Illness & Conditions - Special Health Issues
COPD (Chronic Obstructive Pulmonary Disease)
What is chronic obstructive pulmonary disease (COPD)?
COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
COPD is often a mix of two diseases:
COPD gets worse over time. You can't undo the damage to your lungs. But you can take steps to prevent more damage and to feel better.
What causes COPD?
COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.
Other things that may put you at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke also may damage the lungs.
It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.
You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. But this is rare.
What are the symptoms?
The main symptoms are:
As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.
At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation (say "egg-ZASS-er-BAY-shun"). An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.
How is COPD diagnosed?
To find out if you have COPD, a doctor will:
If there is a chance you could have COPD, it is very important to find out as soon as you can. This gives you time to take steps to slow the damage to your lungs.
How is it treated?
The best way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.
Your doctor can prescribe treatments that may help you manage your symptoms and feel better.
People who have COPD are more likely to get lung infections, so you will need to get a flu vaccine every year. You should also get a pneumococcal shot. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably won't be as sick.
How can you live well with COPD?
There are many things you can do at home to stay as healthy as you can.
Dealing with flare-ups: As COPD gets worse, you may have flare-ups when your symptoms quickly get worse and stay worse. It is important to know what to do if this happens. Your doctor may give you an action plan and medicines to help you breathe if you have a flare-up. But if the attack is severe, you may need to go to the emergency room or call 911.
Managing depression and anxiety: Knowing that you have a disease that gets worse over time can be hard. It's common to feel sad or hopeless sometimes. Having trouble breathing can also make you feel very anxious. If these feelings last, be sure to tell your doctor. Counseling, medicine, and support groups can help you cope.
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Frequently Asked Questions
COPD is often a mix of two diseases: chronic bronchitis and emphysema . Both of these diseases are caused by smoking. Although you can have either chronic bronchitis or emphysema, people more often have a mixture of both diseases.
Other possible causes of COPD include:
When you have COPD:
Many people with COPD have attacks called flare-ups or exacerbations (say "egg-ZASS-er-BAY-shuns"). This is when your usual symptoms quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may have to go to the hospital.
Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Try not to panic if you start to have a flare-up. Quick treatment at home may help you manage serious breathing problems.
What Increases Your Risk
Tobacco smoking is the most important risk factor for COPD. Compared to smoking, other risks are minor.
To learn more, see the topic Quitting Smoking.
Some people may be more at risk than others for getting the disease, especially if they have low levels of the protein alpha-1 antitrypsin (alpha-1 antitrypsin deficiency), a disorder that runs in families.
Preterm babies usually need to have long-term oxygen therapy because their lungs are not fully developed. This therapy can cause lung damage (neonatal chronic lung disease) that can increase the risk for COPD later in life.
Asthma and COPD are different diseases, even though both of them involve breathing problems. People with asthma may have a greater risk for getting COPD, but the reasons for this are not fully understood.
Risks in the environment
When to Call a Doctor
Call 911 or other emergency services now if:
Call your doctor immediately or go to the emergency room if you have been diagnosed with COPD and you:
If your symptoms (cough, mucus, and/or shortness of breath) suddenly get worse and stay worse, you may be having a COPD flare-up, or exacerbation. Quick treatment for a flare-up may help keep you out of the hospital.
Call your doctor soon for an appointment if:
Talk to your doctor
If you have been diagnosed with COPD, talk with your doctor at your next regular appointment about:
Who to see
Health professionals who can diagnose COPD and provide a basic treatment plan include:
You may need to see a specialist in lung disease, called a pulmonologist (say "pull-muh-NAWL-uh-jist"), if:
Exams and Tests
To diagnose COPD, your doctor will probably do the following tests:
Tests done as needed
Tests rarely done
Because COPD is a disease that keeps getting worse, it is important to schedule regular checkups with your doctor. Checkups may include:
Tell your doctor about any changes in your symptoms and whether you have had any flare-ups. Your doctor may change your medicines based on your symptoms.
The sooner COPD is diagnosed, the sooner you can take steps to slow down the disease and keep your quality of life for as long as possible. Screening tests help your doctor diagnose COPD early, before you have any symptoms.
Talk to your doctor about COPD screening if you:
The U.S. Preventive Services Task Force (USPSTF) doesn't recommend COPD screening for adults who are not at high risk for COPD. 5 And some experts recommend that screening be done only for people who have symptoms of a lung problem. 6
The goals of treatment for COPD are to:
Much of the treatment for COPD includes things you can do for yourself.
Quitting smoking is the most important thing you can do to slow the disease and improve your quality of life.
Other things you can do that really make a difference including eating well, staying active, and avoiding triggers. To learn more, see Living With COPD.
The medicines used to treat COPD can be long-acting to help prevent symptoms or short-acting to help relieve them. Medicines include:
Other treatment you may need
If COPD gets worse, you may need other treatment, such as:
Dealing with flare-ups
COPD flare-ups, or exacerbations, are when your symptoms—shortness of breath, cough, and mucus production—quickly get worse and stay worse.
Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Don't panic if you start to have one. Quick treatment at home may help you prevent serious breathing problems.
A flare-up can be life-threatening, and you may need to go to your doctor's office or to a hospital. Treatment for flare-ups includes:
The best way to keep COPD from starting or from getting worse is to not smoke.
There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs. For most people who quit, loss of lung function is slowed to the same rate as a nonsmoker's.
Stopping smoking is especially important if you have low levels of the protein alpha-1 antitrypsin. People who have an alpha-1 antitrypsin deficiency may lower their risk for severe COPD if they get regular shots of alpha-1 antitrypsin. Family members of someone with alpha-1 antitrypsin deficiency should be tested for the condition.
Avoid bad air
Other airway irritants (such as air pollution, chemical fumes, and dust) also can make COPD worse, but they are far less important than smoking in causing the disease.
If you have COPD, you need to get a flu vaccine every year. When people with COPD get the flu, it often turns into something more serious, like pneumonia . A flu vaccine can help prevent this from happening.
Also, getting regular flu vaccines may lower your chances of having COPD flare-ups. 7
People with COPD often get pneumonia. Getting a shot can help keep you from getting very ill with pneumonia. Usually, people need only one shot, but doctors sometimes recommend a second shot for some people who got their first shot before they turned 65. Talk with your doctor about whether you need a second shot.
Pertussis (also called whooping cough) can increase the risk of having a COPD flare-up. 8 So making sure you are current on your pertussis vaccinations may help control COPD.
COPD gradually gets worse over time.
Shortness of breath gets worse as COPD gets worse.
It's very important to stop smoking. If you keep smoking after being diagnosed with COPD, the disease will get worse faster , your symptoms will be worse, and you will have a greater risk of having other serious health problems.
The lung damage that causes symptoms of COPD doesn't heal and cannot be repaired. But if you have mild to moderate COPD and you stop smoking, you can slow the rate at which breathing becomes more difficult. You will never be able to breathe as well as you would have if you had never smoked, but you may be able to postpone or avoid more serious problems with breathing.
Other health problems from COPD may include:
Care at the end of life
Treatment for COPD is getting better and better at helping people live longer. But COPD is a disease that keeps getting worse, and it can be fatal.
It's important to talk with your doctor about these issues:
Living With COPD
When you manage COPD, you:
It's never too late to quit smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow down the disease and improve your quality of life.
Although lung damage that already has occurred doesn't reverse, quitting smoking can slow down how quickly your COPD symptoms get worse.
You may think that nothing can help you quit. But today there are several treatments shown to be very good at helping people stop smoking. They include:
Today's medicines offer lots of help for people who want to quit. You will double your chances of quitting even if medicine is the only treatment you use to quit, but your odds get even better when you combine medicine and other quit strategies, such as counseling. 9
For more information, see the topic Quitting Smoking.
Make breathing easier
Do all you can to make breathing easier.
Good nutrition is important to keep up your strength and health. Problems with muscle weakness and weight loss are common in people with severe COPD. People with COPD who are very underweight, especially those with emphysema, are at higher risk of early death than are people with COPD who have a normal weight. 10
Seek education and support
Treating more than the disease and its symptoms is very important. You also need:
Medicine for COPD is used to:
Most people with COPD find that medicines make breathing easier.
Some COPD medicines are used with devices called inhalers or nebulizers . Most doctors recommend using spacers with inhalers. It's important to learn how to use these devices correctly. Many people don't, so they don't get the full benefit from the medicine.
Tips for using inhalers
The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This doesn't always mean that the medicine won't help. Try the medicine for a while before you decide if it is working.
Many people don't use their inhalers right, so they don't get the right amount of medicine. Ask your doctor or nurse to show you what to do. Read the instructions on the package carefully.
Lung surgery is rarely used to treat COPD. Surgery is never the first treatment choice and is only considered for people who have severe COPD that has not improved with other treatment.
Other treatment for COPD includes:
Other Places To Get Help
Last Revised: July 20, 2012
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Poole PJ, et al. (2005). Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
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Talwar A, et al. (2004). Pharmacotherapy of tobacco dependence. Medical Clinics of North America, 88(6): 1528–1529.
Global Initiative for Chronic Obstructive Lung Disease (2011). Global Strategy for the Diagnosis, Management, and Prevention of COPD. Available online: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf.
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