What Is Chronic Obstructive Pulmonary Disease (COPD)?

At a glance:

  • COPD is a chronic condition that leads to inflammation of the tissues of the lungs and obstructed airflow
  • COPD is an umbrella term for a number of conditions including emphysema and chronic bronchitis
  • According to Lung Foundation Australia, around one in seven people in AUstralia over 40 have COPD
  • Chronic Obstructive Pulmonary Disease is the second most common cause of avoidable hospitalisation in Australia
  • Common symptoms include shortness of breath, a chronic cough increased production of phlegm and fatigue
  • COPD is a progressive disease, meaning that it worsens over time, and is currently incurable

What is COPD?

Chronic Obstructive Pulmonary Disease is a chronic (long term) condition causing inflammation in the tissues of the lungs that leads to obstructed airflow. Rather than being a single disease, COPD is an umbrella term for a number of conditions that lead to inflammation of the lungs, including emphysema and chronic bronchitis.

The lungs are two lobes of spongy tissue in the chest and are contained and protected by the ribcage. Air travels down the trachea into a pair of tubes known as bronchi. Each of these tubes services a lobe of the lungs. The bronchi divide into smaller tubes called bronchioles and divide further and terminate in tiny air sacs known as alveoli.

In a normally functioning lung, the alveoli exchange oxygen and carbon dioxide (gas exchange) with the bloodstream through a number of miniscule capillaries. The oxygenated blood is pumped around the body and the carbon dioxide is exhaled.

The alveoli and bronchial tubes have a natural elasticity that helps expel the air in the lungs, but the inflammation of COPD causes these tissues to lose some of this elasticity. This means that some of the carbon dioxide laden air remains left in the lungs, reducing lung capacity.

According to Lung Foundation Australia, Chronic Obstructive Pulmonary Disease is a very common condition in Australia, with around one in seven people over 40 having some form of COPD. Aboriginal and Torres Strait Islander Australians are over two times more likely to develop COPD than any other group. COPD is the second leading cause of avoidable hospitalisation in Australia.

COPD is a progressive disease, meaning that it worsens over time and is currently incurable. With lifestyle change and other management, COPD symptoms can be controlled and people with the condition can experience good quality of life.

Symptoms of Chronic Obstructive Pulmonary Disease

The initial symptoms of COPD typically come on gradually over a number of years and may be overlooked as being a factor of aging or being out of shape. In some cases the symptoms won’t be notable until the lung damage has become quite significant.

Common symptoms of COPD include:

  • Shortness of breath and difficulty breathing
  • A chronic cough that doesn’t go away
  • Phlegm - increased production of mucus and thick, often white or brown phlegm
  • Fatigue
  • Chest infections - increased frequency of chest infections and an increased recovery period for chest infections and colds
  • Wheezing
  • Tightness in the chest or chest pain
  • Swollen ankles, feet or legs
  • Weight loss (in the later stages of COPD)
  • Cyanosis - a bluish tinge to the skin and lips due to a lack of oxygen. Medical care should immediately be sought if this occurs

In addition to ongoing symptoms, people living with COPD may experience flare ups or exacerbations of symptoms. These worsened symptoms may last for a period of several days before returning to “normal”.

In addition to the symptoms, COPD may also lead to a number of complications, including:

- Heart Disease - for reasons not entirely understood at the moment, people with COPD have a higher risk of developing heart disease, including myocardial infarction (heart attack)

- Depression - dealing with any serious illness that may limit a person’s ability to function normally may increase the risk of developing depression

- Lung Cancer - people living with COPD have a higher risk than normal of developing lung cancer

- Pulmonary Hypertension - high blood pressure in the lungs 

- Collapsed Lung - the trapped air in the lung may develop into an air pocket that may rupture during a coughing fit, causing the lung to deflate

- Hypoxaemia - a lack of oxygen to the brain. May lead to confusion, memory issues and depression

- Withdrawal from Physical Activities - some people with COPD may reduce physical activities to reduce periods of breathlessness. This may lead to a cycle of a reduction in overall fitness making breathlessness more common, leading to a further reduction in activity

What Causes COPD?

The two most common conditions that fall under the umbrella of COPD are emphysema, chronic bronchitis and chronic asthma.

  1. Emphysema - in people with emphysema, the alveoli (air sacs) in the lungs have been damaged. Over time these damaged alveoli rupture, decreasing the surface area of the lungs making it more difficult to transfer oxygen into the blood. In addition, the ruptured alveoli trap air, making it more difficult to fill the lungs.
  2. Chronic Bronchitis - a persistent inflammation of the lining of the airways leading to the lungs, the bronchial tubes. The inflammation increases the production of mucus, leading to a persistent, productive cough and restricts the amount of air that can be drawn into the lungs. 

Far and away the most common cause of chronic obstructive pulmonary disease is tobacco smoking. Around 20% to 25% of smokers will develop some form of COPD. While not as likely to develop COPD as current smokers, ex-smokers still have an increased risk of developing the condition.

Passive exposure to tobacco smoke may also increase your risk of developing COPD. Other environmental factors, such as frequent exposure to dust, chemical fumes, gas and air pollution (including non-tobacco smoke) also increase the risk of developing COPD.

For a small number of people with COPD, genetics also plays a part. A rare protein disorder known as alpha-1-antitrypsin deficiency (AATD) leaves people with a deficiency in a protein that helps protect the lungs. This lack of protection may lead to the development of a form of emphysema, even if none of the other usual triggers for the development of the condition are present.

Having asthma (combined with smoking) may be a significant risk factor for the development of COPD. A study by the University of Tucson that monitored 3,000 test subjects over a period of 20 years found that, adults who smoke and have asthma may be 17 times more likely to be diagnosed with emphysema, 10 times more likely to develop symptoms of chronic bronchitis and 12.5 times more likely to develop COPD. 

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Living With and Treatment For COPD

While COPD is progressive and incurable, the condition can be managed through a mixture of medication, lifestyle changes and other measures.

Common medical treatments for COPD include:

  • Medications - a person with COPD may be prescribed a number of medications to help control symptoms. These medications include corticosteroids to help reduce inflammation in lung tissue, bronchodilators to help open constricted airways and expectorants to help loosen up phlegm, making it easier to cough up.
  • Oxygen Therapy - oxygen is prescribed for a number of people with chronic lung diseases as it aids in returning blood oxygen to a normal level. Oxygen is typically an ongoing treatment. In some cases oxygen may also alleviate shortness of breath.
  • Pulmonary Rehabilitation - a tailored and supervised exercise program designed to help strengthen the lungs. Pulmonary rehabilitation programs typically last for around eight weeks. At the end of the program the patient's lungs will be reassessed and they will be given an ongoing exercise program to help maintain the health of their lungs.
  • Surgery - in some cases, lung volume reduction surgery may be used to help increase lung function. WIth this surgery, areas of damaged lung tissue are removed allowing the healthy tissue to better draw in and expel air. 

No matter the treatment, frequent monitoring and assessment is needed to chart the course of the disease so any changes in treatment can be made to offset the profession of COPD.

In addition to prescribed treatments, there are a number of things that people living with COPD can do to help reduce or minimise COPD symptoms as well as maintain quality of life, including:

  • Avoid environments that can exacerbate symptoms, such as dusty or smoky environments
  • Eat a healthy diet
  • Get plenty of rest
  • Join a lung disease support group
  • Remaining as physically active as possible. This may be through pulmonary rehabilitation or maintenance exercise, regular exercise or simply maintaining active activities such as playing sport or gardening
  • Stay hydrated. Good hydration means that any mucus in your lungs will be more liquid and easier to expel through coughing
  • Quit smoking

Rather than managing symptoms of COPD, the best thing anyone can do to significantly reduce their risk of developing the condition is to quit smoking.

If you need help quitting smoking, or are experiencing a shortness of breath, schedule an appointment to see a doctor .

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