Chronic obstructive pulmonary disease, or COPD, is an umbrella term for lung conditions that block airflow and make breathing difficult. Millions of Americans live with the disease, which can cause debilitating symptoms like wheezing, shortness of breath, and fatigue.
There are two main types of COPD: emphysema and chronic bronchitis. Most people with COPD experience both.
“Think of COPD as a spectrum of disease, with chronic bronchitis on one end and emphysema on the other,” says Jeffrey Michaelson, MD, a pulmonologist with
Wellstar Health System in Marietta, Georgia.
Emphysema occurs when the air sacs of the lungs (alveoli) become damaged and enlarged, causing breathlessness.
Bronchitis is an inflammation of the bronchial tubes (airways), which bring air to and from the lungs. This causes the lining of the airways to swell and produce an excess amount of mucus.
Bronchitis can be either
acute or chronic, with the latter being a far more serious, incurable lung disease involving periods of persistent coughing, shortness of breath, chest tightness, wheezing, and fatigue.
COPD symptoms can develop slowly. There may be no apparent symptoms at first, but early signs and symptoms may include:
- Persistent cough that may contain mucus, referred to as “smoker’s cough.”
- Chest tightness
- Wheezing
- Dyspnea, or shortness of breath that worsens with activity
- Fatigue
- Weight loss
- Swelling of the feet and ankles, called edema
- Blueness of the skin, lips, and fingernails, called cyanosis
- Mental confusion or disorientation
People with COPD often experience flare-ups, or periods of time when symptoms worsen. These usually result from a respiratory infection or an increase in air pollutants.
A COPD diagnosis usually requires an assessment of the patient’s health history, along with certain tests.
To determine whether you have COPD, a doctor will typically begin by asking questions about symptoms, smoking habits, exposure to airborne irritants, and
family history of COPD or the genetic disorder alpha-1 antitrypsin (A1AT) deficiency, which can cause emphysema.
A physical examination is performed to inspect the strength and function of your lungs and heart and to look for any visible signs of COPD, such as cyanosis. Your doctor may order one or more
lung function tests, such as:
- Spirometry This involves blowing into a tube connected to a spirometer, a machine that measures the airflow into and out of the lungs. This is the main test used to diagnose COPD.
- Bronchial Provocation Test The patient undergoes spirometry after inhaling a certain drug (methacholine or histamine) to evaluate the sensitivity of their lungs. Pulmonologists rarely order this test.
- Exercise Tolerance Test This can identify dyspnea (difficulty breathing) and evaluate how exercise affects the ability of the heart and lungs to provide oxygen to, and remove carbon dioxide from, the bloodstream. This test is rarely done to diagnose COPD but rather to explore alternative diagnoses.
- Exercise for Desaturation Test: Also known as the six-minute walk test, this assessment measures your oxygen needs while at rest and during exercise.
Your doctor might also order blood tests and imaging scans, such as:
- Arterial Blood Gas Test This evaluates your lungs’ gas exchange capabilities by measuring the amount of oxygen and carbon dioxide in your blood.
- A1AT Deficiency Blood Test This tests for a deficiency in A1AT, a protein made in the liver, which can lead to lung damage.
- Chest X-Rays X-rays are performed to look for lung enlargement, bronchial scarring, and the formation of air-filled cavities in the lungs called bullae.
- Computerized Tomography (CT) Scans CT scans provide more information than typical X-rays, such as whether there is airway inflammation.
Other diagnostic tests may also be necessary, such as a heart test called an electrocardiogram (EKG), bronchoscopy (where a thin tube with a camera is inserted into the airways to examine the lungs), and a lung or bronchial biopsy.
There are
four stages of COPD, and they're categorized according to the results of lung function tests, as well as other factors, including the severity of symptoms, risk of exacerbations, and the presence of other medical conditions.
Stage 1: Mild COPD
Mild COPD involves minor airflow limitation. Symptoms may include some shortness of breath. Treatment may include a short-acting bronchodilator and smoking cessation if the patient smokes.
Stage 2: Moderate COPD
With moderate COPD, airflow limitation begins to worsen. Symptoms, which are similar to mild COPD, include:
- Chronic coughing
- Increased sputum production
- Difficulty breathing
Stage 3: Severe COPD
Severe COPD means that lung function has been seriously impaired and the condition is having a noticeable impact on a person’s quality of life. In addition to chronic coughing, sputum, and breathing difficulties, severe COPD symptoms may include:
- Weight loss
- Tiredness and difficulty exercising
- Respiratory infections
The goal of stage 3
COPD treatment is to manage the disease’s symptoms. Treatment options are the same as for stages 1 and 2 and may also include inhaled corticosteroids.
Stage 4: Very Severe COPD
Very severe COPD means that the patient’s lung function is markedly impaired. The disease can start to affect the heart and circulatory system. In addition to severe COPD symptoms, signs of very severe COPD include:
- Blueness of the lips or fingernail beds (cyanosis)
- Chronic respiratory failure
Treatment may require oxygen therapy or lung volume reduction surgery.
All forms of COPD, including emphysema and chronic bronchitis, stem from airborne irritants that are inhaled.
Smoking is the main
cause of COPD, though nonsmokers can also get the disease. Between 85 and 90 percent of all COPD cases in high-income countries like the U.S. are caused by cigarette smoking.
Long-term exposure to other lung irritants, such as secondhand smoke, can also contribute to COPD.
Most people who develop COPD symptoms are age 40 and older. People younger than 40 can have COPD, too, but it’s uncommon.
In about one percent of cases, emphysema can be caused by the hereditary disorder alpha-1 antitrypsin (A1AT) deficiency. People with this deficiency have low levels of a protein made in the liver, which can lead to lung damage with exposure to airborne irritants.
Other causes of COPD include:
- Indoor air pollution
- Exposure to dust and chemical fumes in the workplace
- Asthma
- Frequent childhood respiratory infections
Treatment focuses on relieving symptoms, reducing flare-ups of the disease, improving quality of life, and correcting lifestyle habits that may worsen the condition.
To slow the progression of the disease, it’s not only important to stop smoking and avoid exposure to lung irritants, but also to take medications and vaccinations, and to follow a healthy lifestyle.
Pulmonary Rehabilitation
Pulmonary rehabilitation, which can improve your well-being, may include:
- An exercise or activity plan to strengthen the muscles used for breathing
- Psychological counseling
- Dietary changes to maintain a healthy weight
Medications and Therapies
While not comprehensive, the list below notes some of the main types of COPD treatment.
Bronchodilators
These medicines can help relieve coughing and shortness of breath by relaxing your airways.
When the airways are relaxed and open, it’s easier to breathe. Bronchodilators come as inhalers in both short- and long-acting forms: short-acting for alleviating acute attacks, and long-acting for sustained relief.
Short-acting bronchodilators, such as beta 2 agonists and antagonists (also known as anticholinergics), work quickly — usually 3 to 5 minutes after first inhaling. But they wear off in a few hours.
Examples include:
- albuterol
- levalbuterol
- terbutaline
Long-acting inhalers, which can also be beta 2 agonists or anticholinergics, provide relief for many hours, but the effect may be slower. Long-acting bronchodilators are taken daily, even when you feel well.
Examples include:
- formoterol fumarate (Perforomist)
- salmeterol xinafoate (Serevent)
Steroids
Doctors often treat acute COPD exacerbations with steroids — either in pill form or via inhaler — to reduce inflammation in the airways, but inhalers are used in combination therapy and oral medications for only short periods of time. The Pulmicort Flexhaler (budesonide) is a well-known example of an inhaled steroid.
Combination Inhalers
Some inhalers combine bronchodilators and steroids. Common examples include the Advair Diskus (fluticasone-salmeterol), Breztri Aerosphere (budesonide, glycopyrrolate, and formoterol fumarate), Trelegy Ellipta (Fluticasone furoate, umeclidinium, and vilanterol), and Symbicort (budesonide and formoterol) inhalers.
Additional Medications
Other medicines may be prescribed to treat COPD, including:
- roflumilast (Daliresp), to relax airways and decrease inflammation
- ensifentrine (Ohtuvayre), an inhaled medication that works as a bronchodilator and an anti-inflammatory while also helping to clear mucus from the lungs
- dupilumab (Dupixent), an injectable biologic therapy for certain adults with poorly controlled COPD who have high levels of eosinophils, white blood cells that can cause inflammation in the lungs and trigger breathing problems
- theophylline (Uniphyl, Theo-24), an older and less-expensive oral bronchodilator
- Antibiotics, which are sometimes prescribed to treat acute exacerbations or pneumonia
- Vaccinations: Patients with COPD should be fully vaccinated to decrease the risk of Influenza, Pneumonia, Covid, Pertussis, shingles, etc.
COPD Medication Prices
Here are some price ranges for COPD medications without insurance, but with pharmacy coupons for both generic and brand-name versions.
COPD is a chronic, lifelong condition, but treatment can help you manage symptoms and slow the progression of the disease, delaying the onset of later-stage COPD.
Life expectancy with COPD depends on the stage of the disease. The BODE index is a tool that’s used to predict mortality. It looks at four factors in people with COPD: body-mass index (B), degree of airflow obstruction (O), dyspnea (D), and exercise capacity (E), as measured by a six-minute walk test. A higher score on the BODE index indicates a higher risk of death.
Talk to your doctor if you have questions about your life expectancy with COPD, but keep in mind that tools like the BODE index are generalized measurements, and life span varies tremendously from person to person.
One of the best ways to prevent COPD is to never start smoking or to stop smoking if you already do.
If you have trouble
quitting smoking, there are numerous options to help you, including gums, patches, and prescription medication. Additionally, support groups and classes to help you quit smoking can often be found through hospitals, workplaces, and community associations.
Heavy and long-term exposure to various lung irritants, including air pollution, dust, and chemical fumes in the workplace, and secondhand smoke, can also cause COPD.
Here are some tips to reduce your exposure to COPD-causing irritants:
- Make sure any wood-burning stove or fireplace is well ventilated.
- Stay indoors if there’s noticeable air pollution outside.
- Make your home an environment free from secondhand smoke.
- If you work in an environment where you are exposed to chemical fumes and dust, speak with your supervisor about respiratory protective equipment and other ways to protect yourself.
COPD shares signs and symptoms with several other conditions, including:
- Asthma Overlapping symptoms include shortness of breath, cough, wheezing, and chest tightness.
- Rheumatoid Arthritis (RA) This autoimmune disease affects the joints, and it's been linked to a higher risk of COPD. The reason for this is unknown, but inflammation may play a role.
- Eosinophilic Esophagitis (EoE) This chronic disease of the esophagus may look like COPD or occur along with it. EoE causes white blood cells to fill and inflame the lining of the esophagus, leading to breathing and swallowing problems.
