COPD

What is COPD?

Chronic obstructive pulmonary disease (COPD) is a chronic lung condition that causes difficulty breathing.

COPD includes both chronic bronchitis and emphysema. A person with COPD can have one or both conditions.

Chronic bronchitis. Chronic bronchitis affects the passages that carry air to and from the lungs. It is characterized by a cough that produces phlegm or mucus. 

The condition develops when the bronchial tubes are consistently irritated. The body attempts to resolve the irritation by activating the immune system, which causes inflammation and constant mucus production. The swelling and mucus obstruct or block the airway, making it harder to breathe. 

Chronic bronchitis differs from acute or short-term bronchitis, which is caused by an infection and typically doesn’t last longer than several weeks.

Emphysema. Emphysema affects the lungs. It is characterized by shortness of breath. In its early stages, a person might only feel breathless after exercise or exertion. In later stages, a person might feel short of breath at rest.

With emphysema, the lungs lose their resilience or elasticity. It becomes more difficult to exhale air from the lungs, and the air becomes trapped in the alveoli (tiny air sacs located at the end of the bronchial tubes in the lungs).

What are the symptoms of COPD?

COPD symptoms develop slowly, often over many years. Symptoms will depend on whether the illness results from chronic bronchitis, emphysema, or both. In addition, there are some overlapping symptoms.

Symptoms of chronic bronchitis include:

●       Frequent coughing with mucus production

●       Wheezing (a whistling sound when taking a breath)

●       Shortness of breath, especially after physical activity

●       Tightness in the chest

Symptoms of emphysema include:

●       Shortness of breath, especially after physical activity

●       Breathlessness that continues to worsen as the disease progresses

●       Frequent cough

●       Fatigue

●       Tightness in the chest

●       Weight loss

How do you treat COPD?

There isn’t a cure for COPD, and any damage done to the lungs is permanent. However, medications can slow the disease’s progression and improve symptoms and quality of life. 

Bronchodilators. These medications widen or open the airways in the lungs, improving airflow. They are given through an inhaler or nebulizer. Bronchodilators can improve quality of life by increasing a person’s ability to participate in activities without becoming breathless. 

There are two main types of bronchodilator medications: beta-agonists and anticholinergic agents. 

Beta-agonists work like adrenaline—a natural hormone the body releases during a “fight or flight” reaction to stress. In people whose airways are constricted, these drugs relax the muscles of the airway walls that are causing the constriction. Short-acting beta-agonists provide quick relief and last for about six hours. Long-acting beta-agonists are taken one to two times per day and last for about 12 hours. Side effects of beta-agonists include anxiety, restlessness, headaches, and a fast heartbeat.

Anticholinergic agents reduce muscle contractions in the airways to make breathing easier. Short-acting anticholinergics begin working in about 15 minutes and last six to eight hours, while long-acting versions can last up to 24 hours. Side effects of anticholinergics include dryness in the throat, blurred vision, dry cough, and worsening of glaucoma. 

Corticosteroids. These drugs suppress inflammation of the airways. They can be taken through an inhaler, a nebulizer, or by mouth as a tablet. Corticosteroids may be used as a maintenance inhaler for people with COPD who do not get enough help from bronchodilators. They help reduce symptoms and the frequency and severity of flare-ups. Oral steroids, such as prednisone, are typically not prescribed for long-term use because of potential side effects. In the short-term, oral prednisone may be used to treat flare-ups or exacerbations of COPD.

Oxygen therapy. Oxygen therapy temporarily counters one of the main problems of lung disease—insufficient oxygen in the blood. In people with COPD whose oxygen level drops too low, oxygen therapy can be added to inhaled medications to help with breathing and prevent complications. In people with low oxygen levels, oxygen therapy is the only treatment that has been shown to prolong life.

Surgery. People with severe COPD who have trouble breathing despite other treatments may consider surgery. The main types of surgery for emphysema are lung volume reduction surgery, bullectomy (removal of large holes called bullae), and lung transplantation.

What is pulmonary rehabilitation for COPD?

Pulmonary rehabilitation for COPD can improve quality of life and exercise tolerance and can potentially reduce hospital stays.

Pulmonary rehab for COPD is usually an outpatient program that lasts about six weeks, with two to three weekly sessions. Inpatient therapy might be done daily. It combines medically supervised therapies that include the following: 

• Exercise therapy
• Breathing retraining
• Training of muscles that support breathing
• Chest physiotherapy (to help clear mucus from the airways)
• Nutritional counseling
• Strategies to conserve energy
• Occupational therapy to help you better complete daily activities
• Psychological support for living with COPD