Chronic obstructive pulmonary disease
Also called: COPD, Emphysema, Chronic bronchitis
A long-term lung disease in which airways are narrowed and air sacs are destroyed, mostly by tobacco smoke. Breathlessness slowly worsens and flare-ups (exacerbations) cause hospital admissions.
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About 390 million people worldwide; the third leading cause of death.
What happens in the body
Inhaled toxins cause chronic inflammation: small airways narrow and fill with mucus (chronic bronchitis) and alveolar walls are destroyed (emphysema), trapping air in the lungs.
Causes
- Tobacco smoking (the main cause)
- Indoor biomass fuel smoke
- Occupational dusts and fumes
- Alpha-1 antitrypsin deficiency
Risk factors
- Smoking history
- Age over 40
- Childhood lung infections and low birth weight
- Air pollution
Symptoms
- Breathlessness on exertion, gradually worsening
- Persistent cough
- Daily sputum
- Wheeze
- Frequent chest infections
- Weight loss in advanced disease
Diagnosis — tests and examinations
- Spirometry: FEV1/FVC below 0.7 after bronchodilator
- Chest X-ray or CT
- Oxygen saturation and blood gases
- Alpha-1 antitrypsin level in younger patients
Treatment
Medicines and medical treatment
- Long-acting bronchodilators (LAMA and LABA inhalers)
- Inhaled steroid added for frequent exacerbations with high eosinophils
- Antibiotics and steroids for exacerbations
- Azithromycin or roflumilast for recurrent exacerbations
- Dupilumab for COPD with type-2 inflammation
- Long-term oxygen therapy for chronic low oxygen
- Home non-invasive ventilation for chronic high carbon dioxide
Operations and procedures
- Lung volume reduction surgery or endobronchial valves in emphysema
- Lung transplantation
Self-care, home remedies and lifestyle
- Stopping smoking is the only measure that slows decline
- Pulmonary rehabilitation (exercise and education)
- Influenza, pneumococcal, COVID-19 and RSV vaccination
- Breathing techniques such as pursed-lip breathing
- Self-management plan with rescue medicines
Possible complications
- Exacerbations and respiratory failure
- Cor pulmonale (right heart failure)
- Pneumonia
- Pneumothorax
- Lung cancer
- Depression and anxiety
Prevention
- Never smoking or quitting
- Clean cooking fuels and workplace protection
Outlook
Progressive, but quitting smoking, rehabilitation and inhalers improve symptoms and survival.
When to see a doctor
See a doctor for persistent cough or breathlessness if you smoke or have smoked. Seek urgent care for rapidly worsening breathlessness, confusion or blue lips.
Sources and further reading
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