Q&A: What is COPD?
12/28/2023 by Denise Dupras, M.D., Ph.D.
Chronic obstructive pulmonary disease, or COPD, includes emphysema and chronic bronchitis. It is a chronic and progressive condition. Once people develop COPD, they will have it for life. In most cases, it develops in older adults, but it is preventable and treatable.
A survey in 2018 found that 15.8 million people in the U.S. reported they had COPD. The medical community previously thought COPD was a disease mainly affecting men, but since 2000, more women than men have died from COPD. Women seem to develop COPD at younger ages and with lower levels of tobacco exposure. They also may respond differently to COPD treatments.
What is emphysema?
Emphysema is a condition where the small air sacs within the lungs, called alveoli, are destroyed. This results in larger air spaces and causes less surface to be available to absorb oxygen from the bloodstream. Air becomes trapped in the lungs and the alveoli don't work correctly. The result of trapped old air prevents new air from entering. This effect, combined with less opportunity for oxygen to be absorbed, results in shortness of breath and lower blood oxygen levels.
What is chronic bronchitis?
Chronic bronchitis results from inflammation of the linings of the bronchial tubes that carry air to and from the air sacs of the lungs. This inflammation leads to increased mucus production, causing people to have a daily mucus-producing cough. Shortness of breath also is common and is often accompanied by wheezing.
Is COPD the same as asthma?
COPD is different from asthma. While symptoms may be similar, asthma is an inflammatory reaction caused by spasms of the small airways, which are reversible. COPD is generally not reversible, although symptoms are treatable.
Asthma is more likely to present earlier, even in children. One type occurs in response to exposures to specific irritants that may be present in the environment, such as pollen. Exercise also may induce asthma in susceptible people.
What causes COPD?
The most common cause of COPD is tobacco, either used directly or inhaled as secondhand smoke. Exposure to particles in the workplace, such as dust and chemicals, also can contribute to the disease and are much more common.
While less common, a genetic deficiency in alpha-I antitrypsin protein can cause or contribute to the development of COPD. Development of COPD at a younger age or multiple family members who develop COPD at a younger age are clues to possible alpha-I antitrypsin deficiency. Approximately 1 in 30 people with COPD may have undetected alpha-I antitrypsin deficiency.
What are the symptoms of COPD?
Common symptoms include shortness of breath, which is often worse with activity; wheezing; chest tightness; cough, which may produce mucous of variable colors; and frequent respiratory infections. As the condition worsens, weight loss and swelling in the feet, ankles and legs may occur.
How can you tell if you have COPD?
If you smoke and have shortness of breath and a cough, regardless of whether it produces mucus, you likely have COPD. Therefore, you should discuss these symptoms with your healthcare clinician. Exposure in your home or workplace to things that irritate your lungs, such as dust or fumes, or a family history of COPD in nonsmokers, increases the risk that these symptoms are due to COPD.
How is COPD diagnosed?
While your healthcare clinician can diagnose COPD based on symptoms, a test called spirometry, which measures the flow of air in and out of the lungs, can help determine if symptoms are due to emphysema or chronic bronchitis. Additional testing may be needed to confirm the diagnosis.
How is COPD treated?
The first step in treating COPD is to remove exposure to smoke, dust and fumes. Smokers should stop smoking and secondhand smoke should be eliminated. Additional treatments may include inhalers, which are bronchodilators to open airways, with the addition of inhaled corticosteroids to decrease inflammation.
Healthcare clinicians will develop action plans to manage infections or flares in COPD. Additional treatment may include gene replacement therapy, specific for alpha-I antitrypsin deficiency; supplemental oxygen; pulmonary rehabilitation; lung reduction surgery; and lung transplantation.
Take-home messages:
- COPD can be prevented.
- Stopping smoking can prevent COPD from developing.
- COPD is a chronic condition, and once it develops, a patient will have it for life.
- If you have COPD symptoms, talk to your healthcare clinician.
- Medications are available to treat COPD symptoms.
- Medications can control the symptoms of COPD.
- Get all recommended vaccinations, including the annual influenza vaccination.
Denise Dupras, M.D., Ph.D., is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minn. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.