Chronic obstructive pulmonary disease (COPD) is a descriptive medical term for a number of similar overlapping diseases that include chronic bronchitis, emphysema and some chronic asthma that has become resistant to treatment. These conditions have in common a persistent and slowly progressive pattern of symptoms such as shortness of breath, cough and wheeze. In particular, on formal measurement they all share reduced flow of air through the bronchial tubes, due to narrowing or damage.

Chronic bronchitis means having a cough with sputum for at least three months a year for two consecutive years. In its mildest form this could simply be a smoker’s cough in the morning with small amounts of sputum. Severe chronic bronchitis, on the other hand, involves a much greater degree of cough and sputum linked with shortness of breath, wheeze and frequent episodes of acute bronchitis, especially during the winter months. Chronic bronchitis relates to producing excess amounts of phlegm with narrowing of breathing tubes.

Emphysema can be more difficult to diagnose clinically until more advanced. The symptoms are shortness of breath with wheeze and chest tightness. They are caused by permanent damage to the small breathing tubes and air sacs where oxygen and carbon dioxide are exchanged with the blood.

Chronic bronchitis and emphysema often occur in the same patient. Both conditions tend to start after the age of 50 and are more common in men than women.

What causes COPD?

By far the most common cause is cigarette smoking. Generally, the greater the tobacco exposure the greater the risk of developing CPD. About 15% of smokers will develop symptoms of COPD but what makes this group susceptible to cigarette smoke compared with other smokers is not at present understood. Other risk factors for COPD are working in dusty environments or, possibly, living in industrialised large cities. Rarely, emphysema is a result of a inherited deficiency of protective protein called alpha-1—antitrypsin.

How common is it and how does it progress?

After the age of 50, COPD causes an increasing number of visits to GPs and hospital - in one survey, 12% of all medical hospital admissions were due to COPD.

The progression of COPD, while smoking continues, is one of steady deterioration towards increasing disability and death. In 1992 there were 26033 deaths in England and Wales from COPD.

If patients stop smoking, symptoms and lung damage remain largely unchanged. Unfortunately, damage to the lung does not repair itself. But the progression to disability does not occur, and any deterioration thereafter is slight and no different from a non-smoker. Sometimes, if the main symptom is cough and sputum, this may completely resolve.

What treatments are available?

Stopping Smoking
Without any doubt the mot important part of treatment is to give up smoking completely. This will prevent progression of the disease and prolong life.

Bronchodilator Inhalers
These come in a range of different devices and it is essential that you are shown how to use your device and feel confident using it. For mild symptoms, the inhalers should be used as required - when breathless, or before more strenuous activity that might cause breathlessness. For more severe symptoms, inhalers will need to be taken four or more times a day regularly. Inhalers have a rapid onset of action and have very few side-effects.

These inhalers reduce breathlessness, improve exercise capability and encourage more effective expectoration.

Other bronchodilators
In more severe COPD your doctor might prescribe bronchodilator tablets to supplement the inhalers. New, long-acting inhaled bronchodilators are currently being assessed in COPD.

Inhaled corticosteroid inhalers and steroid tablets
Most patients with severe COPD will require a two week therapeutic trial of steroid tablets. About 15% of patients will show a beneficial response and will then be allocated a regular corticosteroid inhaler.

Treatment of acute infections

Acute bronchitis is a common feature of COPD. This might start with a cold or viral infection, and progress to increasing cough and sputum changing colour from white to green. Such episodes normally require a course of antibiotics and an increase of bronchodilator inhaler use.

Treatment of acute breathlessness

Sometimes particularly with emphysema, breathing and wheeze become worse, often for no clear reason. Bronchodilators should be increased and your doctor might wish to prescribe a course of steroid tablets for 7-14 days.

Oxygen might occasionally be needed in severe COPD but an assessment by a hospital respiratory specialist must be made first.

Regular exercise - improves mobility and well being.

Weight - if overweight, weight reduction improves breathlessness. With severe emphysema, patients might be underweight and require nutritional advice.

Flying - with severe COPD - might not be recommended due to the lower levels of oxygen in the plane. Consult your GP or nurse before planning a holiday.

Benefits - you might be entitled to DSS benefits or orange car badge.

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