Introduction:

Chronic obstructive pulmonary disease (COPD) is the term used to describe chronic lung conditions that cause severe shortness of breath and obstruct the airways in your lungs. Usually it refers to chronic bronchitis or emphysema, but can also encompass asthmatic bronchitis (bronchial asthma). All of these diseases cause the air sacs and tubes in your lungs to become blocked.

With chronic bronchitis, a constant cough that produces mucus causes bronchial tubes to become inflamed and, eventually, scar tissue to form in the lungs, which doesn't allow in as much oxygen as you need. With emphysema, the walls of your lungs lose their elasticity – they can't compact to allow you to exhale. People with COPD can have either or both of these diseases.

The main risk factor for COPD is smoking. There is no cure for COPD, and while treatments may help control symptoms, they can't undo the damage to the lungs. The most important thing you can do to prevent COPD or to stop the damage from getting worse if you have it is not to smoke.

Signs and Symptoms:

• Ongoing cough, often with phlegm that may be hard to "bring up"
• Shortness of breath, especially during exercise
• Production of increased mucus
• Difficulty exhaling
• Wheezing
• Frequent respiratory infections

Causes

Smoking is the No. 1 cause of COPD. It can also be caused by exposure to pollutants or toxic chemicals. One rare form is inherited (see Risk Factors).

Risk Factors:

• Smoking — the longer you smoke and the more packs of cigarettes you smoke, the higher your risk. People who smoke pipes and cigars, and those who are exposed to large amounts of second-hand smoke, also have greater risk
• Genetics — people with a a rare hereditary disorder called alpha-1 anti-trypsin deficiency lack an enzyme that normally helps protect the lungs from damage
• Being over age 50
• Exposure to toxic chemicals such as silica or cadmium
• Working around industrial smoke, excessive dust, or other air pollutants (for example, miners, furnace workers, and grain farmers)

Diagnosis:

Your doctor will listen to your chest for wheezes and decreased breath sounds. He or she will also look for signs of that you are having trouble breathing, like flaring of your nostrils and contracting of the muscles between your ribs. Your respiratory rate (number of breaths per minute) may be elevated.

Your doctor may order tests to determine your lung function. The most common such test is spirometery, where you'll be asked to blow into a tube connected to a machine called a spirometer. The spirometer measures how much air you have in your lungs, and can help detect COPD before your symptoms become obvious.

Your doctor may also order a chest X ray will to look for over-expanded (hyperinflated) areas in the lungs; a CT scan to check the severity of your COPD; an examination of your sputum; or a blood test to measure the levels of oxygen and carbon dioxide in your blood.

Preventive Care:

• If you smoke, quit.
• If you have COPD, avoiding respiratory infections is very important. Your doctor will recommend that you receive an influenza vaccine (flu shot) each year and a pneumococcal vaccine to protect you from pneumonia.
• Eating foods rich in antioxidants, magnesium and other minerals, and omega-3 fatty acids (including fruits, vegetables, and fish) may help lower your risk for COPD.

Treatment Approach:

Not smoking is the key to preventing COPD or stopping it from getting worse. Treatment varies depending on the severity of the disease. Your doctor may talk with you about lifestyle changes you can make to help relieve the symptoms of COPD, such as exercising and eating a healthy diet. Support groups or therapy (see Mind/Body Medicine) can help make it easier to live with the condition.

Lifestyle

Quitting smoking is crucial. Other lifestyle measures you can take include dietary changes and exercise as described below.

Diet

People with COPD often lack essential nutrients in their bodies. Low levels of antioxidants and certain minerals including vitamins A, C, and E, potassium, magnesium, selenium, and zinc are associated with having COPD and may contribute to poor lung function. Eating lots of fruits, vegetables, and whole grains is recommended to get the nutrients you need.

Exercise

Although it may seem odd to recommend exercise when you have trouble breathing, exercise does in fact help many people with COPD. By strengthening your legs and arms and improving endurance, you may be able to breathe better. Walking, for example, is a good exercise to build endurance. Talk to your doctor and/or respiratory therapist about how to build up slowly and safely. Attending a comprehensive pulmonary rehabilitation is the best way to learn exercise and safe breathing techniques (see below).

Breathing

There are breathing exercises (for example, a pursed lip technique, breathing from the diaphragm, or using a breathing device called a spirometer twice a day) that may help improve lung function. You can also learn which breathing and relaxation techniques work best when you are short of breath. Talk to your doctor about working with a respiratory therapist in order to learn such exercises.

Medications

There are several types of medications used to control symptoms.

Bronchodilators — increase airflow by opening airways and help make it easier to breathe

Corticosteroids — reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe COPD

Leukotriene modifiers — help prevent inflammation and swelling in airways, and reduce mucus

Antibiotics — used to treat respiratory infections

Surgery and Other Procedures

When flare-ups are severe, requiring hospitalization, you may need supplemental oxygen. At later stages of the disease, many people with COPD need continuous oxygen at home.

Lung reduction surgery, in which a surgeon removes damaged parts of your lung to create more space for remaining lung tissue to work better, and lung transplant is sometimes performed for severe cases of COPD.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

• N-acetylecysteine (NAC, 400 to 1,200 mg per day) — NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies using it to treat COPD indicate that it may help relieve symptoms by acting as an antioxidant to reduce oxidative stress on the lungs (damage caused by free radicals, particles that harm cells and DNA). Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis.
• Magnesium — People with COPD often have low levels of magnesium. Magnesium deficiency may be associated with poor nutrition (often a problem for people with COPD), or it may be caused by some drugs taken to manage COPD. Magnesium is important for normal lung function, and one study found that giving intravenous (IV) magnesium to people who were having an acute flare-up of COPD helped them breathe easier and reduce the number of days they spent in the hospital. It isn’t known, however, whether taking magnesium orally would have the same effect. Your doctor may recommend checking your magnesium level through (a simple blood test) if you have COPD and taking magnesium supplements if your levels are low. Magnesium can lower blood pressure and cause diarrhea. Talk to your doctor before taking magnesium supplements.
• L-carnitine — A few studies suggest that L-carnitine may help people with COPD increase their exercise tolerance.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine. Also, be sure to talk to your physician about any herbs that you are taking or considering taking.

• Eucalyptus (Eucalyptus globulus) — is frequently used in cough drops and acts as an expectorant, which means that it loosens phlegm in your lungs. A combination of eucalyptus, a kind of citrus oil, and an extract from pine (called essential oil monoterpenes) has been studied for respiratory problems. In one study, essential oil monoterpenes appeared to help prevent acute flare-ups of chronic bronchitis.
• Ginseng (Panax ginseng, 100 mg per day) — One study suggested that taking ginseng helped people with COPD improve their exercise tolerance and lung function, but more studies are needed to see if there is any real benefit.
• Lobelia (Lobelia inflata) — Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.
• Mullein (Verbascum densiflorum, 3 g per day) — Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for COPD.

Acupuncture

Preliminary studies suggest that acupuncture may help relieve shortness of breath in those with COPD. More research is needed.

If you are trying to quit smoking, acupuncture can help you break the habit.

Mind/Body Medicine

• COPD is a difficult disease to live with, and joining a support group where members share common experiences and problems can help relieve stress of the disease.
• Yoga and tai chi use deep breathing techniques and meditation, and may be helpful for someone with COPD. Talk to your doctor to see whether they are right for you.
• Relaxation techniques may help reduce anxiety and shortness of breath associated with COPD.

Other Considerations:

If you have COPD, you are prone to respiratory infections. Your health care provider will most likely tell you to get a flu shot every year and a pneumococcal vaccine once in your lifetime.

Prognosis and Complications

COPD is considered a chronic illness. Whatever damage there is to your lungs will not improve. If you stop smoking, the damage is likely to not get worse. If you continue to smoke, however, your lungs and lung function will continue to deteriorate.

Potential complications of COPD include:

• Abnormally high pressure in the lungs called pulmonary hypertension
• Enlargement of the heart and heart failure, leading to excessive fluid and weight gain
• Abnormal rhythms of the heart
• Dependence on mechanical ventilation (a respirator) and/or oxygen therapy
• Pneumothorax (collapsing of part of the lung due to air leaking from the lung)
• Pneumonia and other infections
• Eventually, weight loss and wasting can occur

Alternative Names:

Chronic bronchitis; COPD; Emphysema