COPD
Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a number of lung conditions that are long-term, gradually worsen, and cause shortness of breath by reducing the normal flow of air through the airways. The most common are emphysema, chronic bronchitis and chronic asthma. Each of these conditions can occur on its own, although many people have a combination of conditions.
In Australia, up to 1 in 5 people over 40 years old are believed to be affected by COPD, and it is currently the fourth most common cause of death in men and sixth most common in women.
Note: COPD was previously known as COLD (Chronic Obstructive Lung Disease), COAD (Chronic Obstructive Airways Disease) or CAL (Chronic Airflow Limitation).
Who is at risk of COPD?
Some factors that put you at risk of developing COPD include:
Smoking
Smoking is the main cause of COPD. Around half of all smokers will develop some form of airflow limitation, and 15-20% of smokers will develop severe lung problems. The most important thing you can do to help yourself if you have any lung condition is to stop smoking.
Environmental exposure
COPD can occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to second-hand smoke or other air pollutants may also contribute to COPD.
Genetic factors
In a few people, COPD is caused by a genetic condition known as alpha-1 antitrypsin deficiency. People with alpha-1 antitrypsin deficiency can get COPD even if they have never smoked or had long-term exposure to harmful irritants. They tend to develop emphysema-type lung problems between the ages of 20 and 50. This is quite a rare condition.
What are the symptoms of COPD?
The main symptoms of COPD are:
- Shortness of breath
- Cough
- Increased mucus production
Wheezing and chest tightness are also common. Some people in the very early stages of COPD can show no symptoms at all, and it may only be detected with breathing tests. In the early stages, breathlessness may occur when walking up hills or stairs. As COPD becomes more severe, breathlessness can worsen to a point where everyday tasks, such as hanging out the washing or showering become difficult.
What is emphysema?
Emphysema is a condition where the elastic fibres in the breathing tubes (bronchi and bronchioles) and in the air sacs (alveoli) of the lungs are destroyed. The breathing tubes become floppy and narrow, and the air sacs become stretched. The narrow airways make it harder to breathe air out, which can lead to air getting trapped (or hyperinflation) in the lungs. The trapped air leads to an over-expansion of the lungs and is often called a barrel chest. The combination of having extra air in the lungs, and the extra effort needed to breathe results in a feeling of shortness of breath.
What is chronic bronchitis?
Chronic bronchitis is a constant swelling and irritation of the breathing tubes (bronchi and bronchioles), resulting in increased mucus production (phlegm or sputum). This causes the breathing tubes to become narrower than usual, making it harder to breathe. Frequent infections can also occur. This is different from the short-term bronchitis that people may get which lasts a few days or weeks.
What is chronic asthma?
Asthma causes changes in the airways that stop the air from moving through freely. If asthma is well-controlled with the right medication, these changes may only affect breathing occasionally. If asthma is not well treated, or is very severe over a long time, the long-term inflammation that occurs can become permanent, and cause continuing shortness of breath.
What’s the difference between asthma and COPD?
Asthma usually starts at a younger age, and people are more likely to have a history of allergic conditions such as hayfever or eczema. When breathing tests such as a spirometry test are done, the airways may show some changes, but these are mostly or completely reversible back to normal with medical treatment.
COPD gets worse over time, and symptoms don’t usually appear until over the age of 50. People with COPD are likely to have smoked for a long time, and the changes in the airways shown by a spirometry test do not respond much to medication. Some people have a mixture of both conditions.
Note: It’s important to understand that some people do get asthma for the first time when they are over 50 years old, so you should always have spirometry test done to help with diagnosis.
How is COPD diagnosed?
A diagnosis of COPD is usually based on:
- History (including history of smoking or exposure to other irritants)
- Physical examination (e.g. listening to the chest)
- Lung function tests (e.g. spirometry test)
How is COPD managed?
COPD cannot be cured but it can be managed using a range of treatments. Quitting smoking is by far the most important way of managing COPD, and will help stop the rapid decline in lung function. Stopping smoking is not easy however. Talk to your doctor about medications and programs that can support you in quitting.
Other important treatments that help manage COPD include:
- Exercise (including pulmonary rehabilitation)
- Medications to help decrease the swelling, and open up the breathing tubes
- Eating a healthy diet
- Getting a flu vaccination every year
- Oxygen therapy (though this is only useful for people with severe lung disease)
- Learning how to manage breathlessness and stressful situations
Effective management of COPD is based on a partnership between you, your family and your health care professionals. You may find it helpful to ask your doctor to fill in a COPD Action Plan for you.
For more information on COPD, visit the Australian Lung Foundation.