Chronic obstructive pulmonary disease

COPD; Chronic obstructive airway disease; Chronic obstructive lung disease; Emphysema; Chronic bronchitis

The leading cause of COPD is smoking. Between 15 - 20% of long-term smokers will develop COPD. Using tobacco for a long time causes lung inflammation and destroys air sacs in the lungs. (In rare cases, non-smokers who lack a protein called alpha-1 anti-trypsin can develop emphysema.)

Other risk factors for COPD are:

• Exposure to certain gases or fumes in the workplace
• Exposure to heavy amounts of secondhand smoke and pollution
• Frequent use of cooking gas without proper ventilation

• Cough
• Decreased exercise tolerance
• Shortness of breath (dyspnea) lasting for months to years
• Wheezing

Some people, even those with severe COPD, have few or no symptoms.

People with COPD may make wheezy air sounds, difficult-to-hear air sounds, or normal sounds when the doctor listens to them during an exam. In severe cases, a person with COPD can seem anxious and may breathe through pursed lips (the shape lips make when you whistle).

During a flare of the disease, the muscles between the ribs contract while the person is breathing in (intercostal retraction) and the person will use other muscles to breathe. The number of breaths per minute (respiratory rate) may be high.

A chest x-ray may show that the lung is expanding too much (hyperinflation). A chest CT scan may show emphysema.

A sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis). The best test for COPD is lung function testing.

Treatment for COPD includes inhalers that open the airways (bronchodilators) and sometimes theophylline. Patients with COPD must stop smoking. In some cases inhaled steroids are used to reduce lung inflammation. In severe cases or flare-ups, the health care provider may prescribe steroids through a vein (intravenous) or by mouth (oral).

Antibiotics are used during flare-ups of symptoms, because infections can make COPD worse. Some people may need chronic, low-flow oxygen, non-invasive ventilation, or a tube to get oxygen (intubation). Surgery to remove parts of the diseased lung may be helpful for some patients with COPD.

Lung rehabilitation does not cure the lung disease, but it teaches a patient to breathe in a different way so they can stay active.

Lung transplant is sometimes performed for severe cases.

This condition is a long-term (chronic) illness. The disease will get worse if patients keep using tobacco.

• Arrhythmias
• Need for breathing machine and oxygen therapy
• Pneumonia
• Pneumothorax
• Right-sided heart failure or cor pulmonale (enlargement of the heart and heart failure from chronic lung disease)

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath or if you develop complications.

Not smoking prevents most COPD. In people who smoke, finding and treating small airway disease and taking part in stop-smoking programs may prevent the disease from getting worse.

Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007.