Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition that causes breathing difficulties due to obstructed airflow. It is an umbrella term encompassing lung diseases, primarily chronic bronchitis and emphysema. These conditions often coexist and can vary in severity among individuals with COPD. 

Chronic bronchitis is characterised by long-term inflammation and narrowing of the airways (bronchial tubes) that carry air to and from the lungs. This inflammation leads to excessive mucus production, coughing, and restricted airflow. Emphysema, on the other hand, involves the breakdown of the tiny air sacs (alveoli) at the end of the bronchioles, where oxygen is transferred into the bloodstream. The damaged air sacs lose their elasticity, causing air to become trapped and making breathing increasingly difficult.

COPD is a common condition that primarily affects middle-aged or older adults who smoke or have a history of smoking. However, exposure to other irritants like air pollution, chemical fumes, dust, or childhood respiratory issues can also increase the risk of developing COPD. 

In the United Kingdom,1.4 million people have been diagnosed with COPD. Each year, around 30,000 individuals in the UK lose their lives due to COPD. When it comes to diagnosed cases, COPD stands as the second most common lung disease in the country, after asthma. Notably, approximately 2% of the entire population, or 4.5% of all individuals aged over 40, live with diagnosed COPD, underscoring the significant burden this condition places on public health.

COPD Symptoms

The symptoms of COPD can vary in severity from person to person, but they typically worsen over time as the disease progresses. While some individuals may experience only mild symptoms initially, others may suffer from more severe breathing difficulties.

Common symptoms of COPD include:

• Shortness of breath, especially during physical activity 
• Persistent cough that may produce mucus (which can be clear, white, yellow or greenish)
• Frequent chest infections
• Wheezing
• Chest tightness  
• Lack of energy/fatigue
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs (oedema)

Additionally, individuals with COPD may experience exacerbations, which are episodes where their symptoms become worse than the usual day-to-day variation and persist for several days or longer. Seek immediate medical attention if you experience severe shortness of breath, blueness of the lips or fingernail beds (cyanosis), rapid heartbeat, or confusion/fogginess. These could be signs of a medical emergency.

COPD Risk Factors

While COPD can develop for various reasons, certain factors significantly increase an individual’s likelihood of developing this chronic lung condition. Understanding these risk factors is crucial for early detection, prevention, and effective management of the disease. Some of the key risk factors for COPD include:

• Age over 65
• Female gender
• Alpha-1 antitrypsin deficiency (genetic disorder)
• Childhood respiratory infections
• Smoking or exposure to secondhand smoke
• Exposure to air pollutants
• Occupational exposure to chemicals, dust or fumes
• Asthma
• Indoor air pollution from burning fuels (in developing regions)

It’s important to note that while these risk factors increase the likelihood of developing COPD, some individuals may develop the condition without any identifiable risk factors. In contrast, others with multiple risk factors may not develop COPD.

TreatmentS for COPD

The most crucial step in any COPD treatment plan is to stop smoking, as it can prevent further lung damage. However, quitting smoking is a challenging task, especially for those who have tried and failed in the past. Therefore, it is advisable to discuss nicotine replacement products, cessation medications, and strategies for handling relapses with a healthcare provider.

Furthermore, COPD treatment often encompasses a multidisciplinary approach, with involvement from your local GP or local healthcare provider and hospital respiratory specialists. This allows for seamless care with support available to you at all times. 

Medications

Bronchodilators are a key medication used to treat COPD; they improve coughing and shortness of breath by relaxing the muscles surrounding the airways. Short-acting bronchodilators may be used before activities for quick relief, while long-acting bronchodilators are taken daily to control symptoms over an extended period.

Another important medication for COPD is inhaled corticosteroids. They help to reduce airway inflammation and prevent exacerbations of symptoms, though side effects like bruising, oral infections, and hoarseness may occur with their use.

Short courses of oral corticosteroids may be prescribed in acute exacerbations to prevent further deterioration. However, their long-term can lead to serious side effects, so their use is limited. Additional medications include phosphodiesterase-4 inhibitors, theophylline, and antibiotics, which can be used to treat respiratory infections that may exacerbate COPD symptoms.

Lung Therapies

For some COPD patients, additional therapies beyond medication may be required. Supplemental oxygen therapy is often necessary to improve oxygenation and alleviate respiratory distress in individuals with low blood oxygen levels. Pulmonary rehabilitation can also play a vital role; this involves exercise training, education, nutritional counselling, and other services according to patient needs. 

Non-invasive ventilation therapies administered at home, such as bilevel-positive airway pressure (BiPAP), may be recommended in severe cases. BiPAP can improve breathing, decrease carbon dioxide retention, and potentially reduce the risk of acute respiratory failure and subsequent hospitalisation for COPD patients.

Surgical Options

In cases of advanced or severe emphysema where other therapies have been exhausted, surgical interventions may be considered as a final treatment option. Lung volume reduction surgery is one such procedure, which involves removing damaged lung tissue to allow the remaining healthy tissue to function more efficiently. Another option is endoscopic lung volume reduction, a minimally invasive technique where a one-way endobronchial valve is placed in the lung to shrink the most damaged lobe, creating more space for the healthier lung tissue to expand and function better. For certain individuals meeting specific criteria, lung transplantation may be an option. Additionally, a bullectomy may be performed to remove large air spaces called bullae.

Regardless of which interventions are pursued, individuals with COPD must work closely with a multidisciplinary healthcare team. By combining various pharmacological and non-pharmacological approaches, many COPD patients can significantly improve symptoms, slow disease progression, reduce complications, and ultimately enhance their overall ability to live an active life.

Complications

COPD can lead to several long-term effects, impacting not just the lungs but also other systems in the body. Some of the complications associated with COPD include:

• Increased risk of heart disease and heart attacks
• Higher susceptibility to respiratory infections like pneumonia
• Greater likelihood of developing lung cancer
• Potential for depression and anxiety due to chronic illness and reduced quality of life
• Risk of developing conditions like osteoporosis and muscle wasting due to long-term steroid use and inactivity

PreventiNG COPD

While COPD is not fully reversible, it is a preventable disease in most cases. The best way to prevent the development of COPD is to avoid exposure to the major risk factors that lead to lung damage over time. Steps that can help to prevent COPD are:

• Quit smoking
• Avoid secondhand smoke exposure 
• Avoid inhaling other lung irritants in the environment or workplace. 
• Those in at-risk occupations should use proper protective equipment.
• Get routine check-ups to catch early signs of lung disease.
• Properly manage underlying conditions like asthma and alpha-1 antitrypsin deficiency. 
• Maintain a healthy lifestyle (regular exercise, balanced diet, staying hydrated, and practising breathing exercises)

Worried you may have COPD?

COPD is a long-term and debilitating chronic disease. It is important to contact the right doctors and specialists if you think you may be struggling with your COPD or feel it has worsened in recent days. Alternatively, if you suspect that you have begun to develop issues with your breathing please reach out for support from your local GP or respiratory specialist. 

As a leading sleep and respiratory physician specialising in COPD and sleep-related breathing disorders, I offer consultations to diagnose and treat these conditions. Please contact me if you have any further queries about COPD or would like further advice on the potential treatments available.