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Patient Instructions

Chronic obstructive pulmonary disease (COPD) is lung disease that makes it difficult to breathe. There are two main forms of COPD:

• Chronic bronchitis, which causes long-term swelling and a large amount of mucus in the main airways in the lungs
• Emphysema, a lung disease that destroys the air sacs in the lungs

Most people with COPD have symptoms of both.

Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop severe bronchitis. Secondhand smoke may also cause chronic bronchitis. Air pollution, infection, and allergies make chronic bronchitis worse.

In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

Other risk factors for COPD are:

• Exposure to certain gases or fumes in the workplace
• Exposure to heavy amounts of secondhand smoke and pollution
• Frequent use of cooking gas without proper ventilation

• Cough that produces mucus - may be streaked with blood
• Fatigue
• Frequent respiratory infections
• Headaches
• Shortness of breath (dyspnea) that gets worse with mild activity
• Swelling of the ankles, feet, or legs, which affects both sides
• Wheezing

Some people may have few or no symptoms.

The health care provider make hear wheezing or abnormal breathing sounds when listening to the chest and lungs with a stethoscope. However, lung sounds can be normal during the exam.

In severe cases, a person with COPD can seem anxious and may breathe through pursed lips (the shape lips make when you whistle).

During a flare up, the muscles between the ribs contract while the person is breathing in. This is called intercostal retractions. The person will use other muscles to breathe. The number of breaths per minute (respiratory rate) may be high.

The best test for COPD is lung function testing.

A chest x-ray may show that the lung is expanding too much. A chest CT scan may reveal emphysema.

A sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen and high levels of carbon dioxide (respiratory acidosis).

There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse.

Persons with COPD must stop smoking. This is the only way to prevent the lung damage from getting worse.

Medications used to treat COPD include:

• Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), or formoterol (Foradil)
• Inhaled steroids to reduce lung inflammation

In severe cases or during flare-ups, you may need to receive steroids by mouth or through a vein (intravenously).

Antibiotics are prescribed during symptom flare ups, because infections can make COPD worse.

Other treatments for COPD include:

• Breathing support, such as long-term, low-flow oxygen, noninvasive ventilation, or a breathing tube
• Surgery to remove parts of the diseased lung

Lung rehabilitation does not cure the lung disease, but it teaches a patient to breathe in a different way so they can stay active.

Lung rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Many hospitals offer these programs. They can also help you learn more about COPD. Exercise is very important, and helps keep you strong.

Things you can do to make it easier for yourself around the home include:

• Avoiding very cold air
• Making sure no one smokes in your home
• Reducing air pollution by eliminating fireplace smoke and other irritants

Lung transplant is sometimes performed for severe cases.

People often can help ease the stress of illness by joining a support group in which members share common experiences and problems.

See also: Lung disease - support group

This condition is a long-term (chronic) illness. The disease will get worse if you continue to smoke or use tobacco.

• Irregular heart beats (arrhythmias)
• Need for breathing machine and oxygen therapy
• Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
• Pneumonia
• Pneumothorax

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath.

Not smoking prevents most COPD. Diagnosing and treating small airways disease and taking part in stop-smoking programs may prevent the disease from getting worse in persons who smoke.

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

Anthonisen N. Chronic Obstructive Pulmonary Disease. In: Goldman L, Auseillo D. Goldman: Cecil Medicine. Philadelphia, PA: Saunders Elsevier; 2007:chap 88.

Qaseem A. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147:633-638.

Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532-555.

Updated by: Benjamin Medoff, MD, Assistant Professor of Medicine, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.