ritzmoon
29-06-2005, 02:59 PM
My Mum had emphysema it was very hard to watch her suffer.
Cause
Chronic obstructive pulmonary disease (COPD) is most often caused by smoking. Nearly everyone with COPD (80% to 90%) has been a long-term smoker, and research supports the fact that smoking cigarettes increases the risk of developing COPD. 1 At least 10% to 15% of long-term smokers develop COPD with symptoms; some studies indicate up to 50% of long-term smokers older than age 45 develop COPD. 2 This may be in part due to inherited factors (genes) and exposure factors that can affect your risk of developing COPD. 1
COPD is often a mix of two diseases, chronic bronchitis and emphysema. Both of these diseases are caused by smoking. Although you can have either chronic bronchitis or emphysema, people more often have a mixture of both diseases.
Chronic bronchitis
Almost all people with chronic bronchitis are, or have been, tobacco smokers. Over time, tobacco smoke and other lung irritants can lead to inflammation in the airways of the lungs (bronchial tubes). As a result, the airways produce more mucus than they normally would. Inflammation and excess mucus cause coughing and narrow the airways. It is difficult to breathe through the narrow airways, making you feel short of breath.
Long-term (chronic) mucus production and inflammation over many years may lead to worsening and permanent lung damage and may make it more likely you will get lung infections.
Emphysema
In emphysema, tobacco smoke and other irritants can damage the elastic fibers in the lungs. These stretchy strands of tissue are needed for normal lung function. They allow the lung tissue to stretch when you breathe in and help pull the lungs back to their normal size and shape as you breathe out. When the elastic fibers are damaged:
The tiny air sacs (alveoli) at the end of the bronchial tubes are damaged. These air sacs are where the blood exchanges carbon dioxide (a byproduct of metabolism) for oxygen. When air sacs are damaged or destroyed, their walls break down and the sacs become larger. These large air sacs move less oxygen into the blood. Once air sacs are destroyed, they cannot be replaced.
The smaller airways in the lungs (bronchioles) tend to collapse when you breathe out, trapping air in the alveoli. As a result, oxygen-rich air has difficulty entering the air sacs and the bloodstream.
See an illustration of bronchitis and emphysema.
Other causes
Other possible causes of COPD include:
Long-term exposure to lung irritants such as industrial dust and chemical fumes.
Low birth weight and having repeated lung infections.
Inherited factors (genes), including alpha1-antitrypsin deficiency, a rare condition in which your body may not be able to make a protein (alpha1-antitrypsin) that helps protect the lungs from damage. People with this disorder who smoke generally develop the symptoms of emphysema in their 30s or 40s. Those who have this disorder but do not smoke generally develop symptoms in their 80s.
COPD exacerbations
A COPD exacerbation is a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath). A COPD exacerbation can be mild to life-threatening, and you may have to go to the hospital. They are most commonly caused by a bacterial or viral infection in the lung, such as bronchitis or pneumonia, and by air pollution.
Symptoms
People who have chronic obstructive pulmonary disease (COPD) usually have some symptoms of both chronic bronchitis and emphysema. Your symptoms will change depending on the severity of your COPD.
Key symptoms include:
Long-term (chronic) cough.
Chronic mucus (sputum) production when you cough.
Repeated episodes of acute bronchitis.
Shortness of breath that is persistent and gets worse, occurs during exercise, and worsens during respiratory infections, such as colds.
You may have a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath), especially if your COPD is mainly chronic bronchitis. This is called a COPD exacerbation. A COPD exacerbation can be life-threatening, and you may have to go to the hospital.
A number of medical organizations have classified COPD according to symptoms and lung function. Lung function is based on spirometry tests that measure how much air you can breathe out compared to a person without COPD (the predicted value). The specific tests used evaluate how much air you can breathe out in one second (forced expiratory volume, or FEV1) and the amount of air you can breathe out after taking a deep breath (forced vital capacity, or FVC).
The guidelines are all similar. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses the following classifications:
At risk for COPD
You are at risk for COPD if you have long-term (chronic) cough and mucus production. People at risk for COPD have normal lung function, as measured by FEV1.
Mild COPD (stage 1)
Symptoms of mild COPD include a usually, but not always, chronic cough that often brings up mucus from the lungs.
People with mild COPD have impaired lung function, as measured by a FEV1 of 80% or more of predicted value. You may have no shortness of breath and may not know you have impaired lung function until a lung test is done.
Moderate COPD (stage 2)
In moderate COPD, you have some of the symptoms of stage 1, plus you may have:
A worsening chronic cough that brings up a large amount of mucus from the lungs.
Shortness of breath and fatigue with exercise and strenuous daily activities.
An occasional COPD exacerbation, which is a rapid, sometimes sudden, worsening in your usual shortness of breath or in other symptoms.
People with moderate COPD have a FEV1 of 50% to 79% of predicted value. Early symptoms of COPD often are overlooked or considered part of getting older.
Severe COPD (stage 3)
In severe COPD, you have some of the symptoms of stages 1 and 2, plus you may have:
Shortness of breath with even simple daily activities, such as getting dressed and eating.
Weight loss.
Repeated and sometimes severe COPD exacerbations that have an impact on your life.
People with severe COPD have greatly reduced lung function (a FEV1 of 30% to 49% of predicted value).
Very severe COPD (stage 4)
In very severe COPD, you have some of the symptoms of stages 1 through 3, plus you may have:
Blue skin color (cyanosis), especially in the lips, fingers, and toes.
Fluid buildup in the legs and feet (edema).
Bloated abdomen.
Confusion (because of too little oxygen and too much carbon dioxide in the blood).
Life-threatening COPD exacerbations.
People with very severe COPD have a FEV1 of less than 30% of predicted value or 30% to 49% of predicted value plus chronic respiratory failure (carbon dioxide remains in the lungs).
Conditions with similar symptoms include heart failure and coronary artery disease.
Asthma is another lung condition that may have symptoms similar to COPD, and some people with COPD may have asthma. The two conditions differ in a number of ways, including the age at which the conditions develop and what triggers a reaction.
Treatment Overview
Although chronic obstructive pulmonary disease (COPD) cannot be cured, it can be managed. Treatment for COPD focuses on:
Slowing the progression of the disease by avoiding tobacco smoke and other environmental factors, such as air pollution.
Reducing and controlling symptoms, such as shortness of breath.
Increasing your activity level.
Improving your overall health.
Preventing and treating a COPD exacerbation—a rapid and sudden increase in your cough, amount of mucus, and/or shortness of breath—and other complications.
Following your treatment plan may reduce symptoms enough to allow you to participate in hobbies, daily activities, and family events.
Because people are diagnosed at different stages of COPD, your initial treatment will depend on the severity of your COPD and your associated symptoms.
Initial treatment
Initial treatment for chronic obstructive pulmonary disease (COPD) helps you breathe better and slow the disease. It includes:
Quitting smoking. This is the most important step you can take to prevent or slow damage to your lungs—it is never too late to stop smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow the progression of the disease and improve your quality of life. Nicotine replacement therapy, use of the medication bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting. 5 For more information, see the topic Quitting Tobacco Use.
Doing all you can to make breathing easier.
Avoid conditions that may irritate your lungs, such as indoor and outdoor air pollution; smog; cold, dry air; hot, humid air; or high altitudes.
Take rest breaks. Schedule rest breaks when doing household chores and other activities. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
Learn breath training techniques to improve airflow in and out of your lungs.
Staying as active as possible and getting regular exercise. Exercise improves shortness of breath and will help you be more active. If you stay active, you may develop fewer complications, have a better attitude about your life and the disease, and be less likely to feel isolated from friends and family or depressed. For more information on exercising with COPD, see:
Exercises for chronic obstructive pulmonary disease.
Assessing the need for oxygen treatment, which is mainly used to prevent or slow the worsening of right-sided heart failure and to prevent premature death.
Avoiding respiratory illnesses, such as the flu (influenza) and pneumonia. Avoiding these illnesses can help prevent worsening of COPD. Talk with your health professional about getting a yearly flu shot and the pneumococcal vaccine to protect against pneumonia.
Eating regularly and well. Problems with muscle weakness and weight loss are frequent with COPD. For more information, see:
Eating well when you have COPD.
Avoiding weight loss when you have COPD.
Medications can help relieve shortness of breath and prevent a rapid, sometimes sudden, and prolonged worsening cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Medications include:
Anticholinergics (ipratropium, tiotropium), inhaled corticosteroids (beclomethasone dipropionate, fluticasone propionate, budesonide) and beta2-agonists (albuterol, metaproterenol). These medications help you breathe more easily and may prevent COPD exacerbations. They usually are used with an inhaler, which delivers more medication directly to the lungs. If you use a metered-dose inhaler (MDI), be certain you know how to use it properly. For more information, see:
Using a metered-dose inhaler.
Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.
Treating more than the disease and its symptoms is vital to success. Treatment should also include:
Education. Educating yourself and your family about COPD and your treatment plan helps you and your family cope with your lung disease.
Counseling and support groups. Shortness of breath may reduce your activity level and make you feel socially isolated because you cannot enjoy activities with your family and friends. You should be able to lead a full life and be sexually active. Counseling and support groups can help you and your family learn to live with COPD.
Building a support network of family and friends. Learning that you have a disease that may shorten your life may trigger depression or grief. Anxiety can make respiratory symptoms worse and can trigger or prolong exacerbations. Support from family and friends can reduce anxiety and stress and make it easier to live with COPD.
Ongoing treatment
As chronic obstructive pulmonary disease (COPD) progresses, it is important to recognize and treat complications, especially a COPD exacerbation. COPD exacerbations are a sudden and prolonged increase in symptoms—shortness of breath, cough, and mucus (sputum) production. A COPD exacerbation can be life-threatening, and you may need to go to your health professional’s office or to a hospital. Treatment includes:
Anticholinergics (ipratropium, tiotropium), oral corticosteroids (prednisone, budesonide), and beta2-agonists (albuterol, metaproterenol), which make it easier to breathe.
Mechanical ventilation, which is a machine that helps you breathe. Ventilation is used only if medication is not helping you.
Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of some people who have severe COPD.
Antibiotics, which are used when a bacterial lung infection is considered likely. People with COPD have an increased risk of pneumonia and frequent respiratory infections. Although most infections are caused by a virus, some are caused by bacteria. Some experts believe that since most exacerbations are caused by viruses, antibiotics should not be used unless there is a confirmed bacterial infection.
Other complications you may have include depression, which is treated through counseling and medication, and problems with muscle weakness and weight loss, which can be treated by improving your diet. For more information, see:
Eating well when you have COPD.
Avoiding weight loss when you have COPD.
Your health professional may also suggest a pulmonary rehabilitation program, which is a supervised program that includes activities such as exercise and breath training.
Treatment if the condition gets worse
As chronic obstructive pulmonary disease (COPD) worsens, you may experience increased shortness of breath and more COPD exacerbations, and it will become more and more difficult to perform daily activities. A pulmonary rehabilitation program, which includes activities such as exercise and breath training, can help make it possible for you to perform daily activities.
Other treatment includes:
Using medications such as methylxanthines or oral corticosteroids.
Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of some people who have severe COPD.
Lung volume reduction surgery, which removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently.
A lung transplant, which is surgery to replace a diseased lung with a living lung from a person who has recently died. Lung transplants are not common.
A bullectomy, which removes bullae from the lungs in those who mainly have emphysema. Bullae are formed when the tiny air sacs in the lungs break into larger air spaces. They sometimes can become so large that they interfere with breathing. However, they are rarely treated surgically.
Heart failure that affects the right side of the heart (cor pulmonale) frequently occurs in people with COPD. Depending on its severity, oxygen and diuretic medication may be needed.
Treatment for COPD is increasingly successful at prolonging life. However, COPD is a progressive and possibly fatal disease. You and your health professional should discuss what types of medical treatment you want to receive if sudden, life-threatening breathing problems develop, such as whether you want to receive mechanical ventilation. This discussion may include the possibility of your creating an advance directive to state your wishes if you become unable to communicate them. For more information, see the topics Writing an Advance Directive and Care at the End of Life.
Medications
Medication for chronic obstructive pulmonary disease (COPD) is used to reduce shortness of breath, control any coughing and wheezing, and to prevent and reduce a rapid, sometimes sudden, and prolonged worsening of cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Most people with COPD find that medications make breathing easier.
Bronchodilators and inhaled corticosteroids are often used with a metered-dose inhaler (MDI), a dry powder inhaler (DPI), or through a mouthpiece or mask (nebulizer). Most health professionals recommend that everyone using an MDI also use a spacer, which efficiently delivers medication to the lungs and makes it easier to control the dose. Use of a spacer is especially important when using an inhaler containing a corticosteroid medication. Do not use a spacer with a dry powder inhaler (DPI).
Many people use an MDI incorrectly and do not get the full benefit from the medication. For more information, see:
Using a metered-dose inhaler correctly.
Medication Choices
Bronchodilators are used to open or relax the airways of the lung (bronchial tubes) and relieve shortness of breath. They include:
Anticholinergics (ipratropium, tiotropium), which are considered first-line therapy for treating persistent symptoms.
Beta2-agonists (albuterol, metaproterenol), which are considered first-line therapy for treating symptoms of mild COPD that come and go (intermittent symptoms).
Oral corticosteroids (prednisone, budesonide) may be used for a COPD exacerbation (in pill form) or to prevent COPD exacerbations (in inhaled form). They are often used if you also have asthma.
Other medications used for COPD include:
Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.
Methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects.
Other medications used for COPD include leukotrienes, cromolyn, and nedocromil. However, they are not very effective and are rarely used.
What to Think About
The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This does not always mean the medication will not help. It is usually best to try the medicine for a period of time before you decide whether it is working.
Combining beta2-agonists with anticholinergics or corticosteroids provides better results than using these medications alone. 8, 9 It may also reduce the risk of side effects compared to increasing the dose of one medication. 10
An MDI works as well as a nebulizer in delivering medication and is less expensive. Most health professionals use nebulizers only for people who cannot properly use an MDI or who have serious symptoms that require more medication than an inhaler supplies.
It is important to keep track of your inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medication but also prevents you from inhaling only propellant after the medication has run out.
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