Chronic obstructive airway disease

Definition

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that cause swelling of the airways.  Emphysema and chronic bronchitis are the most common forms of COPD.

Alternative Names

Causes

The leading cause of COPD is smoking. Between 15% and 20% of long-term smokers will develop COPD. Prolonged tobacco use causes lung inflammation and destroys air sacs in the lungs. (In rare cases, an enzyme deficiency called alpha-1 anti-trypsin deficiency can cause emphysema in non-smokers.)

Other risk factors for COPD are exposure to secondhand smoke, male gender, and working or living in a polluted environment.

Symptoms

• Shortness of breath (dyspnea) persisting for months to years
• Wheezing
• Decreased exercise tolerance
• Cough with or without phlegm

Exams and Tests

An examination often reveals increased work involved in breathing: nasal flaring may be evident during air intake, and the lips may be pursed (the shape lips make when you whistle) while exhaling.

During a flare of disease, chest inspection reveals contraction of the muscles between the ribs during inhalation (intercostal retraction) and the use of accessory breathing muscles. The respiratory rate (amount of breaths per minute) may be elevated, and wheezing may be heard through a stethoscope.

A chest X-ray can show an over-expanded lung (hyperinflation), and a chest CT scan may show emphysema.

A sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis). Pulmonary function tests show decreased airflow rates while exhaling and over-expanded lungs.

Treatment

Treatment for COPD includes inhalers that dilate the airways (bronchodilators) and sometimes theophylline. The COPD patient must stop smoking. In some cases inhaled steroids are used to suppress lung inflammation, and, in severe cases or flare-ups, intravenous or oral steroids are given.

Antibiotics are used during flare-ups of symptoms as infections can worsen COPD. Chronic, low-flow oxygen, non-invasive ventilation, or intubation may be needed in some cases. Surgery to remove parts of the disease lung has been shown to be helpful for some patients with COPD.

Lung rehabilitation programs may help some patients.

Lung transplant is sometimes performed for severe cases.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See lung disease - support group.

Outlook (Prognosis)

This condition is associated with chronic (long-term) illness. The disease continues to worsen if tobacco use continues.

Possible Complications

• Right sided heart failure or cor pulmonale (enlargement of the heart and heart failure associated with chronic lung disease)
• Arrhythmias
• Dependence on mechanical ventilation and oxygen therapy
• Pneumothorax (air outside the lung)
• Pneumonia

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if there is a rapid increase in shortness of breath or if complications develop.

Prevention

Avoidance of smoking prevents COPD. Early recognition and treatment of small airway disease in people who smoke, combined with smoking cessation, may prevent progression of the disease.

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