COPD: symptoms, causes and treatments

COPD is a combination of inflammation, mucus production and lack of elasticity in the lung tissue. People sometimes refer to COPD by the subcategories: emphysema and chronic bronchitis. Airways tubes – the bronchioles – can become inflamed and swollen, causing the tubes to narrow, and this usually gives the wheezy symptoms of bronchitis. This is not to be confused with bronchiolitis. Along with this, you may produce more mucus, blocking the airways and causing a thick chesty cough.

The airways tubes lead to tiny air sacs, like balloons – in emphysema these air sacs get less elastic, so they are harder to inflate (think of how tough it is to start blowing up a balloon), and join together which allows less exchange of oxygen to the blood stream and tissues. This makes you feel out of breath.

Some may have more of one subcategory than the other, but most have a combination of both and treatment is much the same, according to symptoms and flare-ups.

COPD symptoms usually will not appear until notable damage has been done to the lungs. Symptoms will most likely magnify over time and can be made worse by continued exposure to cigarette smoke.

Symptoms of COPD can include:

• Shortness of breath, most notably while doing any physical activities.
• Persistent wheezing.
• A chronic cough that often produces phlegm (mucus or sputum) which can vary in appearance from clear, white, yellow or green. People may sometimes ignore this thinking it’s simply a "smoker's cough".
• Regular chest infections/respiratory infections.
• No energy and feeling lethargic.
• Swelling of the ankles, feet or legs.
• Unexpected weight loss can occur in later stages of COPD.

The symptoms of COPD will generally get progressively worse when left untreated. People with COPD will sometimes experience periods where their symptoms are noticeably worse. This is referred to as a COPD exacerbation.

What is a COPD exacerbation?

A COPD exacerbation is a flare-up of the disease which results in intensified symptoms which can last for a few days or even weeks. Exacerbations can vary from person to person and the warning signs can be different. The most prominent sign is a feeling of being unable to catch your breath. You should seek immediate medical help if this becomes severe.

Exacerbations are normally brought on by a lung infection but your environment can also trigger them with smoke and air pollution increasing the chances of it happening.

When should I suspect COPD?

Many people don’t realize they have COPD, and as symptoms come on gradually, they often dismiss them as a smoker’s cough or lack of fitness. If you are a smoker or ex-smoker, especially if you're over 35, and have a persistent cough where you bring up thick sputum, if you feel wheezy or short of breath with minimal exercise, and if you suffer frequent chest infections, these are all reasons to book a routine appointment with your doctor.

If you are a smoker with a cough that persists beyond three weeks, you are coughing up blood, and you may also have weight loss, you should book an urgent appointment with your doctor as this could require urgent investigations.

Do not ignore the symptoms as if it turns out to be COPD, it’s best to start treatment at the earliest signs to reduce the amount of damage to your lungs.

Does COPD only occur in smokers?

Smokers or ex-smokers account for most cases of COPD. Around 90% of cases are caused by smoking.

Cigarette smoke contains harmful chemicals that can damage the lining of the lungs and airways. Stopping smoking can help prevent COPD from getting worse.

Passive smoking may also cause it, if you’ve had prolonged exposure either at home or through your job.

Other causes of COPD

Chemicals and substances

Your job may expose you to other harmful chemicals and substances. Ones which have been linked to COPD include:

• asbestos
• welding fumes
• isocyanates
• silica dust
• coal dust
• grain and flour dust

These can cause COPD as they can damage the lungs in the same way as smoking over long-term exposure. If you smoke, too, these irritants can combine to be even more damaging to your lungs, increasing your chance of COPD and accelerating the process of damage.

Air pollution

Being exposed to polluted air for an extended period can impede the lungs ability to perform properly and scientific research suggests it can increase the chances of developing COPD.

Further research is being done looking into the correlation between air pollution and COPD and it is currently inconclusive.

Genetic conditions

In some very rare cases, you can develop COPD if you have a genetic condition called alpha-1 antitrypsin deficiency. You may have a family history of this and it usually develops at a younger age and it’s not smoking-related.

Your doctor will ask you about your symptoms and if you currently smoke or have done so before. They will assess your symptoms, take your vital signs and listen to your chest and heart. They will likely order further tests, which may include lung function tests, a peak flow diary, trial of an inhaler and symptom diary, or they may order a chest X-ray.

To rule out other lung conditions such as asthma, they can set up a breathing test to make sure it is definitely COPD before starting any treatments. Lung function tests are usually conducted by your doctor at the office. You blow into a tube and a machine records how well your lungs are working. COPD gives a distinctive pattern, compared to other lung conditions like asthma.

If you’ve been diagnosed with COPD, the damage to your lungs is permanent; however treatment can help to slow down the progression of the disease.

Inhalers

You may be given different types of COPD inhalers. One is a short-acting bronchodilator to relax and widen the airways if you have a bout of coughing, wheezing or feeling out of breath. The effect is short-lived, and you shouldn’t use it more than four times per day. If you are regularly needing this, you may be given a long-acting bronchodilator, which lasts for up to 12 hours.

Your doctor may consider prescribing a steroid inhaler or a combination inhaler, to keep inflammation low and prevent you from getting symptoms.

Your doctor or practice nurse will teach you inhaler technique and tell you when to use the inhalers.

Other treatments for COPD

• Pulmonary rehabilitation is an exercise and education program created for people who experience symptoms of breathlessness due to a lung disease. Your doctor may refer you to this which provides you with lung exercises to build flexibility and stamina and education to manage your condition.
• Surgery or a lung transplant is a very rare option for some cases of COPD.

Your doctor will be your main point of contact, and they will review you any time that symptoms suddenly worsen. You will have an annual review with your doctor or practice nurse, where they may ask you to do a peak flow and symptom diary, or repeat lung function tests, to see how well medication is helping symptoms.

Hopefully symptoms will become manageable with treatment and it will slow down the disease. In some cases it can get worse, especially with continued exposure to smoke and other harmful chemicals. This can have a significant impact on quality of life and can result in life-threatening health problems.

How to improve COPD

Give up smoking

Giving up smoking is the best thing you can do for your health, improving any COPD and reducing your risk of many types of cancer and of heart disease, which ultimately reduces the risk of early death. COPD means you have permanent damage to some of the lung tissue. You can’t reverse this damage, but while you continue to smoke, damage will spread further and your COPD will get much worse, with more flare-ups and chest infections.

People are more successful at quitting for good with assistance from Stop Smoking services, where they can help break behavioral patterns and provide nicotine replacement therapy, among other techniques. If you or someone you know is wanting to give it up, have a look at our helpful article on how to quit smoking written by Healthwords's team of doctors and pharmacists based in the UK.

Are there other ways to help my condition?

The lungs are composed of elastic tissue and muscles that allow you to breathe in oxygen and breathe out the waste gas carbon dioxide. The lungs need exercise along with the rest of the body – you should keep as active as you are able, for example brisk walks, gym work and so on. Singing can be a great way to exercise your lungs, so consider joining a choir if it appeals. And continue with your pulmonary rehab exercises.

Obesity adds further stress to the lungs, as respiratory muscles have to work against additional weight on the chest, and there are additional body demands for oxygen. It also adds a further hurdle to keeping active. If you are obese (with a body mass index (BMI) over 30), take steps to lose weight.

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