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1 Chapter 1 : Chronic obstructive pulmonary disease (COPD) - NHS Chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic bronchitis, emphysema, pulmonary emphysema, others Gross pathology of a lung showing centrilobular-type emphysema characteristic of smoking. Print Overview Chronic obstructive pulmonary disease COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus sputum production and wheezing. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs alveoli of the lungs. Emphysema is a condition in which the alveoli at the end of the smallest air passages bronchioles of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. For chronic bronchitis, the main symptom is a daily cough and mucus sputum production at least three months a year for two consecutive years. Other signs and symptoms of COPD may include: Shortness of breath, especially during physical activities Wheezing Chest tightness Having to clear your throat first thing in the morning, due to excess mucus in your lungs A chronic cough that may produce mucus sputum that may be clear, white, yellow or greenish Blueness of the lips or fingernail beds cyanosis Frequent respiratory infections Unintended weight loss in later stages Swelling in ankles, feet or legs People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed. How your lungs are affected Air travels down your windpipe trachea and into your lungs through two large tubes bronchi. Inside your lungs, these tubes divide many times â like the branches of a tree â into many smaller tubes bronchioles that end in clusters of tiny air sacs alveoli. The air sacs have very thin walls full of tiny blood vessels capillaries. The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide â a gas that is a waste product of metabolism â is exhaled. Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale. This creates one larger air space instead of many small ones and reduces the surface area available for gas exchange. Bronchitis Bronchitis Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Causes of airway obstruction Causes of airway obstruction include: This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways. 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 there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD. Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes. Alphaantitrypsin deficiency In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alphaantitrypsin. Alphaantitrypsin AAt is made in the liver and secreted into the bloodstream to help protect the lungs. Alphaantitrypsin deficiency can affect the liver as well as the lungs. Page 1

2 Damage to the lung can occur in infants and children, not only adults with long smoking histories. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs. Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke. People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more. Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs. Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin. The uncommon genetic disorder alphaantitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. Complications COPD can cause many complications, including: People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. Quitting smoking may reduce this risk. People with COPD have a higher risk of developing lung cancer. High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs pulmonary hypertension. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke â or to stop smoking now. But keep trying to quit. Occupational exposure to chemical fumes and dust is another risk factor for COPD. If you work with this type of lung irritant, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment. Page 2

3 Chapter 2 : COPD Chronic Obstructive Pulmonary Disease MedlinePlus Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a chronic lung disease that makes it hard to breathe. The disease is increasingly common, affecting millions of Americans, and is the third leading cause of death in the U.S. Lungs - Lung conditions Summary Chronic obstructive pulmonary disease COPD is the collective term for a number of lung diseases that prevent proper breathing. Two of the most common types of COPD are emphysema and chronic bronchitis. Cigarette smoking is the most significant risk factor for COPD. There is no cure for COPD, but disease management can slow disease progression, relieve symptoms and keep you out of hospital. Treatment aims to prevent further damage, reduce the risk of complications and ease some of the symptoms. Treatment options include pulmonary rehabilitation, medicines and oxygen therapy. Chronic obstructive pulmonary disease COPD is an umbrella term for a number of lung diseases that prevent proper breathing. These conditions can occur separately or together. The main symptoms of COPD are breathlessness, chronic cough and sputum mucus or phlegm production. Cigarette smokers and ex-smokers are most at risk of COPD. However, there are things you can do to slow progress of the disease, improve your symptoms, stay out of hospital and live longer. The structure of the lungs The lungs are spongy lobes inside the chest, protected by the ribcage. Inhaled air is directed down the trachea windpipe into two tubes bronchi that each service a lung. The bronchi divide into smaller tubes called bronchioles, and further still into tiny air sacs called alveoli. Each alveolus has a fine mesh of capillaries where the exchange of oxygen and carbon dioxide takes place. Oxygen molecules dissolve and migrate across a thin film of moisture from the air sac to the bloodstream. Oxygenated blood is sent to the heart and then pumped around the body. At the same time, carbon dioxide in the blood crosses from the capillaries to the air sacs using the same film of moisture. The carbon dioxide is then breathed out. The weakened and ruptured air sacs are unable to efficiently move oxygen from the air to the blood. As the disease progresses and damages more air sacs, you may eventually feel breathless even when you are resting. Bronchitis means inflammation of the bronchi. The lungs normally produce a small amount of fluid to keep healthy, but chronic bronchitis causes an overproduction of fluid. This leads to frequent and productive coughing producing mucus or phlegm. The damage done to the lungs can be considerable before the symptoms are severe enough to notice. Steroid use in people with COPD is thought to contribute to osteoporosis anxiety and depression â breathlessness or the fear of breathlessness can often lead to feelings of anxiety and depression oedema fluid retention â problems with blood circulation can cause fluid to pool, particularly in the feet and ankles hypoxaemia â caused by lack of oxygen to the brain. Symptoms include cognitive difficulties such as confusion, memory lapses and depression risks of sedentary lifestyle â as symptoms of COPD progress, many people adjust their lifestyle to avoid symptoms. For example, they reduce their physical activity to avoid breathlessness. As they reduce their physical activity, they become less fit and even more breathless on exertion. This downward spiral of inactivity means they are prone to a range of potentially serious health problems, such as obesity and cardiovascular disease. Around 20 to 25 per cent of smokers will develop COPD. Ex-smokers remain at risk and should be aware of symptoms of breathlessness long-term exposure to lung irritants â such as chemical vapours or dust from grain or wood. Severe air pollution can make COPD worse in smokers genes â a genetic disorder known as alphaantitrypsin deficiency can trigger emphysema, even if no other risk factors are present. This can be done in a general practice surgery, specialised laboratory or by a specialist. Other tests that may also be carried out include: Page 3

4 Chapter 3 : CDC - Basics About COPD- Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. Usually, it includes two diseases, namely chronic bronchitis and emphysema. The first disease causes the inflammation of the bronchial tubes, which have the mission to carry the air to and from the lungs, and the production of mucus, a blockage for the airways that leads to difficulties in normal breathing. The second disease refers to the major damage of the air sacs in the lungs. In those people who do not have emphysema, the tiny air sacs are stretchy meaning that during breathing, they change size in order to permit the air move through the lungs. However, people with this condition feel short of breath because the respective air sacs lose the necessary elasticity so the lungs do not receive enough air. Unfortunately, nobody can restore the health of the lungs entirely but there are efficient ways to avoid more damage and decrease the risk of associated conditions. Causes of Chronic Obstructive Pulmonary Disease COPD In developed countries, the primary cause of COPD is smoking and breathing tobacco as well as the exposure to fumes coming from burning fuel and heating resulting from homes with poor ventilation. With the passage of time, cigarette smoke proves to be extremely harmful for the lungs because it destroys the elastic fibers in the lungs and irritates the bronchial tubes. Taking into account that the lung damage needs many years to start manifesting and showing the characteristic symptoms, elders are more prone to chronic obstructive pulmonary disease. In addition, only a certain percentage of the smokers develop this condition, which means that other factors like genetic susceptibility and severe lung infections during childhood contribute to its development. Risk factors for COPD involve: Long-term exposure to tobacco smoke, which represents the most significant cause for developing this disease; practically, the risk increases after smoking many packs of cigarettes for many years. People with airway hyper-responsiveness, which is a feature of chronic asthma, and smoking habits, face a greater risk of chronic obstructive pulmonary disease. Exposure to dusts, vapors and chemicals in the work environment can lead to irritation and inflammation of the lungs. Alpha-1 antitrypsin deficiency represents a genetic factor that, even though is very rare, places a certain percentage of individuals at higher risk for this condition due to the absence of a protective factor necessary for lung tissue elasticity. Immune deficiency syndromes, connective tissue disorders, intravenous drug use and other genetic problems also represent harmful factors that could damage the lungs. Nevertheless, if the tobacco exposure continues, the symptoms will become worse gradually and people usually start eliminating certain activities from their daily schedule as well as avoiding stairs. With the passage of time, the lungs suffer more damage and they simply cannot overlook the serious and specific symptoms of COPD that refer to chest tightness, lack of energy, shortness of breath caused by simple actions like normally walking up stairs, frequent colds and respiratory infections, chronic cough, daily necessity of clearing mucus from the lungs and noisy breathing. Ultimately, in later stages, chronic obstructive pulmonary disease provokes weight loss, fatigue and swelling of the feet. People with COPD must seek immediate medical attention or care if they experience heart palpitations and confusing or fainting episodes, trouble catching their breath or inability to speak or if they have low oxygen levels in the blood, which they can recognize by the color of their lips and fingernails, usually bluish or grey. In people with chronic obstructive pulmonary disease, the body does not benefit from the needed oxygen. Furthermore, eliminating the carbon dioxide waste produced in the body becomes significantly more difficult. In serious cases, people experience hypoxia, meaning that a low level of oxygen flow through the blood and hypercapnia, which refers to high levels of carbon dioxide. On the long term, these two can provoke acute respiratory failure leading to arrhythmia. Practically, the heart starts to beat irregularly. Besides arrhythmia, coronary artery disease can result from lung inflammation and narrow the blood vessels that have the purpose to bring oxygen, nutrients and blood to the heart. This represents a very dangerous infection caused by the presence of bacteria or viruses in the lungs, which can lead to death in certain cases. The risk becomes even greater for those with chronic obstructive pulmonary disease, due to their weakened pulmonary system. Thus, in order to prevent lung infections, maintaining an overall good health is essential. Prevention methods include Page 4

5 quitting the harmful habit of smoking, washing their hands consistently, drinking plenty of water, getting flu and pneumonia vaccines. It should not be surprising that smokers develop lung cancer, taking into consideration the warnings on the cigarettes packs. Nevertheless, researchers have discovered a connection between chronic obstructive pulmonary disease and lung cancer, even in people who do not smoke. The cause lies in the chronic inflammation of the lungs. Another possible cause is genetics. Even though COPD does not lead to diabetes, it becomes an obstacle in battling the symptoms of diabetes. Dealing with chronic obstructive pulmonary disease and diabetes at the same time could cause complications due to the combination of medications for both conditions. These types of people may experience an aggravation of symptoms because diabetes restricts the cardiovascular system. Failing to monitor the blood sugar levels can reduce lung function. The implication of a doctor becomes imperative for prescribing medications that work together as a treatment for both conditions. Psychiatric complications of COPD Older COPD patients are most likely to experience a gradual mental decline, usually dementia because of the irreversible damage in the blood vessels of the brain, high carbon dioxide and low oxygen. Several actions and methods have the power to prevent dementia development, such as controlling diabetes and cholesterol, maintaining a normal and healthy body weight as well as engaging in stimulating activities to sharpen the mind. Furthermore, people in late stages of the condition, encounter difficulties when it comes to performing everyday activities including walking up stairs or lifting and carrying heavier objects. A good percentage of those people suffer from insomnia, which increases the risk for psychiatric conditions including anxiety, depression and agoraphobia, a fear of situations and places that might cause negative feelings like embarrassment, helplessness and even panic. Considering that most cases appear as a direct result of tobacco smoking, putting an end to this habit represents the most certain way of preventing COPD development. For tobacco fiends, this efficient solution is quite challenging, almost impossible. However, working with a specialist and creating a beneficial tobacco cession program is critical. After all, this represents the only chance of preventing lung damage. The exposure to dust and fumes at the workplace is another risk for COPD because these chemicals provoke lung irritation so for those people with harmful work environments talking with a supervisor and agreeing on certain protection methods like respiratory protective equipment is very important. Moreover, discussing with the doctor concerning flu, pneumonia or influenza vaccines is imperative because it can significantly lower the chances of dealing with these types of illnesses in the near future. After reviewing the symptoms, they proceed to ask about the family and medical history as well as performing a physical exam and various tests. The patient has the duty to be very honest and inform the doctor if he is or he was a smoker, if he works in a harmful environment for the lungs, if he suffers from respiratory conditions like asthma or if he takes over the counter medications. After receiving the necessary information from the medical history, the conversation with the patient and the physical exam, the doctor may choose to perform further tests in order to complete the diagnosis for COPD. This represents the most common procedure for evaluating the lung function. After taking a deep breath, the patient must blow into a tube connected to a small apparatus known as spirometer, hence the name of the test. This is very useful for the doctor because it helps him determine the amount of air the lungs can support and the amount of time before blowing the air out. Spirometry can detect COPD before the manifestation or the appearance of symptoms. In addition, doctors use it for tracking the progression of the condition and monitoring the efficiency of the treatment. They easily detect emphysema, which represents a main cause of chronic obstructive pulmonary disease. Arterial blood gas analysis: Doctors use this test when looking for clear signs of COPD because it helps them measure the capacity of the lungs when it comes to bringing oxygen into the blood and eliminating carbon dioxide. For instance, it gives them the ability to determine the presence of the genetic factor alpha-1 antitrypsin deficiency, which can lead to COPD in certain cases. Usually, they choose laboratory tests for patients with a family history of chronic obstructive pulmonary disease or patient under 45 who develop this condition. Generally, different specialists intervene including a pulmonologist as well as physical and respiratory therapists. Doctors prescribe multiple medications for patients with chronic obstructive pulmonary disease, according to their needs. Bronchodilators have the purpose to help the patient breathe easier by relaxing the muscles of the bronchial tubes. In addition, they can add other medications to the treatment for reducing the inflammation in the airways. This method is helpful Page 5

6 for those patients with low oxygen levels in the blood because it allows them to receive extra oxygen through a mask or a small tube placed inside the nose. They do not have to remain in the hospital for this therapy because they have the possibility to carry a portable unit with them. Treatment for weight loss and muscle weakness: Patients with COPD encounter difficulties maintaining a healthy weight and a strong body. For this reason, lifestyle changes that focus especially on the diet are necessary. Even though surgery represents the last resort in severe cases of chronic obstructive pulmonary disease, doctors are most likely to consider it for patients with emphysema. Last updated on March 2nd, Editorial Team Academic Association of Medicine is the go to resource for all health related issues. We are an independent body that seeks to offer general information on various health topics and unbiased reviews on health products. Page 6

7 Chapter 4 : Chronic Obstructive Pulmonary Disease (COPD) American Lung Association The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older: Int J COPD. ; Wheaton AG, Ford ES, Cunningham TJ, Croft JB. The law requires that our healthcare facilities and medical personnel protect the privacy of your medical record and other health information We are also required to notify you of our privacy practices with regard to your Protected Health Information. The Lung Institute collects information by various methods including information actively provided by its lead providers, customers and information arising from customer surveys and general feedback. The types of personal information we collect include name, contact information, identification information, credit information and other data types as appropriate. Credit card information is used for billing purposes only. How We Use This Information: This information is used to aid in the provision of our various products and services, including customer service, accounting, billing, collections and the marketing of other products and services. The Lung Institute may use aggregate or anonymous information for various uses for itself and third parties. The Lung Institute does not share personal information with any third parties except as disclosed in this policy. Security Personal information is stored in a combination of paper and electronic files. They are protected by security measures appropriate to the nature of the information. If an individual believes that any of their personal information is inaccurate, we will make appropriate corrections. Cookies are used by the Lung Institute for the convenience of our users. Cookies automatically authenticate the user. However, in doing so they may find themselves challenged for username and password information on multiple occasions. When you click on one of these links, you are moving to another website. We encourage you to read the privacy statements of these linked sites as their privacy policy may differ from ours. Telephone Numbers and Calls: By providing your telephone number to the Lung Institute on this contact form, you acknowledge and agree that you may receive a telephone call from the Lung Institute, at the number you provided on the online form, to receive information regarding the treatments offered at the Lung Institute. By providing your mobile number to the Lung Institute, you further acknowledge and agree that you may receive text messages SMS from the Lung Institute at the number you provided to the Lung Institute. Protected Health Information will not be requested by the Lung Institute, if you choose to respond with Protected Health Information you agree to release the Lung Institute from any liability related to such disclosure. The Lung Institute may amend this policy from time to time. If such amendments affect how the Lung Institute uses or discloses personal information already held by the Lung Institute in a material way, the Lung Institute will obtain consent. Notwithstanding the general terms of this policy, the collection, use, and disclosure of personal information may be made outside of the terms herein to the extent provided for in any applicable privacy or other legislation in effect from time to time. Page 7

8 Chapter 5 : Medical Xpress - chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of chronic (long-term) lung disease that includes emphysema and, often, chronic bronchitis. COPD can make it difficult to breathe. Women may be more likely to develop COPD from smoking or, very rarely, from exposure to pollution or chemicals. Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive lung diseases. The most common are emphysema and chronic bronchitis. Many people with COPD have both of these conditions. Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow. Bronchitis causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up. The top cause of COPD is tobacco smoking. Long-term exposure to chemical irritants can also lead to COPD. Diagnosis usually involves imaging tests, blood tests, and lung function tests. Medications, supplemental oxygen therapy, and surgery are some forms of treatment. Untreated, COPD can lead to a faster progression of disease, heart problems, and worsening respiratory infections. As many as half are unaware that they have it. What are the symptoms of COPD? COPD makes it harder to breathe. Symptoms may be mild at first, beginning with intermittent coughing and shortness of breath. As it progresses, symptoms can become more constant to where it can become increasingly difficult to breathe. You may experience wheezing and tightness in the chest or have excess sputum production. Some people with COPD have acute exacerbations, which are flare-ups of severe symptoms. At first, symptoms of COPD can be quite mild. You might mistake them for a cold. Symptoms can get progressively worse and harder to ignore. As the lungs become more damaged, you may experience: About 90 percent of people who have COPD are smokers or former smokers. Among long-time smokers, 20 to 30 percent develop COPD. Many others develop lung conditions or have reduced lung function. Most people with COPD are at least 40 years old and have at least some history of smoking. The longer and more tobacco products you smoke, the greater your risk of COPD is. In addition to cigarette smoke, cigar smoke, pipe smoke, and secondhand smoke can cause COPD. Your risk of COPD is even greater if you have asthma and smoke. Long-term exposure to air pollution and inhaling dust can also cause COPD. In developing countries, along with tobacco smoke, homes are often poorly ventilated, forcing families to breathe fumes from burning fuel used for cooking and heating. There may be a genetic predisposition to developing COPD. Up to an estimated 5 percent of people with COPD have a deficiency in a protein called alphaantitrypsin. This deficiency causes the lungs to deteriorate and also can affect the liver. There may be other associated genetic factors at play as well. Diagnosis is based on symptoms, a physical exam, and diagnostic test results. When you visit the doctor, be sure to mention all of your symptoms. Tell your doctor if: Based on all this information, your doctor may order some of these tests to get a more complete picture: Spirometry is a noninvasive test to assess lung function. Imaging tests include a chest X-ray or CT scan. These images can provide a detailed look at your lungs, blood vessels, and heart. An arterial blood gas test involves taking a blood sample from an artery to measure your blood oxygen, carbon dioxide, and other important levels. These tests can help determine if you have COPD or a different condition, such as asthma, a restrictive lung disease, or heart failure. Page 8

9 Chapter 6 : Chronic Obstructive Pulmonary Disease (COPD) - Academic Association of Medicine COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and theinnatdunvilla.com main cause of COPD is long-term exposure to substances that irritate and damage the lungs. Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritantsâ such as air pollution, chemical fumes, or dustsâ also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin AAT deficiency can also cause the disease. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide CO2 gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2. The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual and can become clogged. The inset image shows a detailed cross-section of the bronchioles and alveoli. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced. In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person. COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease. Causes Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD. People who have this condition have low blood levels of alpha-1 antitrypsin AAT â a protein made in the liver. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly. Asthma is a chronic lung disease that inflames and narrows the airways. Up to 75 percent of people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include air pollution, chemical fumes and dusts from the environment or workplace, and secondhand smoke, which is smoke in the air from other people smoking. Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Smoking is the Page 9

10 leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. Although these resources focus on heart health, they include basic information about how to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD. As the disease gets worse, symptoms usually become more severe. Shortness of breath, especially with physical activity Wheezing or a whistling or squeaky sound when you breathe Chest tightness If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza. Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD. If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion. The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital. Youâ or, if you are unable, family members or friendsâ should seek emergency care if you are experiencing the following: You are having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood. People around you notice that you are not mentally alert. Your heartbeat is very fast. The recommended treatment for symptoms that are getting worse is not working. Diagnosis Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts. Also, let your doctor know whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD. Pulmonary Function Tests Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Spirometry During this painless test, a technician will ask you to take a deep breath in. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out. Spirometry The image shows how spirometry is done. The patient takes a deep breath and blows as hard as possible into a tube connected to a spirometer. Page 10

11 Chapter 7 : Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is a progressive lifeâ threatening lung disease that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness. The Global Burden of Disease Study reports a prevalence of million cases of COPD globally in The sound of wheezing as heard with a stethoscope. Problems playing this file? The most common symptoms of COPD are sputum production, shortness of breath, and a productive cough. When it persists for more than three months each year for at least two years, in combination with sputum production and without another explanation, it is by definition chronic bronchitis. This condition can occur before COPD fully develops. The amount of sputum produced can change over hours to days. In some cases, the cough may not be present or may only occur occasionally and may not be productive. Sputum may be swallowed or spat out, depending often on social and cultural factors. Vigorous coughing may lead to rib fractures or a brief loss of consciousness. Those with COPD often have a history of " common colds " that last a long time. Note the scales used for females and males differ. The risk is greater in those who are poor, although if this is due to poverty itself or other risk factors associated with poverty, such as air pollution and malnutrition, is not clear. On the right are lungs damaged by COPD with an inset showing a cross-section of damaged bronchioles and alveoli. COPD is a type of obstructive lung disease in which chronic, incompletely reversible poor airflow airflow limitation and inability to breathe out fully air trapping exist. The relative contributions of these two factors vary between people. This form of disease is called bullous emphysema. Those who smoke additionally have Tc1 lymphocyte involvement and some people with COPD have eosinophil involvement similar to that in asthma. Part of this cell response is brought on by inflammatory mediators such as chemotactic factors. Other processes involved with lung damage include oxidative stress produced by high concentrations of free radicals in tobacco smoke and released by inflammatory cells, and breakdown of the connective tissue of the lungs by proteases that are insufficiently inhibited by protease inhibitors. The destruction of the connective tissue of the lungs leads to emphysema, which then contributes to the poor airflow, and finally, poor absorption and release of respiratory gases. This contributes to the inability to breathe out fully. The greatest reduction in air flow occurs when breathing out, as the pressure in the chest is compressing the airways at this time. This can also lead to insufficient ventilation, and eventually, low blood oxygen levels. Both of these changes result in increased blood pressure in the pulmonary arteries, which may cause cor pulmonale. Smaller handheld devices are available for office use. The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath, a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease. Page 11

12 Chapter 8 : Lung Institute Obstructive vs. Restrictive Lung Disease Chronic bronchitis and emphysema, are thought by many to be variations of chronic obstructive pulmonary disease and considered part of the progression of chronic obstructive pulmonary disease by many researchers. URL of this page: Having COPD makes it hard to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves damage to the lungs over time Most people with COPD have a combination of both conditions. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of a cooking fire without proper ventilation Symptoms Symptoms may include any of the following: This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away. Using a stethoscope to listen to the lungs can also be helpful. But sometimes, the lungs sound normal, even when a person has COPD. Imaging tests of the lungs, such as x-rays and CT scans, can be helpful. With an x-ray, the lungs may look normal, even when a person has COPD. Sometimes, a blood test called arterial blood gas may be done to measure the amounts of oxygen and carbon dioxide in the blood. But there are many things you can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is the time to quit. This is the best way to slow lung damage. Medicines used to treat COPD include: Steroids by mouth or through a vein intravenously Bronchodilators through a nebulizer Oxygen therapy Assistance from a machine to help breathing by using a mask, BiPAP, or through the use of an endotracheal tube Your health care provider may prescribe antibiotics during symptom flare-ups, because an infection can make COPD worse. You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure COPD. But it can teach you to breathe in a different way so you can stay active and feel better. You can do things every day to keep COPD from getting worse, protect your lungs, and stay healthy. Walk to build up strength: Ask the provider or therapist how far to walk. Slowly increase how far you walk. Avoid talking if you get short of breath when you walk. Use pursed lip breathing when you breathe out, to empty your lungs before the next breath. Things you can do to make it easier for yourself around the home include: Avoid very cold air or very hot weather Make sure no one smokes in your home Reduce air pollution by not using the fireplace and getting rid of other irritants Manage stress and your mood Use oxygen if prescribed for you Eat healthy foods, including fish, poultry, and lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a provider or dietitian about eating foods with more calories. Surgery may be used to treat COPD. Only a few people benefit from these surgical treatments: Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some people with emphysema. Lung transplant for a small number of very severe cases. Support Groups You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone. The disease will get worse more quickly if you do not stop smoking. If you have severe COPD, you will be short of breath with most activities. You may be admitted to the hospital more often. Talk with your provider about breathing machines and end-of-life care as the disease progresses. Possible Complications Irregular heartbeat arrhythmia Need for breathing machine and oxygen therapy Right-sided heart failure or cor pulmonale heart swelling and heart failure due to chronic lung disease. Page 12

13 Chapter 9 : What is COPD? Chronic Obstructive Pulmonary Disease Signs and Symptoms The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease for patients around the world. What are the complications or effects of COPD? Compared to adults without COPD, those with this disease are more likely to: Have activity limitations like difficulty walking or climbing stairs. A simple test, called spirometry, can be used to measure pulmonaryâ or lungâ function and detect COPD in anyone with breathing problems. Treatment of COPD requires a careful and thorough evaluation by a physician. Treatment options that your physician may consider include: For people who smoke, the most important part of treatment is smoking cessation. Avoid tobacco smoke and other air pollutants at home and at work. Ask your doctor about pulmonary rehabilitation, which is a personalized treatment program that teaches COPD management strategies to improve quality of life. Programs may include plans that teach people how to breathe better and conserve their energy, as well as provide advice on food and exercise. Symptoms such as coughing or wheezing can be treated with medication. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumococcal vaccines, are especially important for people with COPD. Learn more about vaccination recommendations. Respiratory infections should be treated with antibiotics, if appropriate. Some people may need to use a portable oxygen tank if their blood oxygen levels are low. References National Center for Health Statistics. Employment and activity limitations among adults with chronic obstructive pulmonary disease â United States, Obstructive lung disease and low lung function in adults in the United States: Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses â United States, â Association of chronic obstructive pulmonary disease with increased confusion or memory loss and functional limitations among adults in 21 states, Behavioral Risk Factor Surveillance System. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older: Chronic obstructive pulmonary disease, hospital visits, and comorbiditiesâ National Survey of Residential Care Facilities, Association of self-reported cigarette smoking with chronic obstructive pulmonary disease and co-morbid chronic conditions in the United States. Pulmonary function, chronic respiratory symptoms, and health-related quality of life among adults in the United Statesâ National Health and Nutrition Examination Survey Diagnosis and management of stable chronic obstructive pulmonary disease: Page 13