Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a condition caused by damage to the airways and other parts of the lungs. This damage results in inflammation and additional issues that obstruct airflow, making it difficult to breathe. COPD can lead to coughing that produces large amounts of thick mucus. It can also cause breathing difficulties, shortness of breath and chest tightness.

Cigarette smoking is the leading cause of COPD. Long-term smoking or inhaling tobacco smoke and air pollutants damages the lungs and airways. In healthy lungs, the air we breathe travels down the bronchial tubes, which branch into thousands of smaller, thinner tubes known as bronchioles. These tubes end in clusters of tiny, round air sacs called alveoli, which are elastic and stretchy. In COPD, reduced airflow in and out of the airways occurs for one or more reasons:

• 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 produce more mucus than usual and can become clogged.

The following habits or conditions have been shown to increase the risk of COPD:

• The main risk factor for COPD is smoking or exposure to cigarette smoke. Three out of four 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.
• Other lung irritants increase the risk of COPD, including long-term exposure to air pollution, chemical fumes and dust from the environment or workplace, as well as exposure to smoke from home cooking and heating fuels without ventilation.
• Conditions affecting the lungs when a baby is still in the uterus or during childhood can increase the risk. Examples include smoking in pregnancy or childhood asthma. Air pollution can also limit the growth of a child’s lungs and increase their risk of developing COPD.
• Infections such as human immunodeficiency virus (HIV) and tuberculosis can raise your risk.
• Your age may play a role in COPD risk if you have other risk factors, such as smoking. Most people who have COPD are at least 40 years old when symptoms begin.
• Individuals born with a genetic condition called alpha-1 antitrypsin (AAT) deficiency are at a higher risk of developing COPD at a younger age. Other potential genetic risk factors include vitamin D deficiency and mutations in CHRNA genes.

Women may be more likely to receive a diagnosis of severe COPD that develops relatively early, before the age of 55. The majority of people with COPD who have never smoked are women. Women who smoke the same amount as men seem to experience more lung damage, resulting in poorer lung function. Compared to older men, older women may be more prone to experiencing serious symptoms of COPD, such as severe shortness of breath, even if they have smoked less throughout their lives than men.

• More women than men are hospitalized for COPD.
• Women who have COPD tend to have more flare-ups.
• Women with COPD are also more likely than men with COPD to struggle with anxiety and depression.
• Women with insulin resistance are at higher risk of COPD.
• AAT deficiency can increase the risk of being diagnosed with COPD before and during pregnancy. It may also raise the risk of complications such as preeclampsia, miscarriage and preterm birth.

The good news is that COPD can often be prevented, primarily by not smoking. In the United States and other high-income countries, cigarette smoking is the leading cause of COPD. Most individuals with COPD smoke or are former smokers. If you’re having difficulty quitting smoking on your own, consider joining a smoking cessation support group or class at Montefiore Einstein.

If you have smoked or experience COPD symptoms, consult your healthcare provider about your risk of COPD. While there is no cure, treatments and lifestyle changes, such as quitting smoking, can help you feel better, remain more active and slow the progression of the disease.

Certain triggers, like odors, cold air, poor air quality, colds, the flu or a lung infection, can cause a sudden worsening of symptoms. When this occurs, it’s referred to as a flare-up or exacerbation, leading to increased difficulty in breathing. You might also experience chest tightness or fever, have the urge to cough or clear your throat more frequently and notice that you’re coughing up yellow or green phlegm.

Contact your healthcare provider immediately if your symptoms suddenly worsen. Your provider may prescribe antibiotics to address an infection. They might also give you other medications, such as bronchodilators and inhaled or oral steroids, to assist with your breathing. Serious symptoms may necessitate treatment in a hospital. The severity of flare-ups depends on the extent of lung damage you have. Inadequate sleep can also heighten the risk of a flare-up.

Your provider will examine you using a stethoscope to listen for wheezing or other abnormal chest sounds. Lung function and imaging tests are used to determine whether you have COPD and assess how serious it is. Your doctor may then recommend getting an X-ray or computed tomography (CT) scan to confirm the diagnosis.

Our pulmonary physicians examine lung physiology and use the latest CT and X-ray imaging technologies to accurately diagnose COPD according to precise medical guidelines.

If you get a COPD diagnosis, ask about genetic screening. Some people have a genetic condition called AAT deficiency, which increases their risk of developing COPD. Screening is especially important if you have family members with AAT deficiency or who were diagnosed with COPD in their 40s or 50s, or who have liver disease. Likewise, if you are the first in your family to learn that AAT deficiency is part of your genetic makeup, ask your provider for advice on talking with family members about your results.

Because COPD is a progressive disease, its symptoms often develop slowly but worsen over time and may limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities such as walking, cooking or taking care of yourself.

Not everyone who has the following symptoms has COPD. Likewise, not everyone with COPD has all these symptoms. Your healthcare provider can determine whether you have COPD. You may also have additional conditions that need to be diagnosed and treated. It is very common for people with COPD to have other conditions, including heart disease.

Common symptoms of COPD include:

• Shortness of breath, especially with physical activity. You may feel like breathing takes more effort or that you are gasping for air.
• An ongoing cough or a cough that produces a lot of mucus, sometimes called a smoker’s cough. This is often the first symptom of COPD.
• Wheezing or a whistling or squeaky sound when you breathe
• Chest tightness or heaviness, which may make it hard to take a deep breath or make it painful to breathe
• Fatigue or extreme tiredness

If your symptoms are mild, you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. For more serious symptoms, such as shortness of breath during physical activity, your healthcare provider can provide treatments and other ways to help. Severe COPD can cause additional symptoms, such as lack of appetite, loss of weight and muscle, anxiety and depression.

Your provider will diagnose COPD based on your symptoms, your medical and family histories and your test results. Discuss your smoking habits or whether you have had contact with secondhand smoke, air pollution, chemical fumes or dust.

Discuss COPD with your provider if you experience any of the following:

• Persistent shortness of breath that gets worse over time
• An ongoing, persistent cough. Tell your provider how long you’ve had it, how often you cough and how much mucus comes up when you cough.
• A family history of COPD

The primary test for COPD is spirometry, a lung function test that measures how much air you exhale and how fast you can blow air out. This scan can detect COPD before symptoms are recognized. During the test, a technician will ask you to take a deep breath and blow as hard as possible into a tube connected to a small spirometer machine. Your healthcare team may have you inhale medicine that helps open your airways and then blow into the tube again. They can then compare your test results before and after taking the medicine. Your provider may also use the test results to find out how severe your COPD is and create an individualized treatment plan.

A peak expiratory flow test measures how fast you can exhale using maximum effort. This test can be done during spirometry or with a small handheld device. Your doctor may also conduct an arterial blood gas test, which measures your blood’s oxygen and carbon dioxide levels.

Arterial blood gas tests are usually performed in a hospital but may be done in a healthcare provider’s office. This test will take blood from an artery, usually in the wrist, where your pulse is measured.

A chest X-ray is a fast and painless imaging test that looks at the structures in and around your chest. This test cannot diagnose COPD, but it can be used to find other conditions that may interact with COPD. The test can be done in a healthcare provider’s office, clinic or hospital. You will stand, sit or lie still for the test. Chest X-rays have few risks. The amount of radiation used in a chest X-ray is minimal. Talk to your provider if you are or could be pregnant.

A CT scan is a painless imaging test that takes many detailed pictures of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models that show the size, shape and position of your lungs and structures in your chest. A chest CT scan can help identify the cause of lung symptoms such as shortness of breath or chest pain. It can also tell your healthcare provider whether you have other lung problems, such as a tumor, excess fluid around the lungs (known as pleural effusion) or pneumonia. A chest CT scan may be done in a medical imaging facility or hospital.

If you are diagnosed with COPD, your healthcare provider will determine your treatment plan based on your symptoms and whether you have mild or severe COPD.

Medicines used to treat COPD symptoms include bronchodilators, steroids and nonsteroidal medications that reduce inflammation. Your healthcare provider might prescribe an inhaler for you to always carry, which allows the medicine to go straight to your lungs.

If your COPD is mild and you don’t have symptoms often, your provider may prescribe a short-acting bronchodilator that you take only when you have symptoms. Bronchodilators relax the muscles around your airways, opening them up to help make breathing easier. Short-acting bronchodilators last about four to six hours. If your COPD is moderate or severe, you may need long-acting bronchodilators that last 12 hours or more or an anti-inflammatory taken daily.

If your COPD is severe or your symptoms flare up often, your provider may prescribe a combination of bronchodilators along with an inhaled steroid. Steroids help reduce the inflammation or swelling in your airways that makes it hard to breathe. Antibiotics may be used to treat flare-ups caused by an infection. Be sure to discuss a plan with your provider for treating a flare-up, including any special medicine you might need.

Pulmonary rehabilitation is a supervised program that includes exercise, health education and breathing techniques for people who have certain lung conditions or have had a lung transplant. Your provider may talk to you about pulmonary rehabilitation to help you breathe more easily and improve your quality of life. Some people find it helpful to join a rehabilitation program using their phone, the web or a mobile app.

Oxygen therapy is a treatment that delivers oxygen for you to breathe. If you qualify for oxygen therapy, you will receive oxygen through tubes resting in your nose or from a face mask. You may need oxygen therapy if you have a condition that causes your blood oxygen levels to be too low. This treatment can be given in a hospital, in another medical setting or at home. Oxygen poses a fire risk, so you should never smoke or use flammable materials when using oxygen. You may experience side effects from this treatment, such as a dry or bloody nose, tiredness and morning headaches.

Surgery can benefit some people who have COPD. This is usually an option only when serious symptoms have not improved with medication.

A bullectomy removes one or more very large bullae from the lungs. Bullae are larger air spaces that form when the walls of the air sacs are destroyed. These air spaces can become so large that they interfere with breathing.

Stents or small mesh tubes, can help release air trapped in the lungs or keep airways open. One-way endobronchial valves can be implanted in one of your bronchial tubes. These valves allow air to exit the damaged or diseased parts of the lung, but not to reenter.

Lung volume reduction surgery removes damaged tissue from the lungs and helps the lungs work better.

A lung transplant is a surgical procedure that removes a diseased lung and replaces it with a healthy lung. Lung transplants improve the quality of life and extend the lifespan for people with severe or advanced chronic lung conditions that do not respond to other treatments.

Chronic obstructive pulmonary disease has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active and slow the progress of the disease.

Consult your healthcare provider about a program that can help you understand COPD and interventions that can simplify managing the disease and enhance your quality of life. Over time, you may experience a sudden worsening of symptoms, known as a flare-up, which may occur if you come into contact with certain scents or inhale dust or fumes. Identifying what these triggers are can help you steer clear of them and prevent flare-ups.

Here are some recommendations for the daily management of COPD:

• If you have trouble eating enough because of symptoms such as shortness of breath and fatigue, you may not be getting all the calories and nutrients you need. This can make your symptoms worse and increase your risk for infections. Your doctor may suggest eating smaller meals more often throughout the day, resting before eating and taking vitamins or nutritional supplements. Eating a healthy diet that includes fresh fruits and vegetables, whole grains and fish may also help protect your lungs.
• You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness. Work with your care team to develop an exercise program that works for you.
• For ease and convenience, put items you use often in one easy-to-reach place. Find simple ways to cook, clean and do other chores. For example, you could use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.
• Ask for help to make things more accessible in your house so that you won’t need to climb stairs as often.
• Keep your clothes loose-fitting and wear clothes and shoes that are easy to put on and take off.
• Use your medicines as recommended. Make sure you are using the inhaler correctly. It is normal for patients to have problems with their inhaler, so don’t worry about asking your healthcare team multiple times how to use it. There are many different inhaler types, and the best type for you might change over time. Take your inhaler when you visit your healthcare provider so they can give you advice or see if you need a change.
• Stay indoors when air quality is poor and consider using an air purifier or filter. Air pollution can make it harder to breathe and worsen other symptoms of COPD. It can also lead to more flare-ups and make them worse. These threats to the health of people with COPD may grow as climate change increases the frequency of wildfires and periods of extreme heat.
• See a dentist regularly and brush your teeth often to maintain good oral health.
• If you experience heartburn, ask your provider to recommend ways to reduce it. Acid reflux can increase your risk of a flare-up.
• Stay away from lung irritants, including chemical fumes, dust, smoke from home cooking and heating fuels and secondhand smoke (fumes in the air from other people smoking).
• Check the air quality where you live, keep your windows closed and stay at home when there is a lot of air pollution or dust outside. Consider using an air purifier or filter, especially if wildfires are common where you live.
• Avoid being in regions where there are cold temperatures.
• Stay up to date with vaccines. This includes getting regular COVID-19, flu and pneumonia shots, when available, to help prevent infections. Infections can trigger flare-ups. The respiratory syncytial virus (RSV) vaccine is recommended if you are 60 years old or older and have COPD or if you are pregnant. Other vaccines recommended for certain groups are the tetanus, diphtheria and pertussis (Tdap) vaccine, which protects against whooping cough, as well as shingles shots.
• Seek emergency care if you have a severe flare-up.
• Keep phone numbers handy for your healthcare provider, your hospital and someone who can take you for medical care. You should also have directions to the provider’s office and hospital on hand, together with a list of all the medicines you are taking.