COPD (Chronic Obstructive Pulmonary Disease) (219)

Chronic Obstructive Pulmonary Disease

The Facts (3,4, 10, 11, 12)

Chronic bronchitis and emphysema are together called chronic obstructive pulmonary disease, or COPD. This is a chronic condition, usually attributed to tobacco smoking, causing shortness of breath and cough, leading to limitation of everyday activities like walking.

In chronic bronchitis, the airways (or bronchi) that connect the windpipe and the lungs become inflamed and swollen. The airways become narrow and are clogged up with thick mucus, called phlegm. Chronic bronchitis may be found together with emphysema, in which the air sacs in the lung become damaged, reducing the surface area where oxygen exchange takes place. Both diseases make it difficult to breathe.

COPD is a very common condition, especially among people who smoke tobacco. It is estimated over 2 million Canadians have COPD, although many are undiagnosed. COPD is the fourth leading cause of death in Canada.

Causes (5-6)

Smoking is the main cause of COPD. It causes the airways to produce excess mucus that lines the walls of the airways, making the air passages very narrow. This makes it easier to get a bronchial infection. An infection can cause even more damage to the airways by causing more mucus production. Cigarette smoking also destroys the air sacs where oxygen moves from your lungs to our blood, making the lungs work less efficiently.

Less common causes of COPD include a rare genetic disorder called alpha-1 antitrypsin deficiency, air pollution, exposure to occupational dusts and chemicals, and frequent lower respiratory infections during childhood.

Symptoms and Complications (5-7)

People with chronic bronchitis may cough up phlegm almost every day.
It is common for someone with chronic bronchitis to persistently cough and wheeze when breathing. It is also common to feel short of breath and tired. Low oxygen in the blood due to the decreased ability to move oxygen from the air to the blood may cause the lips or fingernails to become bluish in colour.

COPD can lead to heart failure, as the heart has to work harder to pump blood into the lungs. When the heart fails to pump blood properly, it collects in the blood vessels of the legs and ankles and causes them to swell – this is called edema.

Sometimes you may become housebound because of breathing difficulties. You may run out of breath even when doing simple tasks such as getting dressed or washing.

If you have COPD, it is likely that you may occasionally get infections, resulting in increased shortness of breath and more phlegm production or a change in the colour of the phlegm. You may also occasionally cough up blood. These can be signs of a more serious problem and it's important to see your doctor.

Making the Diagnosis (7)

Your doctor will test to see how much air you can forcefully exhale. These pulmonary, or lung breathing, tests are simple and painless. If you exhale less than normal, it could mean your airways are inflamed, in spasm, or clogged up with mucus. If this persists, then you may have COPD.

Treatment and Prevention (8-9)

Even with treatment, COPD becomes progressively worse over time. Medication is able to reduce the symptoms and improve your qualify of life, but cannot cure COPD. Lung function deteriorates with age even in healthy people, but it happens much faster if you're a smoker. Therefore, it is very important to stop smoking.

Your doctor may prescribe medications called short-acting bronchodilators, including salbutamol*, ipratropium bromide, a combination of the two, or terbutaline to relax and widen the bronchi and help relieve shortness of breath.

If symptoms are persistent, treatment with long-acting bronchodilators such as tiotropium, glycopyrronium, salmeterol, formoterol, or a combination product can be added. If you are still having difficulties breathing, your doctor may also suggest that you try adding an inhaled corticosteroid and/or roflumilast (an oral medication that may reduce the inflammation in the lungs). 

There are also medications available that combine long-acting bronchodilators with inhaled corticosteroids. Your doctor may also prescribe antibiotics and oral steroids for you to keep at home in case a bacterial lung infection develops.

Since influenza (the flu) may make COPD symptoms worse and can lead to respiratory failure and hospitalization, it is recommended that people with COPD receive the annual flu vaccine. People with COPD may also benefit from receiving a pneumococcal vaccine to lower their risk of getting pneumonia (lung infection), which can also lead to complications. Talk to your doctor about receiving these vaccines.

Oxygen therapy from oxygen cylinders or an oxygen concentrator can be used for people with severe COPD who do not have enough oxygen in their blood when breathing room air.

Drinking plenty of fluids throughout the day can help loosen phlegm buildup.
Exercise with or without a formal physiotherapy program can improve a person's quality of life and activities. A healthy nutritional intake is important, as weight loss due to the increased work of breathing presents a serious sign of advancing COPD. Lung volume reduction surgery or lung transplantation can also be considered in extreme cases.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
[references]

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