COPD Week

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General Information

COPD Week

What is COPD?

COPD is a chronic breathing condition wherein there is persistent, chronic obstruction to the flow of air through the lungs that makes it harder to breathe. The term chronic obstructive pulmonary disease includes the disorders called chronic bronchitis and emphysema. It also includes some cases of refractory asthma where the airflow obstruction is not fully reversible despite medical treatment, and some cases of bronchiectasis. 

The obstruction to the flow of air can result from narrowing of the airways (the bronchial tubes or bronchi) in the lung due inflammation in the walls of the airways, constriction of the muscle in the airway walls, and/or excess production of mucus into the airways. The term emphysema means there is destruction of some of the air sacs in the lung. 

Inhalation of tobacco smoke is the biggest risk factor for developing COPD. Other risks include environmental exposures such as smoke from wood-burning stoves, organic cooking fuels, prolonged exposures to other chemicals, fumes or dusts, and frequent respiratory infections in early childhood.

What are the major symptoms of COPD?

The major symptoms of COPD include shortness of breath, coughing (either with or without mucus production, and wheezing.  The shortness of breath tends to worsen during physical activities such as walking, running, carrying heavy items, ascending stairs or other forms of physical exertion. For those with more severe impairment of their lung function, even daily activities such as dressing, bathing, and eating can become difficult.   The amount of coughing, wheezing, and phlegm production varies among individuals. While cough and/or mucus production are common and may occur on a daily basis for some, others have very little or none of these symptoms. Other common symptoms of COPD can include general fatigue, a sense of tiredness of the legs during activity, and sleep disruption.  Most people with COPD experience “good days and bad days” with regard to their symptoms. This variation can relate to changes in activity level, temperature and humidity of the air, pollen and/or air pollution levels, use of inhaled medications and other factors.

What are exacerbations of COPD?

Many people with COPD experience intermittent acute exacerbations of their disease. Acute exacerbations of COPD are present when there is a worsening of symptoms beyond the normal day-to-day variation. The worsening symptoms may include shortness of breath, coughing, wheezing, mucus production or a combination of these.  Often, these acute exacerbations require an increase in medications, over and above those required when exacerbation is not present. Acute exacerbations of COPD vary in severity from mild to very severe.  While many can be managed at home (as an outpatient), some are severe enough that they require people to be hospitalized, and some can even lead to respiratory (breathing) failure requiring temporary breathing assistance from a mechanical ventilator (respirator).

How is COPD Diagnosed?

COPD is usually detected by a non-invasive lung function testing called spirometry. This test involves taking deep breaths and exhaling air rapidly and forcefully through a mouthpiece into a machine that detects the flow of air.   Other tests such as imaging (especially CT scans) and blood tests can also be helpful in diagnosing and assessing COPD.

What are the available treatments for COPD?

COPD is not curable, in that it is still present despite maximal treatment. As such, the available treatments often do not make symptoms resolve altogether. However, symptoms can usually be greatly improved by treating COPD! Key goals of treatment are to reduce symptoms and improve activity/exercise tolerance as much as possible, improve quality of life, prevent acute exacerbations of COPD, avoid hospitalizations, and stabilize lung function over time. 

There are several components of treatment for COPD.   Inhaled medications are the mainstay of medical therapy.  These include inhaled bronchodilators, which relieve constriction of muscle in the air passages (bronchial tubes or bronchi) in the lungs to make them open up so that air flows through more easily. There are different types of bronchodilators that work in different ways in the body to relieve this bronchoconstriction. Some of these act quickly and serve as medication to provide fast relief of symptoms (sometimes referred to as rescue medications) and others are longer-acting and serve as regular, maintenance medications to control symptoms, maintain optimal lung function and help prevent exacerbations. Some people, particularly those who experience frequent acute exacerbations, may also benefit from inhaled corticosteroids, which help to reduce chronic inflammation in the bronchial tubes deep in the lungs.  Individuals with COPD can partner with their healthcare providers to determine what inhaled therapies are the most suitable for them.

Some individuals with COPD may have deficiency of a protein in the body called alpha-1-antitrypsin.  Some people with this protein deficiency may benefit from periodic supplementation of this protein delivered intermittently into a vein.

Some people with COPD, typically those with more severe disease, require treatment with supplemental oxygen therapy. This is usually required when the lungs become unable to extract sufficient amounts of oxygen from the air to achieve adequate amounts in the bloodstream.   Oxygen therapy is typically prescribed when blood oxygen saturation levels are less than 88 to 90%, either at rest, during exertion and/or during sleep.  There are many different types of oxygen systems now available for use in the home as well as for portable use outside the home.  Some people also can benefit from use of non-invasive machines to assist breathing (commonly referred to as CPAP or BiPAP machines), particularly when breathing becomes inefficient during sleep despite use of supplemental oxygen or when a condition called obstructive sleep apnea is also present.

Pulmonary rehabilitation (PR) is an essential component of the treatment of COPD for individuals who remain symptomatic despite regular use of inhaled medications. Pulmonary rehabilitation involves gradual exercise reconditioning to improve strength and endurance for daily activities and education designed to help patients manage and cope with their COPD as best as possible. Expected benefits of PR include a reduction in breathlessness, improvements in exercise tolerance and quality of life. Participation in PR can also reduce the risk of future exacerbations and hospitalizations.

Surgical treatments such as lung volume reduction surgery and lung transplantation are considered for some patients with advanced disease that cannot be managed adequately with alternative treatment options.  Individuals can consult with their healthcare providers to see if they may be suitable candidates for these treatments.

What is the expected course of COPD?

While in general COPD tends to be a progressive disease wherein lung function gets worse over time, the rate at which lung function worsens varies a lot among individuals. Some people are more prone to having more rapid decline in lung function than others. A key goal of COPD treatment is to maintain lung function as stable as possible for as long as possible.  When COPD is present, smoking cessation and abstinence from tobacco inhalation is crucial to help stabilize and prevent further loss of lung function.  Regular use of inhaled medications, avoidance of triggers for exacerbations of symptoms, maintenance of a regular daily physical activity routine, participation in pulmonary rehabilitation and use of supplemental oxygen as needed, and close partnering with healthcare professionals can all help to maintain stability of COPD over time.

Where can I go for additional information?

There are many excellent sources of additional information available on COPD.  Some of these include:


Four Facts About COPD

  1. COPD is the third leading cause of death in the U.S., twelve years earlier than predicted.

  2. Every four minutes an individual dies of COPD.

  3. COPD kills more women than men each year. In 2006, COPD killed more American women than breast cancer, Alzheimer’s and diabetes.

  4. The National Heart, Lung and Blood Institute estimates that 12 million adults have COPD and another 12 million are undiagnosed or developing COPD. COPD cost the U.S. government approximately $42.6 billion in both direct and indirect expenses in 2007. A majority of those expenses are due to hospitalizations, which can be prevented with better diagnosis and management practices.