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Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (abbreviated
COPD) is a general term for diseases that are
characterized by long-term or permanent narrowing of
small airways (known as bronchi) connected to the
lungs. The lungs are two organs in the body that help
people breathe. The narrowing of the small airways
obstructs (blocks) the flow of air through them. This
means that the lungs cannot take in or release as much
air.
Smoking tobacco cigarettes is
the main cause of COPD.
 
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Thus, COPD leads to slowed, difficult breathing and increased shortness of breath.
COPD generally gets worse over time (which is why it is called chronic), causing damage
to the airways and tissues of the lungs. There is no cure for COPD.

The term "COPD" is often used when the cause of the breathing problems described
above cannot be determined or a more specific term cannot be applied. Some people use
the term "COPD" to mean a combination of chronic bronchitis and emphysema, both of
which are described below.

Since these conditions often occur together, many doctors prefer to use the term "COPD"
so they don't have to say the name of both conditions. For people with COPD who have
both of these conditions, one is usually more dominant than the other. The damage
caused to the lungs by both bronchitis and emphysema is usually irreversible. Other
conditions that would also qualify as COPD are listed in the next section.

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WHAT MAKES COPD WORSE?

COPD is made worse by the following:

1. SMOKING

2. AIR POLLUTION

3. ASTHMA: A breathing disorder characterized by sudden
shortness of breath at night, abnormal sounds while breathing,
coughing, narrowed bronchi (see above), and the release of mucus
(a thick, slippery fluid) in the bronchi.

4. CHRONIC BRONCHITIS: A common lung disease characterized by increased mucus in the windpipe
and bronchi (see above). The bronchi become inflamed, clogged, and narrow, making it more difficult for
air to pass through. Chronic bronchitis is also caused by coughing and spitting up of mucus for at least
three months of the year or for two straight years.

5. EMPHYSEMA: An abnormality characterized by enlargement and damage of the walls of tiny balloon-
like sacs in the lungs that air travels to. These tiny sacs (known as alveoli) are where gases are
exchanged in the lungs so that breathing can take place. The enlargement and damage of these tiny air
sacs makes it more difficult for oxygen to move from the lungs to the blood.

6. CHRONIC BRONCHIECTASIS: An abnormal condition characterized by irreversible stretching open and
destruction of the bronchi walls.

WHAT CAUSES COPD?

About 80% to 90% of COPD cases are caused by smoking. Air pollution is another cause of COPD. Thus,
COPD is more common in cities that have many people and many businesses that people work in. In such
cities, there are more people that smoke and more businesses that produce air pollution. People who work
in jobs where they are exposed to dust, poisonous gases, and other substances are also at risk for
developing COPD. Frequent lung infections are another possible cause of COPD. In rare cases,
emphysema can be caused by a severe deficiency of alpha 1-antitrypsin, a type protein that helps protect
the body from an enzyme (protein that helps produce chemical reactiosn) known as neutrophil elastase.
Without this protection, elastase can accumulate in the lung tissue and damage the tissue that helps
absorb oxygen.

CAN COPD BE INHERITED FROM PARENTS?

COPD is rarely caused by inheriting an abnormal gene from both parents. Genes are units of material
contained in a person's cells that contain coded instructions as for how certain bodily characteristics
(such as eye color) will develop. A cell is the smallest, most basic unit of life, that is capable of existing by
itself. All of a person's genes come from his/her parents. This is why people have physical characteristic
of their parents.

When COPD is inherited, it is due to a condition known as alpha1-antitrypsin deficiency. In this rare
condition (it occurs in 2 out of 1000 people), people are missing a natural substance in the body, known
as alpha1-antitrypsin. This substance prevents other substances in the body from destroying tissues in
the lungs and liver. If someone is missing alpha1-antitrypsin, then tissues in the lungs and liver will be
destroyed because the substance is not there to prevent it. Unfortunately, this means that whether or not
people with this condition smoke, the lungs will become damaged. However, smoking will make this
damage worse.

TELL ME MORE ABOUT THE CHRONIC BRONCHITIS ASPECT OF COPD?

In chronic bronchitis, the linings of the airways in the lungs respond to irritation from smoke by developing
thicker and narrower air passages into and out of the lungs. Groups of specialized cells, known as mucus
glands, multiply in the linings of the bronchi. This leads to more mucus production. To clear the airways,
coughing occurs so that the person can spit the extra mucus out. However, even coughing becomes
difficult over time in chronic bronchitis and the airways cannot be cleared out as effectively. This leads
mucus to buildup in the airway passages, which can easily lead to infections. The infections, in turn, can
lead to further damage. For example, repeated infections will eventually cause the linings of the airways to
be permanently damaged, thickened, and scarred.

TELL ME MORE ABOUT THE EMPHYSEMA ASPECT OF COPD?

In emphysema, smoke from cigarettes and pollution in the air damage the tissues in the air sacs (known
as alveoli). This leads the air sacs to open up because they are not as stretchy as they used to be.
Picture the damaged air sacs being like small rubber bands that are stretched out but cannot return to their
normal state. The air sacs eventually tear and clump together. This reduces the amount of space in the
lungs and air becomes trapped in the widened air sacs. Since the air is trapped, the amount of oxygen
that enters the blood is reduced. It is in these air sacs where oxygen normally moves from the lungs to the
blood.

WHAT ARE THE SIGNS AND SYMPOMS OF COPD?

The signs and symptoms may take years to develop, but usually develop in this order:

1. Coughing up of material from the lungs in the morning.
2. Coughing throughout the day.
3. Increased production of materials coughed up from the lungs.
4. Frequent chest infections. These infections especially occur in the winter months and produce green or
yellow material that is coughed   
up from the lungs.
5. Wheezing (abnormal breathing sounds), especially after coughing.
6. Shortness of breath when performing activities in which one does not have to put forth much physical
effort. The shortness of breath can become so bad that it can occur even when the person is resting.

The symptoms mentioned above get worse in the cold weather and when infections occur. Other signs of
COPD include breathing failure, which causes the fingers, lips, toes, and tongue to turn blue. In fact, the
entire body can take on a blue appearance from not getting enough oxygen in the blood. Swelling in the
ankles, feet, and legs can occur due to long-term heart failure. The chest of some people with emphysema
can become barrel-shaped as the lungs expand. The skin of some people with COPD may appear red
because they unknowingly breathe faster to get more oxygen into their blood. People with the symptoms
listed above should call their doctor as soon as possible.

HOW IS COPD DIAGNOSED?

To begin with, the doctor examining a patient with suspected COPD will want to know if he/she has a
history of smoking. Since most cases of COPD are due to smoking, such information is very important to
making a diagnosis of COPD. The doctor will also ask the patient if he/she is experiencing any of the
signs and symptoms mentioned above. If anyone in the patient's family has developed COPD before age
50, blood tests may be done to check for the amount of alpha1-antitrypsin in the blood to see if enough of
it is present. See the section above on whether COPD can be inherited, to read about alpha1-antitrypsin
deficiency.

Blood tests may also be done to measure the amount of gases in the blood such as oxygen and carbon
dioxide. The doctor may want to test any material coughed up from the lungs. He/she may perform tests
known as electrocardiography or echocardiography to assess if the heart is working properly. These heart
tests will be able to tell the doctor if the heart is working too hard to pump blood through the lungs.

The doctor may also perform tests that measure lung functioning by having the patient breath into special
machines. The patient may be given tests such as X-rays or computerized axial tomography (CT) scans,
to produce pictures of the chest. These pictures can be used to look for damage of lung tissue and to
make sure the problems that the patient is reporting are not due something other than COPD. Compared
to X-rays, CT scanning is a more advanced imaging technique and produces much clearer pictures.

WHAT CAN I DO IF I HAVE COPD?

As was mentioned earlier, the damage due to the lungs from COPD is mostly irreversible. However, there
are some things that can be done to reduce symptoms. If the COPD occurred from smoking, giving up
smoking forever is the only thing that can be done to prevent COPD from getting worse. Simply reducing
the number of cigarettes smoked will have little or no effect on improving the disorder. The environment
that the patient lives in should be kept clear of smoke, dust, dirt, dampness, cold, and any form of
pollution.

The doctor may prescribe an inhaler (a device that you breathe in from) that contains a medication that
widens walls of the bronchi (air passages). This will help more air get through the bronchi and will
decrease shortness of breath. Also, home oxygen therapy can be used to provide oxygen rich air to the
body. Home oxygen therapy requires placing a tube in the nose that delivers the oxygen. The tube is
hooked up to a special machine that can be taken home. Low doses of oxygen may be given to a patient
with COPD for at least 15 hours a day to prevent heart failure and death.

Swollen ankles or other swollen body parts can be treated with medications known as diuretics that
reduce fluid buildup in the body. Infections in the chest can be treated with antibiotics, which are
medicines that fight infections. Vaccines, which are substances injected into the body to prevent against
certain types of infection (such as the flu and Streptococcus pneumoniae) should be administered.
A procedure known as lung volume reduction surgery is sometimes used to help the lungs move inwards
and outwards more easily. This procedure involves removing some of the lung tissue and is used in
people whose lungs are stretched out very wide. The procedure can help increase the amount of oxygen
that gets to the blood.

WILL EXERCISE HELP MY LUNGS IMPROVE IF I HAVE COPD?

No. Exercise will not help the lungs function better in patients with COPD. However, gentle exercise, such
as walking, may help build up tolerance to exercise.

WHAT IS THE PROGNOSIS FOR PEOPLE WITH COPD?

The answer to this question depends on the severity of the COPD. If the COPD is mild and detected early,
it may be possible to prevent severe, worsening lung damage by immediately stopping smoking.
Unfortunately, many people do not realize they have COPD until it is too late. These people often need to
stop working due to shortness of breath and are forced to stay at home most of the time.

Three out of four people with COPD will survive for one year after being diagnosed with it. However, only
1 out of 20 people will survive for longer than 10 years after being diagnosed with COPD. Between
85,000 and 120,000 people a year die from COPD. Smokers are 10 times more likely to develop COPD
than non-smokers. It is the 4th most common cause of death in the United States.

HOW MANY PEOPLE HAVE COPD?

About 15 million people in the United States have COPD, making it a very common condition.

HOW MANY PEOPLE HAVE COPD?

About 15 million people in the United States have COPD, making it a very common condition.

CAN PEOPLE BECOME DISABLED FROM COPD?

Yes. People can become seriously disabled from COPD due to severe shortness of breath, preventing
them from carrying out simple daily tasks.

WHAT AGE DO PEOPLE USUALLY GET COPD?

COPD is more common after age 40.

ARE MALES OR FEMALES MORE LIKELY TO HAVE COPD?

Males are twice as likely as females to have COPD. However, COPD is becoming increasingly common in
older women.

WHAT ELSE IS COPD KNOWN AS?

Chronic obstructive pulmonary disease is also known as chronic obstructive lung disease.

WHAT IS THE ORIGIN OF THE TERM COPD?

Chronic comes from the Greek word "chronos" meaning "time." Obstructive comes from the Latin word
"obstruere" meaning "to build against." Pulmonary comes from the Latin word "pulmo" meaning "lung."
Disease comes from the Latin word "dis" meaning "separation," and the French word "aise" meaning
"ease." Dis-, in the case of disease, means "bad."