Chronic Obstructive Pulmonary Disease (COPD) – Diagnosis, Symptoms, and Treatment
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is a lung condition that is characterized by the breakdown of lung tissue and obstruction of small air passages leading to reduced lung function. Air classically gets “trapped” in the lungs due to these obstructions which lowers the total amount of air that can be moved with each breath. The most common risk factor for COPD is smoking tobacco. People with COPD often have chronic shortness of breath and cough that occasionally becomes worse due to infection in the blocked areas, leading to increasing cough and shortness of breath that requires medical treatment. Learn more about this condition and the COPD medication we have available to order online.
COPD may eventually lead to heart failure due to the low levels of oxygen in the body increasing the stress on the heart. Patients with severe COPD may even require oxygen to survive. It is one of the leading causes of death in the United States.
What Causes COPD?
COPD is most often caused by multiple years of cigarette smoking or second-hand smoke exposure. There are also some genetic conditions that can result in COPD if left untreated. The most common causes are:
- Air pollution
- Untreated asthma
- Occupational exposures – beryllium, sandblasting, and chemical exposures at work.
- Alpha-1-antitrypsin deficiency – a rare genetic condition associated with lung and liver disease.
Each of these causes has two main effects; first, they slowly destroy the alveoli of the lungs, small sacks that are responsible for exchanging oxygen and carbon dioxide with the blood. Second, they increase the mucus production within the air passages of the lungs, this blocks these passages and can lead to chronic inflammation as bacteria grow in this mucus.
Eventually, this damage and blockage become so severe that it cannot be reversed. Air gets trapped in the blocked areas causing the lungs to become hyper-inflated. The destruction of the alveoli decreases gas exchange and the oxygen levels in the body fall while carbon dioxide levels rise. These changes lead to shortness of breath, cough, and repeated infections that are seen in patients with COPD.
How Common is COPD?
COPD is extremely common in the United States due to the popularity of tobacco throughout the 90’s and early 2000’s. It is estimated that 6.3% of Americans are living with COPD. The majority of patients being between the ages of 45 and 65. More than 126,000 deaths are caused by COPD each year making it a leading cause of death in the United States. Along with lung cancer, and heart disease, COPD is one of the major causes of death that is directly related to tobacco use.
COPD is not always obvious, many patients with mild to moderate COPD have symptoms that are managed with inhaled medications and lifestyle changes. Those that require oxygen and more aggressive treatment are the minority.
Signs and Symptoms
The signs and symptoms of COPD vary based on the severity of the condition. There are mold mild symptoms such as cough and shortness of breath with exercise that are nearly always present. Other more advanced symptoms only occur with severe disease and are a sign that medical treatment is required. These symptoms are as follows:
- Difficulty breathing – especially while at rest
- Productive cough
- Chest tightness
- Fatigue & low energy
- Weight loss
During the medical evaluation, your doctor will look for signs that indicate the severity of COPD. A change in oxygen saturation is often the earliest sign and leads to a majority of the other signs listed below:
- Cyanosis – blue/purple discoloration of the lips or skin due to low oxygen
- Rapid or abnormal breathing
- Barrel chest – hyperinflation of the chest
- Wheezing on lung examination
- Signs of heart failure – swelling in the legs
The diagnosis of COPD is suspected by the signs and symptoms above but is confirmed with breathing tests known as pulmonary function tests. During these tests, doctors will have you breathe in and out of a machine known as a spirometer that monitors how difficult it is for air to enter and leave your lungs. A chest x-ray is also ordered to assess for areas of the lung that appear collapsed due to blockages from mucus, which is known as atelectasis. This x-ray also helps to rule out common complications of COPD and other conditions that can cause shortness of breath such as pneumonia and heart failure.
Blood tests are also usually ordered and include a CMP(comprehensive metabolic panel) and CBC (complete blood cell count). They will also usually check your cholesterol levels and screen for diabetes. If they suspect you have a rare genetic illness that can lead to COPD called alpha-1-antitrypsin deficiency, they will check for alpha-1-antitrypsin levels. Your liver tests may also be abnormal in the setting of this condition.
Some doctors will obtain an ECG (electrocardiogram) and ultrasound of the heart (echocardiogram) if they are concerned about heart disease.
The treatment of COPD involves smoking cessation, proper immunization, and treatment with various medications to improve the symptoms of shortness of breath. In fact, immunization against pneumonia is the only treatment for COPD that is associated with a longer life. The most common vaccinations include Pneumovax and Prevnar – pneumococcal pneumonia vaccines. The annual influenza vaccine is also recommended for most patients.
The most commonly prescribed drugs include to control the symptoms of COPD and reduce blockage of the air passages are:
- Rescue inhalers
- ProAir or Ventolin (albuterol)
- Atrovent (ipratropium)
- Combivent - a combination of albuterol and ipratropium
If your symptoms are moderate to severe, occur even at rest, and you use your rescue inhaler often. Your doctor may prescribe an inhaled controller medication which is used once or twice daily. These medications include:
They work by preventing airway constriction and reducing inflammation on a long-term basis – two important processes that lead to many of the symptoms of COPD. Note – Atrovent should not be taken with Spiriva as these medications have a similar mechanism of action.
COPD exacerbations are sudden and severe increases in COPD symptoms due to an increase in mucus production or inflammation. The most common triggers for these exacerbations are viral infections or allergens in the environment. Episodes of COPD exacerbations often require treatment with oral corticosteroids (eg, prednisone) to reduce inflammation. Your doctor may also prescribe antibiotics such as:
- Z-pack (azithromycin)
- Tetracycline (doxycycline)
- Augmentin (amoxicillin-clavulanate)
Mild to moderate COPD exacerbations are generally treated on an outpatient basis with rescue inhalers, inhaled controller medications, and oral corticosteroids (eg. prednisone).
Severe COPD exacerbations (and some moderate exacerbations in patients with other medical conditions) usually require a visit to the emergency department and may warrant hospital admission.
Long-term, patients with COPD can benefit from pulmonary rehabilitation which focuses on increasing exercise capacity and lung volumes through breathing exercises. Many individuals with severe disease will require treatment with supplemental oxygen on a constant basis. Lung transplantation is the last resort for patients that meet certain criteria such as an expected life expectancy of more than 10 years and the ability to tolerate life-long immunosuppressive medications.
- Balkissoon R, Lommatzsch S, Carolan B, Make B. Chronic obstructive pulmonary disease: a concise review. Med Clin North Am. 2011 Nov;95(6):1125-41. - https://www.ncbi.nlm.nih.gov/pubmed/22032431
- Lee H, Kim J, Tagmazyan K. Treatment of stable chronic obstructive pulmonary disease: the GOLD guidelines. Am Fam Physician. 2013 Nov 15;88(10):655-63, 663B-F. - https://www.ncbi.nlm.nih.gov/pubmed/24364481
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.