What Is COPD?

There are two major diseases included in COPD, chronic bronchitis and emphysema. In both, narrowed bronchi make it hard to exhale. Narrowed bronchi also cause asthma- but in asthma, the narrowing is temporary and reversible. In COPD, it´s permanent and only partially reversible.

In chronic bronchitis, an enlargement of the mucous glands and excessive mucus production contribute to the narrowing. In emphysema, the narrowing comes from damage to the bronchi themselves and is more severe. Inflammation triggered by inhaled irritants also contributes to COPD. White blood cells respond to the irritation, but instead of controlling the problem, they can release chemicals that, if unchecked, damage and eventually destroy lung tissue.

Chronic bronchitis.
Patients with chronic bronchitis have a recurrent cough that brings up large amounts of thick, discolored phlegm almost every day for 3 months or longer over a period of at least 2 years. Over time, the lung disease can put a strain on the heart, and some patients develop congestive heart failure. As a result, they accumulate fluid and gain weight. Their lips and skin may eventually look bluish due to low blood oxygen levels.

Emphysema.
Patients with emphysema look and sound different. Their cough is scant and dry, but their shortness of breath is more severe and they breathe faster than normal. They stay pink and don´t accumulate fluid, but they lose weight, their muscles tend to waste away, and they develop large, barrel-shaped chests.

Most patients with COPD have mixed features of chronic bronchitis and emphysema. Many patients also have two to three exacerbations each year. These are abrupt flares that are often triggered by lung infections. Symptoms get much worse and aggressive treatment may be needed.

Diagnosis

Your doctor will ask about your smoking history and about possible exposures to secondhand smoke, fumes, and dust particles. You should also report any family history of COPD, particularly if your symptoms began in young adulthood and you haven´t been exposed to tobacco. You´ll also be asked to report any symptoms of cough, phlegm, shortness of breath, wheezing, fatigue, and changes in your weight.

Physical exam.
A physical examination can suggest the diagnosis of COPD. Your doctor will check your lips, skin, and nails for bluish discoloration (cyanosis) that suggests low oxygen levels. Your nails may be abnormally rounded (clubbed); you may have fluid in your legs and feet (edema).

Your chest exam is the most important part of the physical exam. With chronic bronchitis, your doctor may hear wheezing and abnormal gurgling sounds (rales) through a stethoscope. If emphysema is the main problem, your chest may be enlarged and sound hollow when your doctor taps on it.

Tests and x-rays.
The most important test of all is a lung function test, the forced expiratory volume at one second (FEV1). It measures the amount of air you can breathe out with a maximal effort in one second. The test is simple and safe. You take a deep breath in, then blow out as fast and hard as you can into a spirometer, which collects the air and measures the amount you´ve exhaled in the first second.

Normal FEV1 values depend on a person´s age, sex, and height. Doctors can diagnose COPD and estimate its severity based on how a patient´s FEV1 compares to normal:

By repeating lung function tests, doctors can tell if COPD is getting worse. And they can also tailor therapy to the stage of the disease.

If you have emphysema, your chest x-ray will show enlarged lungs filled with an excessive amount of air. Scarring and large, air-filled cavities (blebs) may also be evident. The x-ray abnormalities of chronic bronchitis are less specific. CT scans can show damage at an earlier stage, but no imaging test can accurately gauge the severity of COPD or predict its outcome.

In many cases, your doctor will order additional tests, such as complete blood counts, an EKG to look for heart strain, an analysis of your sputum, and a test to measure the oxygen in your blood.

Also known as short-acting beta-agonists, quick-relief medications relieve symptoms quickly by relaxing the muscles that surround the bronchial tubes, enabling the tubes to open wider. You should carry your quick relief medication with you at all times. Ask your doctor about when and how often to use a quick reliever.

In addition to quick-relief and maintenance medications, doctors may prescribe anti-inflammatory drugs and antibiotics, as needed, to treat flare-ups and respiratory infections. Notify your doctor immediately if your breathing becomes worse, if you develop a fever, or if your phlegm becomes thicker, discolored, or more abundant.

While medications will not cure your COPD, they can help you breathe better.

Treatment: Surgery

Some patients with severe emphysema may benefit from special types of lung operations. Expert evaluation by experienced physicians is mandatory. A few COPD patients may be eligible for lung transplantation.

Work with your doctor to develop a treatment plan that is right for you-and then stick with the program!

The earlier, and more aggressively, you treat COPD, the less damage to your lungs and better likelihood that COPD will not be disabling.