What is COPD?

Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make it increasingly difficult for you to breathe.

Emphysema and chronic bronchitis are the two main conditions that make up COPD, but COPD can also refer to damage caused by chronic asthmatic bronchitis. In all cases, damage to your airways eventually interferes with the exchange of oxygen and carbon dioxide in your lungs.

COPD is a leading cause of death and illness worldwide. Most COPD is caused by long-term smoking and can be prevented by not smoking or quitting soon after you start. Damage to your lungs can't be reversed, so treatment focuses on controlling symptoms and minimizing further damage.

COPD Symptoms

In general, symptoms of COPD don't appear until significant lung damage has occurred, and they usually worsen over time. People with COPD are also likely to experience episodes called exacerbations, during which their symptoms suddenly get much worse. Beyond this, signs and symptoms of COPD can vary, depending on which lung disease is most prominent. It's also possible to have many of these symptoms at the same time.

Emphysema
Signs and symptoms of emphysema include:

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness

Chronic bronchitis
Chronic bronchitis occurs mainly in smokers. It's defined as a cough that you have at least three months a year for two consecutive years. People who continue to smoke may go on to develop emphysema, but in smokers who are able to quit, the cough may clear in a few days or weeks.

Signs and symptoms of chronic bronchitis include:

• Having to clear your throat first thing in the morning, especially if you smoke
• A chronic cough that produces yellowish sputum
• Shortness of breath in the later stages
• Frequent respiratory infections

Chronic asthmatic bronchitis
Chronic asthmatic bronchitis is usually chronic bronchitis combined with asthma (bronchospasm). Asthma can occur when inflamed and infected secretions irritate the smooth muscles in your airways. Symptoms are similar to those of chronic bronchitis, but you're also likely to have intermittent — or even daily — episodes of wheezing.

COPD Treatment

There's no cure for COPD, and you can't undo the damage to your lungs. But COPD treatments can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Smoking cessation
The most essential step in any treatment plan for smokers with COPD is to stop all smoking. It's the only way to keep COPD from getting worse — which can eventually result in losing your ability to breathe. But quitting smoking is never easy. And this task may seem particularly daunting if you've tried to quit before. Talk to your doctor about nicotine replacement products and medications that might help, as well as how you might handle relapses. It's not known what role exposure to secondhand smoke plays in COPD, but avoid it whenever possible.

Medications
Doctors use several basic groups of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

• Bronchodilators. These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both.
• Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better. But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. They're usually reserved for people with moderate or severe COPD.
• Antibiotics. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are only recommended when necessary.

Surgery
Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone:

• Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently. The surgery has a number of risks, and long-term results may be no better than for nonsurgical approaches.
• Lung transplant. Single-lung transplantation may be an option for certain people with severe emphysema who meet specific criteria. Transplantation can improve your ability to breathe and be active, but it doesn't appear to prolong life and you may have to wait for a long time to receive a donated organ. So the decision to undergo lung transplantation is complicated.

COPD Causes

Causes of airway obstruction
COPD primarily refers to obstruction in the lungs from two chronic lung conditions. Many people with COPD have both.

• Emphysema. This lung disease causes inflammation within the fragile walls of the alveoli. This can destroy some of the walls and elastic fibers, which allows small airways to collapse when you exhale, impairing airflow out of your lungs.
• Chronic bronchitis. This condition, which is characterized by an ongoing cough, causes inflammation and narrowing of the bronchial tubes. Chronic bronchitis also causes increased mucus production, which can further block the narrowed tubes.

Asthmatic bronchitis — also known as bronchial asthma — refers to chronic bronchitis accompanied by contractions of the muscle fibers in the lining of the airways (bronchospasm). Chronic asthmatic bronchitis is sometimes classified as COPD.

Cigarette smoke and other irritants
In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and certain occupational fumes. Gastroesophageal reflux disease (GERD), which occurs when stomach acids wash back up into your esophagus, can aggravate COPD and may even cause it in some people.

In rare cases, COPD results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin.