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7 Things to Know About COPD

Source: Shutterstock

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Chronic obstructive pulmonary disease, or COPD, is a progressive disease (that means it gets worse over time) that causes difficulty breathing. In COPD, less air flows in and out of the airways within your lungs due to one or more of several reasons: the airways and air sacs lose their elastic quality, the walls between many of the air sacs are destroyed, the walls of the airways become thick and inflamed, or the airways make more mucus than usual, clogging them. COPD is a major cause of disability and it’s the third leading cause of death in the United States. Symptoms worsen over time and can limit your ability to do routine activities such as cooking, cleaning, or exercising.

Here are some of the symptoms and treatments for COPD.

Cough

The first symptom to occur with COPD is a chronic cough. By definition, a chronic cough existing for more than three months a year for more than two years in combination with sputum production and without another explanation is chronic bronchitis. Chronic bronchitis can occur before COPD fully develops. The amount of sputum produced can change over hours to days. In some cases, the cough may not be present or only occurs occasionally. The cough does not always have to be productive.

Shortness of Breath

The symptom that affects people the most is shortness of breath. People with COPD often complain that they feel like they can’t get enough air or breathing requires effort. Typically, the shortness of breath is worse on exertion of a prolonged duration and worsens over time. In the advanced stages of COPD, shortness of breath occurs during rest and may always be present. It is a source of severe anxiety and the cause of poor quality of life for those with COPD.

Other Symptoms

For some people with COPD, it may take longer to breathe out than to breathe in. Some people experience chest tightness, but that is not common and is likely to be caused by another problem. People with obstructed airflow may experience wheezing or decreased sounds with air entry upon examination with a stethoscope. Uncommonly, a barrel chest is a characteristic sign of COPD. Advanced COPD leads to high blood pressure in the lung arteries, which strains the right ventricle of the heart. This can lead to leg swelling and bulging neck veins.

COPD often occurs along with a number of other conditions including diabetes, heart disease, lung cancer, anxiety, and depression.

Bronchodilators

Inhaled bronchodilators are the primary medications used in treating COPD symptoms. They reduce shortness of breath, wheeze, and exercise limitation, resulting in an improved quality of life. In those with mild COPD, short-acting agents are given on an as-needed basis. In those with severe COPD, long-acting agents are recommended. If the long-acting bronchodilators are insufficient to relieve symptoms, then inhaled corticosteroids are added.    The two main anticholinergics used in COPD are ipratropium and tiotropium. The former is a short-acting agent while the latter is long-acting. Tiotropium is associated with a decrease in exacerbations and improved quality of life. Anticholinergics can cause dry mouth and urinary tract symptoms and are also associated with increased risk of heart disease and stroke.

Corticosteroids

Corticosteroids are usually used in inhaled form but may also be used as tablets to treat and prevent acute exacerbations. While inhaled corticosteroids have not shown benefit for people with mild COPD, they decrease acute exacerbations in those with either moderate or severe disease. When used in combination with a LABA they decrease mortality more than either ICS or LABA alone. By themselves they have no effect on overall one-year mortality and are associated with increased rates of pneumonia. It is unclear if they affect the progression of the disease. Long-term treatment with steroid tablets is associated with significant side effects.

Oxygen

Supplemental oxygen is recommended in those with low oxygen levels at rest. In this group of people it decreases the risk of heart failure and death if used 15 hours per day and may improve people’s ability to exercise. In those with normal or mildly low oxygen levels, oxygen supplementation may improve shortness of breath. There is a risk of fires and little benefit when those on oxygen continue to smoke. In this situation, most doctors would recommend against its use.

Surgery

For those with very severe COPD, surgery is sometimes helpful and may include lung transplantation or lung volume reduction surgery. Lung volume reduction surgery involves removing the parts of the lung most damaged by emphysema, allowing the remaining, relatively good lung to expand and work better. Lung transplantation is sometimes performed for very severe COPD, particularly in young individuals.

Kara is more than just a do-it-all writer; she's also a jetsetter who has experienced cities and cultures around the world! Find Kara on LinkedIn!

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