Chronic obstructive pulmonary disease (COPD) is an umbrella term for people with chronic bronchitis, emphysema, or both. With COPD the airflow to the lungs is restricted (obstructed). COPD is usually caused by smoking. Symptoms include cough and breathlessness. The most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucus-thinning (mucolytic) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms.
What is chronic obstructive pulmonary disease?
Chronic obstructive pulmonary disease (COPD) is a general term which includes the conditions chronic bronchitis and emphysema. COPD is the preferred term.
- Chronic means persistent.
- Bronchitis is inflammation of the bronchi (the airways of the lungs).
- Emphysema is damage to the smaller airways and air sacs (alveoli) of the lungs.
- Pulmonary means ‘affecting the lungs’.
Chronic bronchitis or emphysema can cause obstruction (narrowing) of the airways. Chronic bronchitis and emphysema commonly occur together. The term COPD is used to describe airflow obstruction due to chronic bronchitis, emphysema, or both.
I’m a 53 year old non smoker who has suffered with supposedly ‘mild’ asthma since the 1990s. Various inhalers have not helped and symptoms gradually worsened (severe breathlessness when walking up…
— sherylbceroc, Chronic Obstructive Pulmonary Disease
How common is COPD?
COPD is common and important. 14.5% or one in 7 Australians 40 years or over have airflow limitation of their lungs. This figure increases to 29.2% in Australians 75 years or over. However, in many of these people, the condition has not been formally diagnosed (normally these would be mild cases). This is because in the early stages, many people put up with a cough or mild breathlessness without seeing their doctor. They may only see see their doctor when symptoms get worse.
COPD mainly affects people over the age of 40 and becomes more common with increasing age. The average age when it is formally diagnosed is around 67 years. It is more common in men than in women.
A flare-up (exacerbation) of COPD is one of the most common reasons for admission to hospital. 1 in 8 hospital admissions are due to COPD. This makes COPD the second largest cause of emergency admissions, and one of the most expensive inpatient conditions treated by the NHS.
What causes COPD?
Smoking is the cause in the vast majority of cases. There is no doubt about this. The lining of the airways becomes inflamed and damaged by smoking. About 3 in 20 people who smoke one packet of cigarettes (20 cigarettes) per day, and 1 in 4 40-per-day smokers, develop COPD if they continue to smoke. For all smokers, the chances of developing COPD are between 1 in 10 and 1 in 4.
Air pollution and polluted work conditions may cause some cases of COPD, or make the disease worse. The combination effect of occupational exposure to air pollutants and smoking increases the chances of developing COPD.
A small number of people have a hereditary (genetic) risk of COPD due to very rare protein deficiencies that can lead to lung, liver and blood disorders. (The condition is called alpha-1-antitrypsin deficiency). Less than 1 in 100 cases of COPD are due to this.
However, people who have never smoked rarely develop COPD. (Passive smoking remains, however, a potential cause.)
Symptoms of COPD
- Cough is usually the first symptom to develop. It is productive with phlegm (sputum). It tends to come and go at first, and then gradually becomes more persistent (chronic). You may think of your cough as a ‘smokers cough’ in the early stages of the disease. It is when the breathlessness begins that people often become concerned.
- Breathlessness (shortness of breath) and wheeze may occur only when you exert yourself at first. For example, when you climb stairs. These symptoms tend to become gradually worse over the years if you continue to smoke. Difficulty with breathing may eventually become quite distressing.
- Sputum – the damaged airways make a lot more mucus than normal. This forms sputum. You tend to cough up a lot of sputum each day.
- Chest infections are more common if you have COPD. A sudden worsening of symptoms (such as when you have an infection) is called an exacerbation. Wheezing with cough and breathlessness may become worse than usual if you have a chest infection and you may cough more sputum. Sputum usually turns yellow or green during a chest infection. Chest infections can be caused by germs called bacteria or viruses. Bacteria (which can be killed using antibiotic medicines) cause about 1 in 2 or 3 exacerbations of COPD. Viruses (which cannot be killed with antibiotics) are a common cause of exacerbations too, particularly in the winter months. The common cold virus may be responsible for up to 1 in 3 exacerbations.
- Other symptoms of COPD can be more vague. Examples are weight loss, tiredness and ankle swelling.
Chest pain and coughing up blood (haemoptysis) are not common features of COPD. It is possible to have slightly blood-streaked sputum when you have a chest infection. However, chest pain, blood in the sputum or coughing up just blood, should always be reported to a doctor. This is because other conditions need to be excluded (like angina, heart attack or lung cancer).
Difference between COPD and asthma
COPD and asthma cause similar symptoms. However, they are different diseases. Briefly:
- In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are persistent (chronic). Treatment to open up the airways is therefore limited.
- In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.
- COPD is more likely than asthma to cause an ongoing cough with phlegm (sputum).
- Waking at night with breathlessness or wheeze is common in asthma and uncommon in COPD.
- COPD is rare before the age of 35 whilst asthma is common in under-35s.
- There is more likely to be a history of asthma, allergies, eczema and hay fever (so-called atopy) in people with asthma.
Both asthma and COPD are common, and some people have both conditions.
What is the progression and outlook?
Symptoms of COPD typically begin in people aged over 40 who have smoked for 20 years or more. A ‘smoker’s cough’ tends to develop at first. Once symptoms start, if you continue to smoke, there is usually a gradual decline over several years. You tend to become more and more breathless. In time your mobility and general quality of life may become poor due to increasing breathing difficulties.
Chest infections tend to become more frequent as time goes by. Flare-ups (exacerbations) of symptoms occur from time to time, typically during a chest infection.
If the condition becomes severe then heart failure may develop. This is due to the reduced level of oxygen in the blood and changes in the lung tissue which can cause increased pressure in the blood vessels in the lungs. This increase in pressure can put a strain on the heart muscle, leading to heart failure. Heart failure can cause various symptoms including worsening breathlessness and fluid retention.
(Note: heart failure does not mean the heart stops beating – that is called cardiac arrest. Heart failure occurs when the heart does not pump blood very well.)
Respiratory failure is the final stage of COPD. At this point the lungs are so damaged that the levels of oxygen in the blood are low. The waste product of breathing, called carbon dioxide (CO2), builds up in the blood stream. People with end-stage COPD need palliative care to make them more comfortable and ease any symptoms.
Despite falling death rates, COPD is still a leading cause of death and disease burden after heart disease, stroke and cancer. Many of these people have several years of ill health and poor quality of life before they die.
Depression and/or anxiety affect at least 6 in 10 people with COPD, and can be treated if recognised.
How can the course of the disease be altered?
Stop smoking is the single most important piece of advice. If you stop smoking in the early stages of COPD it will make a huge difference. Damage already done to your airways cannot be reversed. However, stopping smoking prevents the disease from worsening. It is never too late to stop smoking, at any stage of the disease. Even if you have fairly advanced COPD, you are likely to benefit and prevent further progression of the disease.
Your cough may get worse for a while when you give up smoking. This often happens as the lining of the airways ‘comes back to life’. Resist the temptation to start smoking again to ease the cough. An increase in cough after you stop smoking usually settles in a few weeks.
Medication, such as varenicline and bupropion, and nicotine replacement therapy(such as patches and chewing gum) can be prescribed, and counselling offered.
Inverell Pharmacy – your locally owned and operated pharmacy at 132 Byron Street (next to Telstra). Phone 0267 223146