Chronic obstructive pulmonary disease (COPD) is an umbrella term for a number of progressive lung diseases that obstruct airflow and make it increasingly hard for patients to breathe. The most common of these diseases — several of which can strike in the same patient — are chronic bronchitis and emphysema. Refractory asthma and some kinds of bronchiectasis are also considered to be part of the COPD umbrella.
COPD: Important facts and statistics
- Globally, an estimated 250 million people suffer from moderate to severe COPD, including around 15 million in the United States.
- In industrialized high-income nations, smoking cigarettes is the leading cause of chronic obstructive pulmonary disease, while cooking with certain kinds of fuel causes a lot of cases in some lower- and middle-income countries. Workplace exposure to pollution, dusts, and other irritants can also lead to COPD, and around 20 percent of cases in the US are thought to be caused by environmental and occupational exposures.
- Genetics play a role too, since a genetically-linked alpha-1-antitrypsin deficiency greatly increases a person's risk of developing COPD.
- Men used to be at a higher risk of developing COPD, but no longer.
How serious is COPD? In 2015 alone, an estimated three million people died from COPD-related causes, and COPD caused five percent of all deaths.
What do you need to know about the stages of COPD?
The progression of chronic obstructive pulmonary disease is divided into four stages, based mainly on the results of a spirometry test that measures your so-called FEV1, the volume of air you can expel during the first second of a breath.
While different classification systems exist, one of the most used is the "GOLD classification". It defines the stages in the following way:
- Grade 1, or mild COPD, features an FEV1 that is about 80 percent of the normal outcome expected in people without COPD.
- Grade 2, or moderate COPD, will be accompanied by FEV1 results of 50 to 80 percent.
- Grade 3, or severe, COPD, can be diagnosed in patients with an FEV1 of between 30 and 50 percent.
- Grade 4, very severe, COPD, is also called end-stage COPD and it's the final stage. During this stage, patients will often have an FEV1 of less than 30 percent, though end-stage COPD can also be diagnosed in people with an FEV4 of between 30 and 50 percent who have low oxygen levels in their blood.
What are the symptoms of COPD during each stage?
During Stage 1, or mild, COPD, patients are often unaware there is anything wrong, and are frequently still undiagnosed. They may easily dismiss the symptoms they do have as the result of aging, fatigue, being unfit, or having a cold.
The symptoms of mild stage COPD can include:
- Fairly mild shortness of breath, which you may notice as you exercise or engage in other strenuous physical activities.
- A persistent but relatively mild cough — the stereotypical smoker's cough.
- Excess mucus production, as signified by needing to clear your throat.
The symptoms of moderate stage COPD (Stage 2) are more noticeable, and people who haven't sought medical attention yet will almost certainly do so at this stage, usually for:
- Increasing shortness of breath (dyspnea), brought on by light physical activities.
- Wheezing, a kind of "whistling sound" you make as you breathe because of constricted airways.
- Feelings of uncomfortable tightness in your chest.
- You're still coughing, and it's only gotten worse since Stage 1.
- Mucus, too, becomes ever-more invasive.
- You may notice that you tire more easily, too.
The symptoms of severe stage COPD (Stage 3) do not differ that much, but become more severe and frequent. By the time a patient has end-stage or Stage 4 COPD, their quality of life is severely impacted by the disease. The symptoms of very severe stage COPD can include, in addition to all the symptoms you already had — and which will continue to get worse:
- Severe shortness of breath (without medication), even at rest
- Swelling in your feet, ankles, and legs
- Involuntary weight loss, as your lungs need to work much harder to get you the air you need and you may find eating itself to be an arduous task.
What is a COPD flare-up (or exacerbation)?
A COPD flare-up or exacerbation, is a period of time during which your COPD symptoms suddenly grow much worse. They generally affect patients in Stage 2 and beyond, and become more frequent as the disease progresses. They can be triggered by irritants or respiratory infections, and lead to red flags like:
- Intense dyspnea
- Intense coughing
- Even more mucus, which can change color and texture
- More wheezing
In addition to "everything COPD patients usually experience, but worse and not necessarily relieved by your usual medications", flare-ups can also cause swollen ankles, mental confusion, severe fatigue, and a fever. It is essential for COPD patients to create a flare-up management plan with their doctors so they know what to do when one hits.
How is COPD diagnosed?
Once the symptoms of COPD become more invasive, patients usually seek medical attention to help them figure out what's wrong. Your doctor will ask you about your lifestyle and the symptoms you've experienced. Your doctor can order tests to diagnose COPD if they suspect this is what you suffer from, but before that, they'll ask you questions to determine how likely to is that you have chronic obstructive pulmonary disease.
COPD screening questions your doctor will ask include:
- Whether you are a former or current smoker, how much you smoke or smoked, and for how long.
- Asking about irritants you may have been exposed to at work or elsewhere.
- If you experience shortness of breath, wheezing, persistent coughs, and excess mucus production.
- If you experience coughs even when you don't have a cold.
After determining your symptoms, medical history, and conducting a physical exam, the tests that ultimately help your doctor diagnose COPD include:
- A spirometry, during which you breathe into a device to measure your total air volume and air volume in the first second.
- A bronchodilator reversibility test, during which you first participate in a spirometry and are then offered a medication to relax your airways, only to repeat the test. This determines whether bronchodilators alleviate your symptoms.
- Imaging tests such as a chest X-ray or CT scan.
- An arterial blood gas test, which looks at the oxygen and carbion dioxide in your blood.
- A blood test to find out if you have an alpha-1-antitrypsin deficiency.
- A sputum biopsy to look at possible respiratory infections.
- An electrocardiogram (ECG or EKG), which looks at your heart function.
How is chronic obstructive pulmonary disease managed?
The treatment that will be offered to patients depend on their symptoms and the stage of COPD they are in. The ultimate goals of COPD management are to minimize symptoms, allowing you to have the best quality of life possible, and to reduce the risk of exacerbations and possible complications. This is achieved through a combination of medications, lifestyle changes, and education.
- Short-acting inhaled bronchodilators are usually the first medication added to a COPD treatment plan. These so-called "rescue inhalers" can quickly alleviate dyspnea.
- Long-acting bronchodilators serve as a maintenance therapy, delivering predermined doses to your lungs that you take at set times every day. Bronchodilators can be delivered through an inhaler or a nebulizer.
- Corticosteroids are also used to treat COPD, typically when a patient has at least reached Stage 2. They fight inflammation and relieve symptoms, and can be delivered orally or as inhaled medications.
- Phosphodiesterase-4 inhibitors and theophylline are less-used medications for COPD that may be recommended when other medications do not work well.
- Antibiotics and antivirals are used primarly to treat respiratory infections. Antibiotics for COPD can also be offer as a prophylactic (preventative) treatment in some cases.
- COPD patients also need vaccines. These include an annual flu shot, pneumoccocal vaccine, and a vaccine that protects against pertussis (whooping cough).
- Oxygen therapy can be recommended for COPD patients whose blood oxygen levels have dropped to low levels. This can be short-term or long-term, and continuous or on an as-needed basis.
Pulmonary rebabilitation for COPD patients is an integrative approach that incorporates:
- Breathing techniques
- Education about COPD, your medications, lifestyle changes, and how to live your best life with COPD
- Nutritional advice, especially during the later stages of COPD when maintaining weight can become very difficult
Pulmonary rehab can offer a positive addition to the lives of COPD patients in any stage, particularly moderate-stage COPD and beyond. It leads to decreased shortness of breath, more energy, and improved wellbeing.
The lifestyle changes COPD patients should adopt to increase their quality of life and the odds that their other treatments will be successful include:
- Stopping smoking immediately, if they smoke — this is the number one step COPD patients at any stage can take to improve their life and prognosis.
- Avoiding known COPD triggers.
- Staying up to date on vaccines that can help prevent respiratory infections and, thus, flare-ups. Avoiding sick people and practicing meticulous hand hygiene.
- Exercising regularly, as it will keep you fit and increase your circulation, ultimately reducing the severity of your symptoms.
- Eating a lung-healthy diet that incorporates plenty of fruits, vegetables, and whole grains and shuns processed foods.
Patients with severe COPD may benefit from surgery in some cases. Three kinds of surgery exist to help some people with chronic obstructive pulmonary disease, candidates are chosen very carefully as all the surgeries carry serious risks as well as potential benefits.
The surgeries, which are only an option after all other treatments have been exhausted, are:
- A bullectomy, during which enlarged air sacs are removed to make breathing easier.
- A lung volume reduction surgery removes a portion of your damaged lung to allow the remaining healthier portion to function more effectively.
- In severe cases, a lung transplant is the only viable option. This can be considered for younger COPD patients with severe lung damage who are otherwise fairly healthy.
Each surgery has its own selection criteria. The criteria that apply to all are that a candidate has to be a non-smoker, participate in a pulmonary rehab program, must have shown that they can adhere to lifestyle recommendations and medication regimes, and that they must be physically healthy enough to undergo the surgery.
What complications can COPD cause?
Chronic obstructive pulmonary disease is serious enough on its own, but patients are also at a higher risk of developing several complications. These include:
- Lung infections, including common colds, the flu, and pneumonia.
- High blood pressure in the pulmonary arteries (pulmonary hypertension).
- Heart problems, such as right-sided heart failure.
- COPD increases your risk of lung cancer.
- Since COPD has a serious impact on patients' quality of life, it is no surprise that COPD patients are more likely to suffer from depression and anxiety.
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People who recognize themselves in the symptoms of COPD — particularly if they are smokers or have been exposed to irritants in the workplace over long periods of time — should seek immediate medical attention. While COPD is a progressive and irreversible disease, treatment that minimizes your symptoms and allows you to be more active exists during every stage of the disease. Timely diagnosis leads to a better prognosis, and the sooner you know you have COPD, the faster you can take effective action to manage it.