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COPD is often discussed as a single disease, but several different conditions actually fall under this umbrella term. What are they, and what do you need to know about their symptoms and treatment?

Chronic obstructive pulmonary disease (COPD) is — at its heart — a chronic condition that interferes with patients' ability to breathe because of lung damage.

You'll already be familiar with the terms "chronic" and "disease", and probably know that "pulmonary" refers to the lungs. The "O" in COPD is for obstructive, and this means that the condition obstructs your airflow. The excess mucus COPD leads to can physically block the airways, but the lungs of COPD patients also become less elastic while the walls of the airways are inflamed and swollen. As COPD progresses, increasingly severe lung damage makes breathing more and more difficult. Oxygen levels decline, and patients' quality of life with them. 

Though COPD is often spoken of as if it is just one thing, it's actually an umbrella term that encompasses multiple conditions. Chronic bronchitis and emphysema are the most well-known ones, and many patients will have symptoms of both these conditions; one of the reasons the term "COPD" is so popular. Refractory asthma and some kinds of bronchiectasis can also fall under the COPD umbrella. 

What should you know about the conditions that make up COPD?

What is chronic bronchitis?

Bronchitis, which can be acute or chronic, refers to a bronchial-tube inflammation — in other words an inflammation of the airways you need to get air into your lungs. Swollen airways are narrower airways, and besides this unfortunate fact, bronchitis also causes a build-up of phlegm, which your body will try to eliminate by coughing. While acute bronchitis is mostly caused by viral infections and sometimes other irritants, and often clears up quickly, the chronic form of the disease is a lot trickier to handle. 

Symptoms, which you must have for at least three months in a row for two consecutive years if you are to be diagnosed with chronic bronchitis, go beyond the characteristic excess mucus production and cough, and also include:

  • Shortness of breath, medically known as dyspnea, particularly when you physically exert yourself, like when you exercise.
  • Wheezing, a "whistling" sound while you breathe.
  • Fatigue.
  • A feeling of tightness in your chest.
  • Being more prone to respiratory infections (like flu and colds).

While smoking is the leading cause of chronic bronchitis in developed nations, workplace exposures, air pollution, untreated asthma, and other factors can also contribute to its development. 

If you present with symptoms that can indicate chronic bronchitis, your appointment will begin with a chat about your symptoms and medical history. The diagnosis is ultimately made using lung function tests, blood tests, and imaging tests. These will not just confirm the diagnosis but also rule out others. 

There is no cure for chronic bronchitis, but the condition can be managed with: 

  • Lifestyle changes — stopping smoking is the most important of these.
  • Medications — including bronchodilators (inhalers), steroids (which can be inhaled or oral), and antibiotics as needed.
  • Oxygen therapy in severe cases.
  • Pulmonary rehabilitation programs, which include exercise and education for a better quality of life.

What is emphysema?

In emphysema, the alveoli — "air sacs" in the lungs — are damaged so you don't get enough oxygen, which leads to shortness of breath, especially during strenuous physical activities, and often a chronic cough. The lungs can also become hyperinflated, trapping excess air inside. Dyspnea is, again, the result.

Smoking is a primary cause of emphysema, which is more likely to strike in older people than chronic bronchitis, but workplace exposure, being around a lot of second-hand smoke, living in a polluted environment, and even genetics can also contribute. Alpha-1 antitrypsin (A1AT) deficiency, a genetic disorder, can cause emphysema. 

While damage that has occurred as a result of emphysema cannot be reserved, this side of the COPD umbrella is also managed with bronchodilators, steroids, antibiotics (where needed), and in severe cases oxygen therapy. Surgery may be an option at the extreme end of emphysema, too, in the form of lung volume reduction or a lung transplant. 

What is refractory asthma?

Refractory asthma, also called non-reversible asthma and "severe asthma" in the UK, is an extreme form of asthma that doesn't respond well to traditional asthma treatment, that is, bronchodilators. Asthma, in general, is a condition in which the bronchial tubes are inflamed and thus sensitive. When the airways come into contact with irritants or allergies, they become constricted and patients get less air.

The symptoms of refractory asthma don't really differ from other asthma cases, and include coughing, wheezing, dyspnea, and feelings of tightness in the chest. Because the condition is so much harder to control, patients are likely to suffer them more often, however, and are prone to asthma attacks. 

People diagnosed with this kind of asthma may benefit from treatment with steroids, and several medications are also available specifically for particular subtypes of refractory asthma. They include Xolair (omalizumab), Nucala (mepolizumab), and Cinqair (reslizumab).

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