Chronic Obstructive Pulmonary Disease

What is COPD?

• Chronic obstructive pulmonary disease (COPD) is a medical condition that causes breathing problems. COPD includes two main illnesses: chronic bronchitis and emphysema. COPD damages parts of your lungs called bronchiole tubes and alveoli. The damage makes it hard for your lungs to move oxygen from the air you breathe into your bloodstream. This can make it hard for you to breathe and do your daily activities.
  
  
• COPD is a serious condition that gets worse over time. Lung damage from COPD cannot be reversed. However, treatment may help prevent more damage. Treatment may also help you breathe better and return to your normal daily activities.

What causes COPD?

You may have COPD at any age. You may be at higher risk of having COPD if you have had other lung conditions. These include asthma and lung infections such as tuberculosis. COPD is most commonly caused by exposure to the following:

• Tobacco smoke. You are at high risk for COPD if you smoke cigarettes, cigars, or a pipe. You are also at risk if you breathe in smoke from other people's tobacco use.
  
  
• Dust, chemicals, or smoke used in the workplace.
  
  
• Air pollution.

What are the signs and symptoms of COPD?

You may have more than one of the following signs and symptoms of COPD:

• Trouble breathing that gets worse with exercise. Trouble breathing can make it hard for you to talk, sleep, or work.
  
  
• Chronic (long-term) cough.
  
  
• Chronic production of sputum (thick fluid from your lungs).
  
  
• Wheezing (difficult breathing that makes a whistling sound).
  
  
• A feeling of tightness in your chest.
  
  
• A bluish tint to your skin, lips, or nailbeds.

How is COPD diagnosed?

Your caregiver will ask about your symptoms, risk factors, and health history. He will also do a physical exam and check how fast you breathe. You may need any of the following tests:

• Spirometry: A spirometer measures how well you can breathe. You will take a deep breath and then push the air out as fast as you can. This test measures how much air you are able to push out. This is called forced expiratory volume (FEV). The test results show caregivers how small your airways have become.
  
  
• Arterial blood gas test: This is also called an ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of oxygen, acids, and carbon dioxide. This test may show how serious your condition is and what treatment is best for you. You may have blood drawn for other tests.
  
  
• Sputum sample: Sputum is collected in a special cup when you cough. It is sent to a lab to check for a lung infection. If you have a lung infection, the sample can also help your caregiver choose what medicine is best for you.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use the x-ray to look for signs of damage to the lungs.
  
  
• Exercise testing: This test checks how long you can walk or do other exercise. It will show how well your lungs work and help caregivers plan your treatment.

How is COPD treated?

• Quit smoking: Smoking is the most common cause of COPD. If you smoke, you should quit. Quitting smoking may help reduce your symptoms. It is never too late to quit. Smoking harms your body in many ways. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. Ask your caregiver for more information about how to stop smoking if you have trouble quitting.
  
  
• Medicines:
  
  
  • Bronchodilators: These help open your airways so you can breathe better. They are most often taken using one of the following devices:
    
    
    • Inhaler: This is a hand-held device that delivers medicine that you breathe in.
      
      
    • Nebulizer: This is a machine that turns liquid medicine into mist that you breathe in through a mouthpiece.
    
    
  • Corticosteroids: These help you breathe better by decreasing swelling in your lungs. They may be inhaled or taken as a pill.
    
    
  • Antibiotics: These are used to treat lung infections that may make your COPD symptoms worse.
  
  
• Pulmonary rehabilitation: This program lasts around 6 to 12 weeks and may help you function better with COPD. You will learn how to manage your symptoms and help keep them from returning. Pulmonary rehabilitation may include exercise training. This includes walking and other exercises that build up your lung strength. Caregivers may also teach you what foods can help you be healthier.
  
  
• Oxygen: You may need to use oxygen if you have severe COPD. You may use oxygen during exercise or to treat breathlessness. Or you may use oxygen all the time. Oxygen may be taken in through a nasal cannula or a face mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose.
  
  
• Surgery: You may need surgery if you have severe COPD and all other treatments have failed. A lung reduction is when part of your lung is removed to help you breathe better. A lung transplant is when your lung is replaced with a lung from a donor. Ask your caregiver for more information about surgery for COPD.

What is an exacerbation of COPD?

An exacerbation is when your COPD symptoms suddenly get worse. You may have a harder time breathing, your cough may get worse, and you may cough up more sputum. You may have a fever, increased heart rate, or feel sleepy. An exacerbation may be caused by a lung infection, air pollution, or other lung irritants. Sometimes the cause of an exacerbation is unknown. Your caregiver may change your treatment to help relieve your exacerbation.

How can I help manage my COPD and prevent exacerbations?

• Avoid cigarette smoke and other irritants. Do not smoke or breathe in smoke from other people's cigarettes. If your workplace has dust and chemicals that bother you, wear protective gear. Stay inside and avoid outdoor exercise when air quality is bad.
  
  
• Take your medicines as directed by your caregiver. This can help you have fewer and less severe exacerbations.
  
  
• Get early treatment if your symptoms are getting worse. This may help you recover faster. Create an action plan for what to do in case of an exacerbation.
  
  
• Exercise as directed by your caregiver. Exercise can help reduce breathing problems and make you feel less tired. Your symptoms may get worse if you are not active.
  
  
• Use pursed-lip breathing. Pursed-lip breathing can be used any time you feel short of breath. It can be especially helpful before you start an activity.
  
  
  • Take a deep breath in through your nose.
    
    
  • Slowly breathe out through your mouth with your lips pursed (slightly puckered). An example of pursed lips is when you pucker your lips to blow out a candle. You should make a quiet hissing sound as you breathe out through your pursed lips.
    
    
  • Try to take a long time to breathe out. It should take you twice as long to breathe out as it did to breathe in. This helps you get rid of as much air from your lungs as possible.
    
    
  • Repeat this exercise several times. Once you are used to doing pursed-lip breathing, you can do it any time you need more air.
  
  
• Keep a healthy weight. Eat several small meals each day if you have trouble breathing while you eat.
  
  
• Vaccines: To prevent influenza (flu), all adults should get the influenza vaccine. They should get it every year as soon as it becomes available. The pneumococcal vaccine is given to adults aged 65 years or older to prevent pneumococcal disease, such as pneumonia. People aged 19 to 64 years at high risk for pneumococcal disease also should get the pneumococcal vaccine. It may need to be repeated 5 years later.

What are the risks of having COPD?

• Bronchodilators may make your mouth dry. You may have headaches, nausea, and seizures. It may be hard for you to sleep. You may also have tremors (uncontrolled movements) and hypokalemia ( low levels of potassium in the blood). Inhaled corticosteroids raise your risk of pneumonia (lung infection). Surgery for COPD can cause infection and respiratory failure. Lung transplant can cause rejection of the lung (when your body does not accept the lung).
  
  
• You may be more likely to get colds and the flu. Your lungs may not be able to send enough oxygen to your body. High blood pressure may occur in your lungs. You are at greater risk of having lung cancer. You may develop chest pain or heart disease. You can have a heart attack.
  
  
• Lack of oxygen may cause damage to your organs, such as your heart or kidneys. You are at greater risk of diabetes (disease caused by too much sugar in the blood). You may develop anemia (not enough red blood cells) and glaucoma (eye disease caused by too much fluid in the eye). You are at greater risk of having osteoporosis (decrease in bone mass) and broken bones. You may feel isolated because of your limited function. You may develop depression, anxiety, and trouble sleeping. Talk with your caregiver about these and other risks of COPD.

Where can I find support and more information?

You may feel worried, scared, and sad if you have COPD. You may worry about your future. These feelings are normal. It may help to learn all you can about COPD. Ask your caregiver for more information. If you smoke, he can help you quit smoking. It may also help to join a support group. This is a group of people who also have COPD. Contact the following for more information about COPD and support groups:

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: http://www.lungusa.org
  

• Smokefree.gov
  Phone: 1- 800 - 784-8669
  Web Address: www.smokefree.gov
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You have trouble talking or doing your usual exercise or activities because it is hard to breathe.
  
  
• You have a cough that lasts three months or longer.
  
  
• You cough up more sputum than is normal for you.
  
  
• You wheeze more than is normal for you.
  
  
• You have a bluish tint to your skin, lips, or nailbeds.
  
  
• You have swelling in your legs or ankles.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You are not getting enough air when you breathe.
  
  
• You become confused, dizzy, or feel like you may pass out.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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