
Latter stage symptoms of COPD can include:
- Swelling of the ankles, feet and legs
- Weight loss (unexplained)
Simple daily things such as getting dressed or preparing a meal can start to become laborious tasks. It becomes increasingly difficult to eat comfortably or exercise. A person becomes increasingly tired and lethargic as breathing takes up more and more of their energy.
It is not uncommon for a COPD sufferer to lose weight and become weaker, or experience intense flare-ups of general symptoms. Flare-ups are known as COPD exacerbation and can range from mild to severe (life-threatening). As the condition progresses, flare-ups will worsen each time they are experienced and persist for several days at a time.
Signs of emergency
Red flags that will signal the need for immediate medical care include:
- Cyanosis (blue or grey lips or fingernails)
- Inability to talk
- Altered mental state – confusion
- Feeling faint or dizzy
- A racing heartbeat
- Inability to breathe properly
Diagnosing and Treating COPD
How will COPD be diagnosed?
Diagnosis is made through a combination of assessed symptoms and a physical examination, as well as a few tests.
Your doctor may ask the following during your consultation:
- Are you a chronic smoker or have you smoked for a period of time in the past?
- Do you frequently inhale second-hand smoke - either at home or in the workplace?
- Are you generally exposed to chemicals and fumes in your place of work?
- Has anyone in your family been diagnosed or treated for chronic bronchitis, emphysema or COPD?
- Do you frequently suffer respiratory conditions, such as viral or bacterial infections?
- Are you asthmatic?
- Are you currently taking any over-the-counter or prescription medications and supplements?
Your doctor will use a stethoscope during your physical examination in order to listen to your lungs as you inhale and exhale. He or she will be looking for any abnormalities or sounds which may point to impaired lung function.
Are there any tests involved?
Should your doctor feel there is any reason to check your lung function following a short discussion about your symptoms, medical history and physical exam, he or she may recommend the following tests:
- Spirometry: This non-invasive pulmonary (lung) function test is commonly used to determine the nature of a person’s lung function. Your doctor will use a spirometer and tube which he or she will ask you to blow into. The test will measure how much air you are capable of inhaling and exhaling (how much air your lungs have the capacity to hold and how quickly you can blow air out of your lungs). The results will help your doctor assess whether or not enough air is reaching your lungs. This test can detect COPD even before you begin showing any progressive symptoms of the condition. Throughout your treatment, your doctor will also use this test to track and monitor your progression and determine whether your treatment plan is working. If necessary your doctor may perform other lung function testing which will assess lung volumes, pulse oximetry and diffusing capacity.
- Imaging tests: These can include a chest X-ray or CT scan which will help your doctor to see in detail the condition of your lungs, heart, and blood vessels. A chest X-ray can clearly show deterioration due to emphysema and also potentially rule out other potential problems such as heart failure. A CT scan can also detect emphysema and rule out other conditions, such as lung cancer. Your doctor may also use CT scan results to determine if surgery is a beneficial treatment option for you.
- An arterial blood gas test: For this test, a blood sample will be taken from an artery in order for blood oxygen levels to be measured. Results will show how much oxygen is present in your blood and how much carbon dioxide is being removed.
Your doctor may wish to see if he or she can determine a cause of your symptoms as a way to rule out any other suspected diagnoses. For this reason, and not necessarily to make a COPD diagnosis, he or she may recommend other laboratory tests. One such test may be recommended to determine whether you have an AAt deficiency if there is evidence that there is a family history of COPD.
If you suspect impaired lung function for any reason, it is best to consult your family physician (general practitioner) as soon as possible. The sooner COPD is diagnosed, the better the treatment plan can be to enhance your quality of life.
Treatments and medications
A diagnosis for COPD may come as a huge shock, particularly because it is not a curable condition. Your doctor will encourage you to take the diagnosis seriously and implement their treatment plan effectively. It is important to understand that the damage already caused cannot be undone, but also that further harm can be effectively reduced and symptoms reasonably controlled.
Your treatment plan will likely include regular consults with a pulmonologist (lung specialist), as well as physical and respiratory specialists (therapists), all working together to provide symptom relief, reduce complication risks and slow down disease progression as much as possible.
Your treatment plan will address the following:
- Smoking: If this is the predominant cause of your condition, it is vitally important that you quit smoking completely. Continued smoking in any amount will worsen your condition and eventually reduce any ability to breathe at all. For many with this condition, becoming a non-smoker is not such a simple task. Talk to your doctor about possible nicotine replacement products or medications which may ease you out of your smoking habit and help you to cope with relapses. Your doctor will not only discourage your smoking habits, but also recommend that you stay clear of second-hand smoke exposure wherever possible too.
- Medications: Your doctor may recommend several kinds of medications to manage your symptoms. Most will be recommended on a regular basis, and others as and when needed (treating flare-ups). Some medications will cause side effects. It is important to take your medications as recommended and keep you doctor in the loop should you experience any adverse reactions. Included in the mix of medications are bronchodilators (inhalers or nebulisers which relax the muscles around the airways and help relieve symptoms of shortness of breath and coughing), inhaled steroids (inhaled corticosteroid drugs which reduce inflammation of the airways and minimise the risk of flare-ups), combination inhalers (bronchodilators and inhaled steroids), oral steroids (usually prescribed in short courses to prevent worsening symptoms), Phosphodiesterase-4 inhibitors (relaxes the airways and reduces inflammation), Theophylline (alleviates chest tightness and eases shortness of breath) and antibiotics (or antivirals as and when needed for treating respiratory infections).
- Lung therapies: Oxygen therapy (supplemental oxygen through lightweight, portable units with a mask or nasal prongs while doing activities or sleeping) and pulmonary rehabilitation programmes (specialist tailored programs combining education, nutrition plans, exercise training and counselling) may be recommended to enhance your quality of life and enable you to participate in everyday activities a little easier. These therapies can also help to shorten hospital stays.
- Surgery: Where a condition is severe, particularly in cases of serious emphysema, and a person’s symptoms have not been sufficiently managed with medications, options for surgery may be recommended. These can include lung volume reduction surgery (small wedges of deteriorated lung tissue are removed from the upper lungs, allowing healthier tissue to expand), a lung transplant (a major procedure which carries significant risks but can dramatically improve quality of life) and bullectomy (bullae or large air spaces are removed from the lungs to alleviate problems with breathing and improve air flow).
Your doctor may also recommend vaccinations as a way to lower your risk of contracting respiratory infections. A yearly flu vaccine, pneumococcal vaccine and tetanus booster protecting you from pertussis (whooping cough) may be recommended. Vaccines may not totally prevent an infection, but can help to lower the severity risk should you fall ill.
Stages of COPD
In general, there are 5 categorised stages of COPD. Many doctors use these stages as a rule of thumb to measure the progression of the disease. The stages can be broken down into the following:
- Stage 0: At risk – This stage is often bordering on a COPD diagnosis. A person may not officially have the disease, but is showing distinguishable symptoms which can develop into COPD. Treatment for the condition may not yet be necessary, but a doctor will raise a red flag and advise a few changes to your lifestyle. If you are a smoker, you will be strongly encouraged to stop immediately. Diet and exercise regimes will also be discussed as steps you can take to improve your overall well-being. Your doctor will make recommendations to minimise as much risk of further damage as possible. Any additional damage caused cannot be undone. Prevention is the best course of action.
- Stage 1: Mild – The presence of symptoms may be so mild a person may not even regard them as all that serious at this stage. You may have a chronic or persistent cough, with or without excess mucus (sputum) production. Mucus that does come up with a chronic cough may be white, greenish or yellowish in colour, and of varying consistencies. A doctor may make a COPD diagnosis and start treatment with a bronchodilator (as and when needed) at this stage to try and curb further damage.
- Stage 2: Moderate – At this point a person’s symptoms have become more noticeable and increasingly difficult to brush off or disregard. Along with a cough (with or without mucus), a person will now begin experiencing shortness of breath. Your doctor will likely recommend a long-acting bronchodilator as a course of treatment.
- Stage 3: Severe – The intensity and frequency of symptoms will increase at this stage. You may become increasingly susceptible to other health concerns and complications too, such as a range of respiratory infections, high blood pressure, lung cancer, heart problems and even depression. Flare-ups (exacerbations) of severe symptoms are common as this stage of the disease. Functioning normally will become increasingly challenging. Medications, such as corticosteroids, and oxygen therapy may be recommended by your doctor at this point.
- Stage 4: Highly severe – Everyday tasks become increasingly difficult as symptoms worsen. At this stage flare-ups are so severe, there is a much greater risk that they may become life-threatening. At this stage, surgery may also be considered as a treatment option.
Living with COPD
Managing flare-ups (exacerbations)
Although your treatment plan will incorporate as much as possible to reduce or slow down impaired lung function, symptoms can go through patches (flare-ups) which are worse than normal. Acute exacerbation can last for a few days or even weeks, and if not treated effectively (and quickly) can result in lung failure.
A respiratory infection, other inflammatory triggers or even air pollution can bring on exacerbations. If you experience a sustained increase in coughing, an increased difficulty in breathing or notice a change in the mucus you bring up with coughing, seek prompt medical attention.
A medical professional may administer supplemental oxygen or prescribe antibiotics and or/ steroids. It may also be possible that you will be hospitalised for further medical care. Inhaled steroids or long-acting bronchodilators can help to lower the risk of exacerbations in the future.
COPD as a condition will worsen over time, so flare-ups are likely to happen. There’s little way around this. Once diagnosed and a treatment plan implemented your doctor will ensure that you understand what to do when exacerbations happen. In milder instances your treatment plan and medications will be able to help provide some relief. In severe cases, medical intervention is essential.
Lifestyle changes and diet
As much as your treatment plan will help to alleviate symptoms, flare-ups and discomforts as you manage your condition, there is plenty you can do to help yourself.
One thing is for certain, your lungs are weakened and will never be in their best condition again. Any triggers or causes that overtax their function or result in exacerbations should be avoided as best you can, especially in the earlier stages of the disease.
On the plus side, there is quite a lot you can do by making changes to your lifestyle in order to improve your quality of life. These can include:
- Maintaining a nutritious diet: What you put into your body matters and can make all the difference. A diet which avoids highly processed foods, or those that contain high amounts of sodium (which can retain water and cause breathing strain) and calories are important (in some cases more calories may be needed). Your body needs nutrients. If you are losing weight as a result of the disease, speak to your doctor or a nutritionist about developing a diet plan that will best ensure you get all the benefits of healthy and balanced meals daily. Nutrient-rich foods such as vegetables, fruits, protein, grains and dairy should be included in your daily diet plan. If you are overweight, you may likely be encouraged to lose weight as a means to significantly improve your breathing capacity. Plenty of non-caffeinated liquids are important to help alleviate discomforts associated with increased mucus production. Your doctor may recommend that you limit caffeinated drinks as they can interfere with many medications you may be taking, as well as increase water loss. Tips your doctor may give you regarding your eating habits can include swapping out 3 big meals a day for 5 or 6 smaller ones, clearing your airways through specifically designed exercises including postural drainage, controlled coughing and/or chest percussion) at least an hour before consuming a meal and drinking any beverages after a meal (instead of at the same time) so that you feel less full while eating. A fuller stomach can make it more difficult for your lungs to expand and thus affect your breathing, making you feel short of breath each time you eat.
- Manage / treat other chronic conditions carefully: It is important to ensure that if you have any other chronic conditions, you work closely with your doctor to effectively treat them. Poorly treated conditions such as diabetes or heart disease can have a devastating effect on your overall health.
- Adjust your living conditions: One thing is for certain, your energy levels are likely to deplete as the condition progresses. Unless you have help, you can take steps to de-clutter your living environment in such a way that makes cleaning and performing household tasks easier. During the more advanced stages, you will likely need help with these daily requirements in the home, as your energy levels will be significantly low. You can also use an air filter in your home, making your personal space healthier for you.
- Be more mindful of your body (breathing): You can learn techniques which may help you to breathe a little easier. A doctor or respiratory therapist can help you with relaxation techniques and breathing positions which will help provide relief when you experience shortness of breath symptoms. You can also learn ways to help alleviate the effects of coughing, especially when there is excess mucus production. Drinking plenty of water and using humidifiers will help to clear your airways and passages, making breathing a little easier and more comfortable.
- Keep your medical appointments: Ensure that you keep all appointments with your doctor and other specialists. The disease is a flexible one and going through changes is inevitable. It is important that your doctor is able to routinely monitor any changes in your lung function, as well as keep track of any infections that may occur, needing prompt treatment.
- Carry your emergency contact information: As the disease progresses, it may become increasingly difficult for you to be able to inform others of your disease and what you need. It is a good idea to be prepared for potential flare-ups and emergency situations where you may be unable to take the appropriate course of action yourself. Carry emergency contact information with you at all times and keep something in your home where it can be easily seen or found, such as on the refrigerator. This information must include any medications and dosages you currently take, as well as all emergency numbers a person assisting you can contact in order to get you the best medical care necessary in a problematic or life-threatening situation.
- Find relief in support: A progressive disease which shortens your life expectancy can be immensely distressing for any individual. It can bring on emotional rounds of sadness, hopelessness and even anxiety. You may find some comfort in joining a support group in your area and talking to others who experience the same things you do. Talk to your doctor about organisations or councillors you may be able to get in touch with as a way to help you cope on an emotional level. As much as you are going through adjustments and changes in your life, those who love and care for you the most will be affected too. Counselling can help you deal with others too.
You may think that exercise isn’t good for your condition. Think again. A given with this disease is that as it progresses you will get weaker. As much as you can do to slow down the process and build up strength will be hugely beneficial to your quality of life. A little each day can go a long way in helping to stay strong. The less you do, the less you will be able to do, and the more your muscles will weaken as things progress. Muscles that are weaker need more oxygen. A healthy dose of exercise is the best thing for this and will help build strength that will make daily / routine activities (such as shopping and cooking) a lot easier.
Your doctor will be able to best advise how much exercise activity you will need as you manage your condition at each stage. Some exercise activities you may benefit from include:
- Walking: Understandably, exercise and the risk of not being able to breathe is intense for many with COPD. If you’re fearful of exercising or are not all that active to begin with, walking is a great starting point. It’s a simple activity which can be done anywhere and it can be increased gradually at your own pace. You can add as little as 30 seconds to your walk each day as you slowly build strength. A slow pace is all you need to get started, so you need not feel that you have to accomplish a lot quickly. Take your time getting comfortable with this activity and ensure to keep you doctor in the loop with your activity levels and frequency too. Stretching (or warming up and cooling down) properly before and after a walk is also important.
- Biking: Riding a stationary bike is a good activity to take up as well. Once you gradually build strength you can even consider outside riding as well and enjoy some lovely scenery at the same time. You’ll need to be mindful of shortness of breath symptoms. You can stop and rest at any time for a few minutes when needed. Pushing yourself will not serve your purpose of building strength and will compromise your breathing.
- Tai Chi: The gentle, flowing movements of this exercise is a great activity for suffers of COPD. A workout helps tone muscles and build strength in the heart and lungs. If you find yourself feeling emotionally overwhelmed as a result of your illness, this activity easily alleviates stress and helps you to relax.
- Weights: Basic things like reaching a high shelf or carrying heavy objects will become increasingly difficult things to do as the disease progresses. A good way to build strength the muscles need for such activities is with weight training exercises. Light dumbbells (hand weights) and stretchy bands can be used to regularly do arm curls and forward arm raise exercises. The exercises will help to strengthen your upper arms and shoulders.
- Leg work: Strengthening muscles in your legs will make exercise activities such as walking a whole lot easier. Working these muscles will also enable you to go further (walk for longer) as you build strength. Calf raises and leg extensions are good exercises to do.
- Easy breathing: The diaphragm is a key breathing muscle in your body and you can learn to ‘exercise it’ at least 3 to 4 times a day for 5 to 10 minutes at a time. Choose a comfortable chair to sit in or lie down with your knees bent up and place one hand on your chest. Place your other hand below your rib cage. Now take a deep breath, inhaling through your nose. You will feel your abdomen rise, raising your one hand (the one below your rib cage). Purse your lips and exhale (also known as pursed lip breathing). Your stomach muscles should tighten. Take care not to move the hand on your chest throughout. You will also need to learn to be conscious of your breathing during exercise. The nose is a natural air filter so it is important to be aware of only inhaling through your nose (mouth closed) and exhaling through your mouth (for twice as long as the time you take to breathe in). When your breath increases in pace and becomes shallow or you begin to pant, stop and rest for a few minutes. It is important to rest so that you do not over exert yourself and restrict your lungs from the natural process of getting air (and carbon dioxide) out of the body.
Other exercise activities mild stage COPD suffers can benefit from include water aerobics and rowing. Once the disease progresses and the use of oxygen becomes necessary, exercise need not stop altogether. Your doctor may even recommend using oxygen during exercise. You should be able to perform most exercises with oxygen. Many are small and light-weight tanks which can easily be used when mobile. Some oxygen units also come with extra-long tubing which is convenient when at home.
Try and get yourself into an exercise routine that you can commit to. Once a habit, 20 to 30 minutes at least 3 times a week will do you the world of good. A little cardio combined with strength training is all you need.
Knowing when not to exercise is just as important as starting an exercise routine. Your symptoms will range from mild and familiar to increasing in intensity and frequency. Pay attention to your coughing or wheezing symptoms. Are you coughing up more mucus than usual? Has your shortness of breath become worse lately? Keep your doctor in the loop of any changes, however subtle, and seek medical attention if any change concerns you or doesn’t improve.
Common Complications and Risk Factors
As with any progressive health condition, impaired bodily functions can result in increased risk of complications.
Common concerns include:
- Respiratory infections that may cause further damage to lung tissue and make it more difficult for a person to breathe.
- Heart problems and heart attack
- Lung cancer
- Pulmonary hypertension (high blood pressure in the lung arteries)
- Emotional problems such as anxiety and depression
Those at higher risk include individuals …
- Who smoke or are constantly exposed to smoke (includes tobacco / cigarettes, pipes, cigars and marijuana)
- Who are asthmatic and or / smoke
- Who are exposed to occupational chemicals, fumes (and burning fuels in the home with poor ventilation) and dust (prolonged periods).
- Who are 40 years or older when the first signs and symptoms begin
- Who have an alpha-1-antitrypsin deficiency
Is there any connection between lung cancer and COPD?
Yes, these two diseases are linked due to the nature of risk factors they both have in common. Most diagnosed with either disease are chronic smokers, or have been exposed to second-hand smoke, chemicals or fumes over prolonged periods of time. Age is also a factor and the majority of those diagnosed are older individuals. Lung cancer is also a common complication of COPD.
What is the outlook for a person diagnosed and managing COPD?
COPD is a progressive, non-contagious disease and you will be required to make very definite changes to your life in order to effectively manage your condition. Symptoms develop as a result of serious damage to the lungs and breathing functionality. Early symptoms can greatly benefit from lifestyle choices that prevent further damage and enhance your quality of life through the progressive stages of the disease.
Intensity of symptoms will make life increasingly limiting and ultimately may result in your not being able to take care of yourself without constant assistance. As the disease progresses, risk of complications significantly increases. The disease will reduce your life expectancy, but if diagnosed early and treated sufficiently, you can reduce the risk of serious complications dramatically.
It is strongly advisable that you work closely with your doctor and other specialists at all times to help manage your condition and get all the relevant information you need to improve your overall lifestyle, as well as cope with all the necessary changes.