Definition Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow as you exhale

and make it increasingly difficult for you to breathe. Emphysema and chronic asthmatic bronchitis are the two main conditions that make up COPD. In all cases, damage to your airways eventually interferes with the exchange of oxygen and carbon dioxide in your lungs. COPD is a leading cause of death and illness worldwide. Most COPD is caused by long-term smoking and can be prevented by not smoking or quitting soon after you start. This damage to your lungs can't be reversed, so treatment focuses on controlling symptoms and minimizing further damage. Symptoms In general, symptoms of COPD don't appear until significant lung damage has occurred, and they usually worsen over time. People with COPD are also likely to experience episodes called exacerbations when their symptoms suddenly get much worse. Signs and symptoms of COPD can vary, depending on which lung disease is most prominent. Most people have more than one of these signs and symptoms at the same time.

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Causes

Shortness of breath Wheezing Chest tightness Chronic cough

COPD primarily refers to obstruction in the lungs caused by chronic asthmatic bronchitis and emphysema. Many people with COPD have both. Chronic asthmatic bronchitis Chronic asthmatic bronchitis causes inflammation and narrowing of the airways that lead into your lungs. This may cause you to cough and wheeze. Chronic asthmatic bronchitis also increases mucus production, which can further block the narrowed tubes. Emphysema Emphysema damages the tiny air sacs in your lungs (alveoli) in two main ways. Alveoli are clustered like grapes and emphysema gradually destroys the inner walls of these clusters, reducing the amount of surface area available to exchange oxygen for carbon dioxide. In addition, emphysema also makes the alveoli walls weaker and less elastic, so they collapse with exhalation trapping air in the alveoli. Shortness of breath occurs because the chest wall muscles have to work harder to expel the air. Cigarette smoke and other irritants COPD is typically caused by long-term exposure to airborne irritants, such as:

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Tobacco smoke Dust Chemical fumes Air pollution

Risk factors for COPD include:

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Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and people exposed to large amounts of secondhand smoke also are at risk. Chronic inhalation of marijuana smoke also can be injurious. Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts can irritate and inflame your lungs. Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin. Genetics. A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of a few cases of COPD. Researchers suspect that other genetic factors may also make certain smokers more susceptible to the disease.

Complications Complications of COPD include:

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Respiratory infections. When you have COPD, you're more likely to get frequent colds, the flu or pneumonia. Plus, any respiratory infection can make it much more difficult to breathe and produce further irreversible damage to the lung tissue. High blood pressure. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). This puts great strain on the right ventricle of your heart and may cause your ankles and legs to swell. Heart problems. COPD also increases your risk of heart disease, including heart attack. This is in addition to the adverse effects of nicotine on the coronary arteries. Depression. Difficulty breathing can keep you from doing activities that you enjoy. And it can be very difficult to deal with a disease that is progressive and incurable. Talk to your doctor if you feel sad, helpless or depressed.

Tests and diagnosis If you have symptoms of COPD and a history of exposure to lung irritants especially cigarette smoke your doctor may recommend some of the following tests. Imaging tests

Chest X-ray. In a few people, a chest X-ray can show emphysema one of the main causes of COPD. More importantly, an X-ray can help rule out other lung problems, such as lung cancer, or heart failure. Computerized tomography (CT). CT scans combine X-ray images taken from many different angles to create detailed, cross-sectional images of internal organs. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD.

Lab tests

Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. The blood is usually drawn from an artery in your wrist. Sputum examination. Analysis of the cells in the mucus you cough up, which is known as sputum, can help identify the cause of your lung problems and help rule out some lung cancers. If you have a productive cough, identifying a bacterial pathogen and treating it before it causes pneumonia is good preventive medicine.

Pulmonary function tests Spirometry is the most common lung function test and the most important in diagnosing COPD and its stage. During this test, you'll be asked to blow into a large tube connected to a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. By repeating it at intervals, this test can also be used to track the progression of disease and to monitor how well treatment is working. Treatments and drugs There's no cure for COPD, and you can't undo the damage to your lungs. But COPD treatments can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Stop smoking The most essential step in any treatment plan for smokers with COPD is to stop all smoking. It's the only way to keep COPD from getting worse which can eventually result in losing your ability to breathe. But quitting smoking is never easy. And this task may seem particularly daunting if you've tried to quit before. Talk to your doctor about nicotine replacement products and medications that might help. Medications Doctors use several basic groups of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

Bronchodilators. These medications which usually come in an inhaler relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both. Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better. But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. They're usually reserved for people with moderate or severe COPD. Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and influenza can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are recommended only when necessary.

Therapy

Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Pulmonary rehabilitation program. These programs typically combine education, exercise training, nutrition advice and counseling. If you are referred to a program, you'll probably work with a range of health care professionals, including physical therapists, respiratory therapists, exercise specialists and dietitians. These specialists can tailor your rehabilitation program to meet your needs. Exercising regularly can significantly improve the efficiency of your cardiovascular system.

Surgery Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone:

Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung

tissue and the diaphragm work more efficiently. The surgery has a number of risks, and longterm results may be no better than for nonsurgical approaches. Lung transplant. Single-lung transplantation may be an option for certain people with severe emphysema who meet specific criteria. Transplantation can improve your ability to breathe and be active, but it doesn't appear to prolong life and you may have to wait for a long time to receive a donated organ. So the decision to undergo lung transplantation is complicated.

Managing exacerbations Even with ongoing treatment, you may experience times when symptoms suddenly get worse. This is called an acute exacerbation, and it may cause lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, a change in outdoor temperatures or high air pollution levels. Seek medical attention if you notice more coughing or a change in your mucus or if you have a harder time breathing.