Symptoms and treatment of COPD

Description

Chronic obstructive pulmonary disease (COPD) is a course of a lung condition caused by damage to the lungs. The damage results in inflammation and irritation, also called inflammation, in the interior of the airways that limits the flow of air into and out of the lungs. This limits the flow of air is known as the obstruction. The symptoms include shortness of breath, a chronic cough that brings up mucus and a tight, wheezing in the lungs, called wheezing.

COPD is most often caused by prolonged exposure to irritants, fumes, gases, dust or chemicals. The most common cause is cigarette smoke.

Emphysema and chronic bronchitis are the two most common types of COPD. These two conditions often occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is the inflammation of the lining of tubes that carry air to the lungs. These tubes called bronchi. The swelling prevents a good flow of air into and out of the lungs and produces more mucus. In emphysema, the tiny air sacs of the lungs, called alveoli, are damaged. The alveoli are damaged and not able to spend enough oxygen in the bloodstream.

Although COPD is a condition that can worsen over time, COPD is a treatable disease. With proper management, most people with COPD can control the symptoms and improve your quality of life. Proper management can also reduce the risk of other conditions associated with COPD, such as heart disease and lung cancer.

Symptoms

COPD symptoms often don't appear until much lung damage has occurred. The symptoms tend to worsen with time, particularly if smoking or other irritants of the exposure continues.

The symptoms of COPD may include:

Shortness of breath, especially during physical activities.
Wheezing or whistling in the chest when breathing.
A persistent cough that may bring a lot of mucus. The mucus may be clear, white, yellow, or greenish.
Tightness in the chest or a feeling of heaviness.
Lack of energy or feeling very tired.
Frequent lung infections.
Losing weight without meaning. This can occur as the condition worsens.
Swelling in the ankles, feet, or legs.

People with COPD are also likely to be times when your symptoms get worse to the usual day-to-day variation. This time of worsening of symptoms is called a flare (eg-zas-er-bay-shun). Exacerbations can last from several days to weeks. They can be caused by triggers such as smells, cold air, air pollution, colds or infections. Symptoms may include:

Working harder than usual to breathe or is having trouble breathing.
Tightness in the chest.
Cough more often.
More mucus, or changes in color of the mucus or thick.
Fever.

When to see a doctor

Talk with your doctor or other health care professional if your symptoms do not improve with treatment, or if symptoms worsen. Also talk with your health care professional if you experience symptoms of an infection, such as fever or a change in the mucus when coughing.

In the united states, call 911 or the local emergency number for help, or go to the emergency room of a hospital right away if you can't catch your breath, your lips or nail beds are blue, have a fast heartbeat, or feel fog and have trouble concentrating.

Causes

The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to smoke from burning fuel for cooking and heating in homes that do not have good air circulation. Long-term exposure to toxic gases, vapors and dusts in the workplace is another of the causes of COPD.

Not all people who have smoked for a long time they have symptoms of COPD, but you can still have damage in the lung, so that your lungs don't work as well as before. Some of the people who smoke are less common lung conditions that can be diagnosed with COPD until a more thorough examination shows a diagnosis.

How the lungs are affected

The air travels through the trachea, or windpipe, called the windpipe and into the lungs through two large tubes called bronchi. In the interior of the lungs, these pipes are divided many times as the branches of a tree. Many smaller tubes called bronchioles end in clusters of tiny air sacs called alveoli.

The alveoli have very thin walls full of tiny blood vessels. The oxygen in the inhaled air passes into these blood vessels and enters the bloodstream. At the same time, the carbon dioxide, a gas that is a waste product of the body, passes into the alveoli and is breathed out.

On the exhale, the natural elasticity of the alveoli of the forces of air, allowing the new air. This elasticity is also called elasticity.

Causes of airway obstruction

Long-term exposure to irritants, such as smoking damages the lungs. This damage prevents the air to move in and out of the lungs freely, which limits their ability to provide oxygen to the bloodstream and carry carbon dioxide. The two main conditions that prevent the efficient flow of air in the lungs are:

Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. The damaged interior of the walls of the alveoli can be destroyed, thus creating a large space of air that is difficult to vacuum in comparison with the many healthy little ones. The alveoli now have less surface area that can be used for the exchange of oxygen and carbon dioxide. Also, the age of air is trapped in the large alveoli so that there is not enough room for fresh air to enter.
Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed. As a result, the tubes are thick, which makes less space for the air to pass through. More mucus than normal caused by the irritation of the blocks of the narrowing of the tubes, even more. A continuous cough of the results of trying to clear the mucus from the airways.

Cigarette smoke and other irritants.

In the vast majority of people with COPD in the united States, the damage to the lungs that leads to COPD is caused by long-term cigarette smoking. But there are other factors at play in the development of COPD, because not everyone who smokes gets COPD. One of these factors can be changes in the genes that make some people more prone to develop the disease.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution, and occupational exposure to dust, fumes, or vapors.

The alpha-1-antitrypsin

In approximately 1% of people with COPD, the condition results from a change in the gene hereditary. This is a genetic form of emphysema. This gene decreases the levels of a protein called alpha-1-antitrypsin (AAT) in the body. The AAT is produced in the liver and is released into the bloodstream to help protect the lungs from damage caused by smoke, fumes, and dust.

Low levels of this protein, a condition called alpha-1-antitrypsin (AAT) deficiency, can cause damage to the liver, lung diseases, such as COPD or both. With AAT deficiency, there is usually a family history of COPD, and symptoms begin at a younger age.

Risk factors

Risk factors for COPD include:

The smoke of the tobacco. The biggest risk factor for COPD is long-term consumption of tobacco. The smoke and the more packs of smoke, the greater your risk. Pipe, cigar, and marijuana smoking can also increase your risk. People who inhale large quantities of second-hand smoke are at risk of COPD too.
Asthma. Asthma is a condition in which your airways narrow and swell and produce more mucus than normal. Asthma may be a risk factor for the development of COPD. The mixture of asthma, and smoking increases the risk of COPD even more.
Exposure in the workplace. Long-term exposure to toxic gases, smoke, fumes and dusts in the workplace can irritate and cause inflammation in the lungs. This can increase the risk of COPD.
The fumes from the combustion of fuel. In the developing world, people exposed to smoke from burning fuel for cooking and heating in households with poor air circulation are at increased risk of COPD.
Genetics. AAT deficiency caused by a change in the gene inherited is the cause of COPD in some people. This genetic form of emphysema is not common. Other genetic factors can make sure that people who smoke more likely to get COPD.

Complications

COPD can cause many complications, including:

Infections of the respiratory tract. People with COPD are more prone to colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and can cause more damage to the lung tissue.
The problems of the heart. For reasons that are not fully understood, COPD can increase your risk of heart disease, including heart attack.
The lung cancer. People with COPD have a higher risk of getting lung cancer.
High blood pressure in the arteries of the lung. COPD can cause high blood pressure in the arteries that carry blood to the lungs. This condition is called pulmonary hypertension.
The anxiety and depression. Difficulty breathing can keep you from doing activities that you enjoy. And have a serious medical condition, such as COPD can sometimes cause anxiety and depression.

Prevention

Unlike some other medical conditions, COPD often has a clear cause and a clear path to avoid it. Most of the time, COPD is directly linked to cigarette smoking. The best way to prevent COPD is to never smoke. If you smoke and have COPD, stopping now you can slow down how quickly the condition worsens.

If you have smoked for a long time, quitting smoking can be difficult, especially if you've tried to quit once, twice, or many times before. But I'm trying to quit smoking. It is critical to find a tobacco cessation program that can help you stop smoking forever. It is your best chance to reduce damage to the lungs. Talk with your health care professional about the options that might work best for you.

Workplace exposure to toxic gases, vapours and dust is another risk factor for COPD. If you work with these types of cancer are lung irritants, talk with your supervisor about the best ways to protect yourself. This may include the use of equipment that prevents you from breathing in these chemicals.

Here are some steps you can take to help prevent the complications associated with COPD:

Quit smoking to help reduce your risk of heart disease and lung cancer.
Get an annual flu vaccination and the vaccination against pneumococcal pneumonia to reduce the risk or prevent some infections. Also talk with your doctor or other health care professional about when you need the COVID-19 vaccine and the vaccine for RSV.
Talk with your health care professional or a mental health professional if you are feeling sad or hopeless, or you think you may have depression.

Diagnosis

Often, COPD can be difficult to diagnose because the symptoms can be the same as those of other lung conditions. Many people who have COPD may not be diagnosed until the disease is advanced.

To diagnose your condition, your health care professional of the comments of his symptoms and asked about their medical and family history and any exposure that I've had that irritating lung — especially cigarette smoke. Your health care professional performs a physical exam that includes listening to your lungs. You also can have some of these tests to diagnose your condition: pulmonary function tests, laboratory tests and imaging.

Pulmonary function tests

Pulmonary function tests are done to find out how well your lungs are working. These tests may include:

Spirometry. In this test, you breathe quickly and with force through a tube connected to a machine. The machine measures the amount of air that the lungs can hold and how fast air moves in and out of the lungs. Spirometry diagnosis of COPD and tells you the amount of air flow is limited.
The volume of the test lung. This test measures the amount of air the lungs hold at different times when breathing in and out.
Lung diffusion test. This test shows how well the body moves oxygen and carbon dioxide between the lungs and the blood.
Pulse oximetry. This simple test uses a small device placed on one of your fingers to measure the amount of oxygen in your blood. The percentage of oxygen in the blood is called the oxygen saturation. You can also have a six-minute walk test with a check of oxygen saturation.
Exercise stress test. An exercise test on a treadmill or stationary bike can be used to control the heart and lung function during the activity.

Images

X-ray of the chest. A chest x-ray may show some of the changes in the lung of COPD. X-rays can also rule out other lung problems or heart failure.
Computed tomography. A ct scan combines X-ray images taken from different angles to create images of the internal structures of the body. A ct scan gives much more detail of the changes in the lungs of an x-ray of the chest is done. A ct scan of the lungs can show emphysema and chronic bronchitis. The CT scan also can help determine if you may benefit from surgery for COPD. The ct scan can be used to check for lung cancer.

Pulmonary function and imaging tests may also be used to check your condition over time and see how the treatments are working.

Laboratory tests

Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into the blood and remove carbon dioxide.
Testing for AAT deficiency. Blood tests can determine if you have the genetic condition called alpha-1-antitrypsin.
Blood tests. Blood tests are not used to diagnose COPD, but it can be used to find the cause of your symptoms or to rule out other conditions.

Treatment

The treatment is based on the severity of the symptoms and if you often have periods of worsening of the symptoms. These battles are called exacerbations. Effective therapy can control the symptoms, slow down how quickly the condition worsens, decrease the risk of complications and improve their ability to lead an active life.

Stop smoking

The most essential step in any treatment plan for COPD is to stop smoking. Quitting smoking can keep COPD from getting worse and making it harder to breathe. But quitting smoking is not easy, especially if you've tried to quit and I have not had success.

Talk with your healthcare provider about smoking cessation programs, nicotine replacement products and medications that could help. They also talk about how to handle relapses. Your health care professional may recommend a support group for people who want to quit smoking. In addition, stay away from secondhand smoke whenever possible.

Medications

Several types of medications are used to treat the symptoms and complications of COPD. You can take some medications on a regular basis and others as needed.

Most of the medications for COPD are given using an inhaler. This small hand-held device, it delivers the medication directly to the lungs when you inhale the fine mist or dust. Talk with your health care professional so that you know the correct way to use the inhaler as prescribed.

The medicine can also be given through a nebulizer. This small machine has a mask or mouthpiece, and a hose connected to a round of the cup of the liquid medicine. The nebulizer changes liquid medicine into a mist so that it can be inhaled into the lungs. Nebulizers also help loosen the mucus. You can be one of these types of nebulizers:

Compressor or nebulizer jet of the air force through the medicine to create fog.
Ultrasonic nebulizers high-frequency vibrations to create fog.
Mesh or membrane nebulizers push the medication through a mesh cap with small holes to create fog.

Bronchodilators

Bronchodilators are drugs that usually come in inhalers. Bronchodilators relax the muscles around the airways. This may help to relieve the cough and make breathing easier. Depending on the severity of the COPD, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both.

Examples of short-acting bronchodilators are:

Albuterol (ProAir, Ventolin, Proventil).
Ipratropium (Atrovent).
Levalbuterol (Xopenex).

An example of a short-acting bronchodilator combination inhaler ipratropium bromide-albuterol (Combivent Respimat).

Inhaled steroids

Inhaled corticosteroids, often simply called steroids, can reduce airway inflammation and help prevent attacks when COPD symptoms get worse. Side effects of inhaled steroids may include bruising, infections of the mouth and hoarseness. These medications are useful if you often have times when COPD symptoms get worse.

The combination of inhalers

Any combination of inhalants include more than one type of bronchodilator. Examples of these include:

Aclidinium bromide / formoterol fumarate (Duaklir Pressair).
Glycopyrrolate-formoterol fumarate (Bevespi Aerosphere).
Bromide tiotropium-olodaterol (Stiolto Respimat).
Umeclidinium-vilanterol (Anoro Ellipta).

Other inhalers combine bronchodilators and inhaled steroids. Examples include:

Budesonide-glycopyrrolate-formoterol fumarate (Breztri Aerosphere).
Fluticasone-vilanterol (Breo Ellipta).
Fluticasone furoate-umeclidinium-vilanterol (Trelegy Ellipta).
Budesonide-formoterol (Breyna, Symbicort).
Fluticasone propionate-salmeterol (Advair, AirDuo RespiClick, Wixela Inhub).

Oral steroids

For the moments in which the COPD symptoms get worse, short courses of oral corticosteroids — for example, from 3 to 5 days — you can prevent further worsening of COPD. Oral corticosteroids are medicines that are taken by mouth. The long-term use of these oral medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

Phosphodiesterase-4 inhibitors

A drug approved for severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include nausea, diarrhea, and weight loss. Roflumilast is used to prevent exacerbations and reduce how often they occur.

Theophylline

When other treatments have not been effective or if cost is a factor, theophylline (Elixophyllin, Theo-24, Theochron), a less expensive medicine, can help to ease breathing and prevent episodes of worsening of symptoms. The side effects depend on the dose and may include nausea, and difficulty sleeping. Blood tests are commonly used to monitor the blood levels of theophylline. Irregular heartbeat, and seizures are possible if the level in the blood is too high.

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can make the symptoms of COPD worse. Antibiotics can help treat these episodes of worsening of the symptoms of COPD, but are generally not recommended in order to prevent infections. Some studies show that certain antibiotics, such as azithromycin (Zithromax), help to prevent exacerbations of COPD. But the side effects and antibiotic resistance may limit its use.

Therapies

Oxygen therapy, a program of pulmonary rehabilitation and in-home non-invasive ventilation therapy can help treat COPD.

Oxygen therapy

If there is not enough oxygen in your blood, you may need supplemental oxygen. You can get this extra oxygen to the lungs through a mask or through a plastic tube with prongs that fit on your nose. These are attached to an oxygen tank. Lightweight, portable units that you can take with you can help you be more mobile.

Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve the quality of life and prolong life. Talk with your health care professional about your needs for oxygen and treatment options.

Pulmonary rehabilitation program

These programs usually combine health education, physical exercise, breathing techniques, nutrition, counselling and guidance. It works with a variety of specialists that can tailor your rehabilitation program to meet your needs.

The pulmonary rehabilitation after episodes of worsening of symptoms can decrease the likelihood that you'll have to go back into the hospital. Pulmonary rehabilitation also allows you to participate more fully in daily activities, and improve their quality of life. Talk with your health care professional about attending a program.

In the home of non-invasive ventilation therapy

This therapy can prevent episodes of worsening of symptoms for some people with severe COPD. The investigation is ongoing to determine the best ways to use this therapy in the home.

The evidence supports in the hospital the use of breathing devices, such as bilevel positive airway pressure (BiPAP). BiPAP may help some people with COPD if they are used in the home during the night. A non-invasive ventilation therapy machine is connected to a mask over the mouth and nose. BiPAP helps make breathing easier and can decrease the chance of going back in the hospital. It also reduces how much carbon dioxide is left behind in your lungs when you exhale. Too much carbon dioxide can lead to acute respiratory failure and the need of being in the hospital.

The management of episodes of worsening of symptoms

Even with the ongoing treatment, you may have times when the symptoms get worse over days or weeks. These are the so-called exacerbations, and that can lead to lung failure if you don't receive treatment right away.

Exacerbations can be caused by a respiratory infection, air pollution or other triggers that worsen the irritation and inflammation in the lungs. Whatever the cause, it is important that you get medical help right away if you experience a cough that seems worse than usual, or a change in the mucus when you cough, or have difficulty breathing.

When exacerbations occur, you may need medications, such as antibiotics, steroids, or both; supplemental oxygen; or the treatment in the hospital. Once symptoms improve, your healthcare provider may talk with you about ways to prevent episodes of worsening of symptoms in the future. You may need to quit; to take inhaled steroids, long-acting bronchodilators or other drugs; get your annual flu vaccine; and avoid contamination of the air whenever possible.

Surgery

Surgery is an option for some people with some types of severe emphysema who are not helped enough by medications alone. Surgical options include:

The surgical reduction of lung volume. In this surgery, the surgeon removes small portions of lung tissue damaged in the upper part of the lungs. This creates an extra space in the chest, so that the more healthy lung tissue, which continues to expand and the muscles that aid in breathing, called the diaphragm, it may work better. In some people, this type of surgery can improve the quality of life and help them live longer.
Endoscopic reduction of lung volume. Also called valve surgery endobronchial, this is a minimally invasive procedure for the treatment of people with COPD. A small one-way endobronchial valve is placed in the lung. The air can come out of the damaged part of the lung through the valve, but not the air that enters. This allows the majority of the damage to the lobe to decrease so that the healthy part of the lung that has more space to expand and function.
Lung transplant. A lung transplant may be an option for some people who meet specific criteria. The substitution of a lung can make breathing easier and to allow for a more active lifestyle. But it is a major surgery that has significant risks, such as the rejection of organs. A lung transplant is required to take lifelong medication that weakens the immune system.
Bullectomy. Large air spaces called bullae are formed in the lungs when the inside walls of the alveoli are destroyed. This leaves a large air sac instead of a cluster of many small ones. These bullae can become very large and cause breathing problems because of the old air is trapped and there is space for a new air. In a bullectomy, the surgeon removes the bullae of the lung to help improve the flow of air.

The alpha-1-antitrypsin

For adults with COPD associated with AAT deficiency, the treatment options include those used for people with more common types of COPD. Some people can be treated also a replacement for the lack of the protein AAT. This can prevent further damage to the lungs.

Lifestyle and home remedies

If you have COPD, you can take steps to feel better and slow the damage to your lungs:

Control your breathing. Talk with your health care professional or respiratory therapist about methods to breathing more efficiently throughout the day. We also talk about the positions that make breathing easier; methods to save energy, such as sitting for the tasks when possible; and ways to relax when you have difficulty breathing.
To clear the airways. With COPD, the mucus to accumulate in the air passages and can be difficult to remove. Remove mucus with cough controlled, drink lots of water and using a humidifier can help.
Get regular physical activity. It may seem difficult to be active when you have trouble breathing. But the physical activity and exercise can improve your strength and endurance and strengthen the muscles used for breathing. Talk with your health care professional about what activities are best for you.
Eat healthy foods. Eating healthy foods can help maintain your strength. If you're underweight, your health care professional may recommend nutritional supplements. If you are overweight, losing weight can be of great help to breath, especially during physical activities.
Avoid the smoke and poor air quality. In addition to quitting smoking, it is important to avoid places where others smoke. The second-hand smoke can add to lung damage. The pollution of the air also can irritate the lungs, so check the daily air quality forecasts before you leave. Identify what may trigger episodes of worsening of the symptoms so that you can avoid as much as possible.
Consult your health care professional regularly. Keep your appointment schedule, even if you feel well. It is important to regularly monitor the function of their lungs. And be sure to get your annual flu vaccine in the fall to help prevent infections that can worsen your COPD. Ask your health care professional about when to get the pneumococcal vaccine, COVID-19 vaccine and vaccine for RSV. Call your health care professional if your symptoms get worse or if you notice symptoms of infection.

Coping and support

Living with COPD can be challenging, especially when it becomes severe and more difficult to recover the breath. You may have to forego some of the activities you used to enjoy. Your family and your friends find they need to adjust some of these changes as well.

Can help you share your feelings with your family, friends, health professional or mental health professional. You may benefit from counseling or medication if you feel depressed or overwhelmed. Think about joining a support group for people with COPD.

Preparing for your appointment

If your primary healthcare professional thinks that you have COPD, it probably refers to a doctor who specializes in diseases of the lungs, called a pulmonologist.

What you can do

You might want to take a friend or family member with you to the appointment to help you remember information.

Before your appointment, make a list of:

The symptoms you are experiencing and when it started. Include anything that makes your symptoms worse or better.
All the drugs, vitamins, herbs and supplements that you take. Include the dose.
The history of the family, as if someone in your family has COPD.
The treatment that you have had for COPD, if any. Include what the treatment was and if it helped.
Other medical conditions you may have, and their treatments.
If you smoke or have ever smoked.
Questions to ask your health care professional.

Questions may include:

What is likely causing my symptoms?
What kinds of tests do I need?
What treatment do you recommend it?
I have other health conditions. How will the COPD affects them?
Are there any restrictions that I need to follow?

Feel free to ask questions during your appointment.

What to expect from your doctor

Your health care professional may ask you questions, such as:

How long have you had a cough?
Do you find it difficult to recover the breath, even with little or no activity?
Have you noticed any wheezing?
Do you now or have you ever smoked cigarettes? If you smoke, would you like help to stop smoking?

Be prepared to answer questions that you have time to talk about what's most important to you.