Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that makes breathing harder over time. It happens when the airways and lung tissue get damaged. This damage makes it harder for air to flow in and out of the lungs and for oxygen to get into the bloodstream.

COPD includes two related problems: chronic bronchitis and emphysema. Chronic bronchitis means the airways stay swollen and make extra mucus, leading to coughing and discomfort in the chest. Emphysema means the tiny air sacs in the lungs get damaged, which makes it harder for oxygen to reach the blood. People with COPD often feel shortness of breath, have a ongoing cough, wheezing, and find it harder to do things that need exercise tolerance.

COPD can develop because of many factors, but the most common cause is long-term exposure to things that irritate the lungs. The biggest risk factors are tobacco smoke, air pollution, and workplace dust and chemical fumes. In some places, smoke from fuels used for cooking and heating is also a big risk, especially for women and young children. Doctors usually confirm COPD with lung function tests that check how well air moves in and out of the lungs.

COPD is most common in people older than 35–40, and the risk gets higher with age. It is one of the leading causes of illness around the world, especially in low and middle income countries. While COPD cannot be cured, treatments and changes in lifestyle can help manage symptoms and slow down the condition. Getting an early diagnosis and starting treatment is important.

Signs and symptoms

The Global Initiative for Chronic Obstructive Lung Disease describes COPD as a lung condition that causes long-lasting symptoms like shortness of breath, cough, and mucus. These symptoms happen because the airways and small air sacs in the lungs become damaged, making it hard to breathe.

One main sign of COPD is feeling out of breath, especially when doing things. This breathlessness can change during the day and might come with wheezing or a tight feeling in the chest. People often lean forward to help ease their breathing. Another common symptom is a chronic cough, which might bring up thick mucus. This cough can be worse in the morning and may continue for many years. Sometimes, the cough and mucus are triggered by infections, pollution, or smoking.

Other conditions

COPD often happens with other health problems, called comorbidities. People with COPD are more likely to have heart disease, lung infections like pneumonia, osteoporosis (weak bones), and conditions like depression, anxiety, and diabetes. These health issues can make managing COPD more difficult.

COPD can also increase the risk of serious problems such as pneumonia, heart issues, and a reduced quality of life. During the COVID-19 pandemic, people with COPD were more likely to have severe illness. Having multiple health conditions with COPD can lead to more serious outcomes.

Categorization

Categorizing COPD helps doctors choose the best treatments. COPD can look different in different people. These differences are called phenotypes. One type, called emphysema, damages the air sacs in the lungs. Another type, called chronic bronchitis, causes a lasting cough. Some people have a mix of both.

Doctors also study the causes behind these differences. These include smoking, pollution, and genetic factors. Knowing the cause can help doctors manage the disease better.

Causes

COPD happens when people breathe in harmful things for a long time, like tobacco smoke. This can hurt the lungs and make it hard to breathe. Smoking is the biggest cause of COPD, whether a person smokes or breathes in smoke from others.

Other causes include dirty air, both outside and inside homes, and breathing in dust or chemicals at work. Some people might also be born with a higher chance of getting COPD. Not developing strong lungs early in life can also make COPD more likely later.

Pathophysiology

COPD is a long-term lung disease where the airways get narrower and the lung tissue gets damaged. This makes it hard to breathe because air can't move in and out easily. The tiny air sacs in the lungs, called small air sacs, lose their shape and can't carry oxygen well into the blood. People with COPD often find it hard to breathe out fully, which can make the lungs swell up more than normal.

The disease happens because the lungs react badly to things we breathe in, like smoke. This leads to swelling and changes in the airway walls. This swelling and damage make it harder to move air. The body also makes extra mucus that blocks the airways. Over time, this can make the lungs work less well and may cause other health problems.

Diagnosis

COPD can affect people over 35 to 40 who have trouble breathing, a long-term cough, or cough up mucus often, especially if they have been around things that can harm their lungs. Spirometry is a test that helps doctors find out if someone has COPD. This test shows how well a person can move air in and out of their lungs. It looks at two important numbers to help confirm if COPD is present.

GOLD, a group that studies COPD, changed its rules in 2023. They now look at how bad the breathing problem is, other symptoms, and past health issues. They also pay attention to times when symptoms suddenly get worse, which can help decide on the best treatment. Other tests like chest X-rays and CT scans can help check for other problems, but spirometry is the main test used to diagnose COPD.

Prevention

Many cases of COPD can be prevented by avoiding tobacco smoke and other pollutants, both inside and outside the home. Keeping lungs healthy from a young age by staying active, eating well, and avoiding sickness can also help stop COPD from developing later.

Quitting smoking is one of the best ways to prevent or slow down COPD. Stopping smoking can make breathing easier and improve life, even if it happens later. Help from friends, special programs, and medicines can make it easier to quit. Lowering exposure to harmful substances at work and improving air quality at home and in public places are also important steps to prevent COPD.

Management

COPD cannot be cured, but treatments can help manage symptoms and slow the disease. Stopping smoking is very important and can make a big difference. If COPD is found early, when symptoms are mild, it can help prevent the disease from getting worse. Early diagnosis and treatment are key to improving quality of life and reducing flare-ups.

Management also includes reducing exposure to risk factors, such as helping people stop smoking. Vaccinations, like the pneumococcal and influenza vaccines, are recommended to lower the risk of flare-ups. For those with severe COPD, palliative care focuses on relieving symptoms. Various medications are used, including bronchodilators, corticosteroids, and antibiotics, to help manage symptoms and exacerbations.

Procedures for emphysema

Main article: Lung volume reduction

Doctors have ways to help people with severe emphysema, a type of lung disease, by making the lungs smaller. One way is through surgery called lung volume reduction surgery (LVRS). This surgery removes damaged lung tissue so the remaining lungs can work better. It is used when the disease is in the upper parts of the lungs.

Another method uses special tools placed through the windpipe. These tools include tiny one-way valves or coils that help shrink parts of the lung. There is also a technique using heated water vapor to reduce lung size. In very severe cases, a lung transplant might be an option. Doctors use special scans to decide the best treatment for each person.

Prognosis

COPD is a condition that gets worse over time and can affect a person’s health. It can make it hard to breathe and do everyday things.

Doctors use different tests to understand how COPD might affect someone in the future. They look at factors like weight, breathing difficulty, and how well a person can exercise, along with other health problems.

Epidemiology

Chronic obstructive pulmonary disease (COPD) affects millions of people around the world. It is more common in older adults, especially those over 60 years old. Both men and women can have COPD, and even women who never smoked can develop it.

The number of people with COPD changes in different countries depending on factors like smoking rates, air pollution, and the use of certain fuels for cooking. While the number of COPD cases has gone down a little worldwide since 1990, it is still a major cause of illness, especially in wealthier countries. In some places, more women are affected than men.

History

Further information: Emphysema § History, and Chronic bronchitis § History

The name chronic obstructive pulmonary disease was first used in 1965. Before that, it had many other names. Two main parts of this disease, emphysema and chronic bronchitis, were defined in 1959 and 1962.

People have noticed problems with lungs for a long time. In the 1700s, doctors described lungs that were swollen with air. In the 1800s, a doctor invented a machine to measure how much air the lungs can hold.

In the 1900s, scientists learned that smoking could cause lung disease. They also began making medicines to help people with this condition.

Society and culture

COPD is often not diagnosed, so many people don’t get the treatment they need. In the United States, November is recognized as COPD Awareness Month to help educate people about this condition.

The cost of treating COPD is very high. In 2010, it cost about $2.1 trillion worldwide for medical care. Costs are expected to rise in the future. In Europe, COPD accounts for a small part of healthcare spending. In the United States, the cost was around $50 billion in 2010, and in the United Kingdom, it was about £3.8 billion each year as of 2021.

Research

Researchers are looking for new ways to help people with chronic obstructive pulmonary disease (COPD). In June 2021, eight clinical trials were done, and seventeen more were starting. They looked at using stem cells to treat COPD. Scientists are also studying better ways to find out what type of COPD a person has. They are also testing if remote healthcare can help people feel better and stay out of the emergency room.

People with COPD and their families think the most important research areas are helping families and communities, improving well-being, finding cures, making new medical treatments, creating better rules, and using whole-body therapy approaches.

Other animals

Chronic obstructive pulmonary disease can affect animals too, often because they breathe in things like tobacco smoke. In horses, this problem is called recurrent airway obstruction or heaves. It is usually started by everyday allergens. This condition is also common in older dogs.