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Overview
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. It includes:
- emphysema – damage to the air sacs in the lungs
- chronic bronchitis – long-term inflammation of the airways
COPD is a common condition that mainly affects middle-aged or older adults who smoke. Many people do not realise they have it.
The breathing problems tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control.
Symptoms
Most people with COPD do not have any noticeable symptoms until they reach their late 40s or 50s.
Common symptoms of COPD include:
- shortness of breath – this may only happen when exercising at first, and you may sometimes wake up at night feeling breathless
- a persistent chesty cough with phlegm that does not go away
- frequent chest infections
- persistent wheezing
The symptoms will usually get gradually worse over time and make daily activities increasingly difficult, although treatment can help slow the progression.
Sometimes there may be periods when your symptoms get suddenly worse – known as a flare-up or exacerbation. It's common to have a few flare-ups a year, particularly during the winter.
Other symptoms
Less common symptoms of COPD include:
- weight loss
- tiredness
- swollen ankles from a build-up of fluid (oedema)
- chest pain and coughing up blood – although these are usually signs of another condition, such as a chest infection or possibly lung cancer
These additional symptoms only tend to happen when COPD reaches an advanced stage.
Causes
Chronic obstructive pulmonary disease (COPD) happens when the lungs and airways become damaged and inflamed.
It's usually associated with long-term exposure to harmful substances such as cigarette smoke.
Risk Factors
Things that can increase your risk of developing COPD are discussed in this section.
Smoking
Smoking is the main cause of COPD and is thought to be responsible for around 9 in every 10 cases.
The harmful chemicals in smoke can damage the lining of the lungs and airways. Stopping smoking can help prevent COPD from getting worse.
Some research also suggests that being exposed to other people's cigarette smoke (passive smoking) may increase your risk of COPD.
Fumes and dust at work
Exposure to certain types of dust and chemicals at work may damage the lungs and increase your risk of COPD.
Substances that have been linked to COPD include:
- cadmium dust and fumes
- grain and flour dust
- silica dust
- welding fumes
- isocyanates
- coal dust
The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke.
Air pollution
Exposure to air pollution over a long period can affect how well the lungs work and some research suggests it could increase your risk of COPD.
But the link between air pollution and COPD is not conclusive and research is continuing.
Genetics
You're more likely to develop COPD if you smoke and have a close relative with the condition, which suggests some people's genes might make them more vulnerable to the condition.
People with alpha-1-antitrypsin deficiency can go on to develop COPD. Alpha-1-antitrypsin is a substance that protects your lungs. Without it, the lungs are more vulnerable to damage.
People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age – particularly if they smoke.
Diagnosis
To help them diagnose COPD, a GP may:
- ask you about your symptoms
- examine your chest and listen to your breathing using a stethoscope
- ask whether you smoke or used to smoke
- calculate your body mass index (BMI) using your weight and height
- ask if you have a family history of lung problems
- They may also do, or arrange for you to have, a breathing test called spirometry, plus other related tests of the lungs and airways.
Spirometry
A spirometry test can help show how well your lungs are working.
You'll be asked to breathe into a machine called a spirometer after inhaling a medicine called a bronchodilator, which helps widen your airways.
The spirometer takes 2 measurements: the volume of air you can breathe out in a second, and the total amount of air you breathe out. You may be asked to breathe out a few times to get a consistent reading.
The readings are compared with normal results for your age, which can show if your airways are obstructed.
Chest X-ray
A chest X-ray can be used to look for problems in the lungs that can cause similar symptoms to COPD.
Problems that can be shown by an X-ray include chest infections and lung cancer, although these do not always show.
Blood tests
A blood test can show other conditions that can cause similar symptoms to COPD, such as a low iron level (anaemia) and a high concentration of red blood cells in your blood (erythrocytosis).
Sometimes a blood test may also be done to see if you have alpha-1-antitrypsin deficiency. This is a rare genetic problem that increases your risk of COPD.
Further tests
Sometimes more tests may be needed to confirm the diagnosis or determine the severity of your COPD.
This will help you and your doctor plan your treatment.
These tests may include:
- an electrocardiogram (ECG) – a test that measures the electrical activity of the heart
- an echocardiogram – an ultrasound scan of the heart
- a peak flow test – a breathing test that measures how fast you can blow air out of your lungs, which can help rule out asthma
- a blood oxygen test – a peg-like device is attached to your finger to measure the level of oxygen in your blood
- a CT (computed tomography) scan – a detailed scan that can help identify any problems in your lungs
- a phlegm sample – a sample of your phlegm (spit) may be tested to check for signs of a chest infection
Treatment Options
There's currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms.
Treatments include:
- stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
- inhalers and tablets – to help make breathing easier
- pulmonary rehabilitation – a specialised programme of exercise and education
- surgery or a lung transplant – although this is only an option for a very small number of people
A doctor will discuss the various treatment options with you.
When To See A Doctor
See a GP if you have persistent symptoms of COPD, particularly if you're over 35 and smoke or used to smoke.
There are several conditions that cause similar symptoms, such as asthma, bronchiectasis, anaemia and heart failure. A simple breathing test can help determine if you have COPD.
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