What Is COPD?

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe airflow obstruction that is associated mainly with emphysema and chronic bronchitis.

• Emphysema causes irreversible lung damage by weakening and destroying the air sacs within the lungs. As a result, elasticity of the lung tissue is lost, causing airways to collapse and obstruction of airflow to occur.

• Chronic Bronchitis associated with airflow obstruction is an inflammatory disease that begins in the smaller airways within the lungs and gradually advances to larger airways. It increases mucus in the airways and increases bacterial infections in the bronchial tubes, which, in turn, impedes airflow.

Back to the top

How Prevalent Is COPD?

COPD affects tens of millions of Americans:

• It has been estimated that six and a half million people have been diagnosed with some form of COPD and over 15 million more have been left undiagnosed.¹

• New government data based on a 1998 prevalence survey suggest that three million Americans have been diagnosed with emphysema and nine million were affected by chronic bronchitis.²

• COPD is the fourth-leading cause of death in the United States³

• COPD accounted for 112,584 deaths in 1998.³

• COPD accounted for an estimated 668,362 hospital discharges in 1998.⁴

Back to the top

What Are the Risk Factors for COPD?

Long-term smoking is the most frequent cause of COPD. It accounts for 80 to 90 percent of all cases. A smoker is 10 times more likely than a nonsmoker to die of COPD.

Other risk factors include:

• Heredity
• Secondhand smoke
• Exposure to air pollution at work and in the environment
• A history of childhood respiratory infections

Back to the top

What Are the Symptoms of COPD?

The symptoms of COPD include: chronic cough, chest tightness, shortness of breath, an increased effort to breathe, increased mucus production, and frequent clearing of the throat.⁵

Back to the top

How Does COPD Have an Impact on a Patient's Life?

COPD decreases the lungs' ability to take in oxygen and remove carbon dioxide. As the disease progresses, the walls of the lungs' small airways and alveoli lose their elasticity. The airway walls collapse, closing off some of the smaller air passages and narrowing larger ones. The air passages become clogged with mucus. Air continues to reach the alveoli when the lungs expand during inhalation; however, it is often unable to escape during exhalation because the air passages tend to collapse during exhalation, trapping the "stale" air in the lungs.

A typical course of COPD might begin after a person has been smoking for at least 10 years, during which time symptoms are usually not very noticeable. Then the patient begins developing a productive, chronic cough. Usually, after age 40 the patient may begin developing shortness of breath during exertion, which continues and worsens over time.⁵

Though the severity may vary, patients with COPD have some degree of airway obstruction. While symptoms may vary over time, the patient will notice a gradual deterioration over the course of four to five years. Repeated and increased productive coughing begins to disable patients, who over time take longer to recover from these attacks.⁵

For patients with COPD, the combination of too little oxygen and too much carbon dioxide in the blood may also have an impact on the brain, and can cause a variety of other health problems, including headache, sleeplessness, impaired mental ability and irritability.⁵

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (April 2001) recommend the classification of disease severity into four stages ⁵:

• Stage 0: At Risk—Chronic cough and sputum production. Lung function is normal, as measured by spirometry.⁵

• Stage I: Mild COPD—Mild airflow limitation (FEV₁/FVC < 70% but FEV₁ > 80% predicted) and usually, but not always, chronic cough and sputum production. At this stage, the individual may not be aware that his or her lung function is abnormal.⁵

• Stage II: Moderate COPD—Worsening airflow limitation (FEV₁/FVC < 70%;30% < 80% predicted [IIA:50% < FEV₁ < 80% predicted; IIB: 30% < FEV₁ < 50% predicted]) and usually the progression of symptoms, with shortness of breath typically developing on exertion. This is the stage at which patients typically seek medical attention because of dyspnea or an exacerbation of their disease. The division into stages IIA and IIB is based on the fact that exacerbations are especially seen in patients with FEV₁ below 50% predicted. The presence of repeated exacerbations has an impact on the quality of life of patients and requires appropriate management.⁵

• Stage III: Severe COPD—Severe airflow limitation (FEV₁/FVC < 70%;FEV₁ < 30% predicted) or the presence of respiratory failure or clinical signs of right heart failure. Patients may have severe (Stage III) COPD, even if FEV₁ is > 30% predicted, whenever these complications are present. At this stage, quality of life is appreciably impaired and exacerbations may be life-threatening.⁵

Back to the top

What Can Patients with COPD Do to Help Themselves Live as Normal a Life as Possible?

The best weapon against COPD is prevention: avoiding or quitting smoking. Avoiding smoking almost always prevents COPD from developing, and quitting smoking can slow the progression of the disease.

Pulmonary rehabilitation programs and medical treatment can be useful for certain patients with COPD. The key goal should be to improve physical endurance in order to overcome the conditions that cause shortness of breath and limit capacity for physical exercise and daily activities.⁵

Back to the top

What Are the Goals of COPD Care?

It is important to identify and treat COPD as early as possible in its natural history. Unfortunately, the diagnosis of COPD is frequently made when patients are in their late 50s or 60s, when FEV₁ has declined to a symptomatic range, and when quality of life is rapidly deteriorating.

Therefore, the goal of any physician treating patients with COPD is to help prevent and relieve their patients' symptoms and to help patients better manage the effects of their disease and live as full and active lives as possible.

If patients work closely with physicians to develop a complete respiratory care program, they can:

• Improve lung function
• Reduce hospitalizations
• Prevent acute episodes
• Minimize disability
• Prevent early death⁵

Back to the top

What Are the Key Components of COPD Care?

In addition to smoking cessation, depending upon the severity of the disease, treatment programs may include bronchodilators that open up air passages in the lungs, antibiotics, and exercise to strengthen muscles. People with COPD may eventually require supplemental oxygen and, in the end-stages of the disease, may have to rely on mechanical respiratory assistance.

1. Medications that are prescribed for people with COPD may include:
• Short-acting beta₂-agonists, such as albuterol, anticholinergic bronchodilators, and long-acting bronchodilators, which all help to open narrowed airways.


• Inhaled or oral corticosteroids, which help treat inflammation. Currently, the role of these anti-inflammatory medications is not well defined, and they are not yet approved for COPD in the United States; however, clinical trials are underway.


• Antibiotics, which are often given at the first sign of a respiratory infection to prevent further damage and infection in diseased lungs.⁵


• Expectorants, which help loosen and expel mucous secretions from the airways, and may help make breathing easier.

2. People with COPD can better manage their disease by:

Avoiding:

• Cigarettes, cigarette smoke, dust, air pollution, and work-related fumes.
• Contact with people who have respiratory infections, such as colds and flu.
• Excessive heat, cold, or high altitudes.⁵

Maintaining:

• A healthy diet and an exercise program supervised by a healthcare provider.
• Regular contact and visits with a healthcare provider so that he or she can carefully monitor the disease; this includes having regular spirometry tests.⁵

3. Additional treatment options for patients with COPD may include:
• Regular immunizations, such as for flu and pneumococcal pneumonia.
• Pulmonary rehabilitation, which can improve exercise tolerance.
• The use of supplemental oxygen, especially in patients in the later stages of COPD.
• Bullectomy, or surgical removal of large air spaces in the lungs.
• Lung volume reduction surgery, which is currently considered experimental.
• Lung transplantation, which also has proven effective in some end-stage patients with COPD.

Back to the top

Sources