Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a disease of the lungs. About 15 million people in the United States have been diagnosed with COPD, and the number of people with the disease is rising. In fact, COPD is the third most common cause of death in the United States.

What is COPD?

COPD is actually a group of lung conditions, most often emphysema and chronic bronchitis.

  • Emphysema is a condition where the air sacs in the lungs (called the alveoli) become over-inflated (think of a balloon that has been blown up almost to the point of popping). This over-inflation results from damage to the walls of the alveoli, which causes the airways to collapse.
  • Bronchitis is an inflammation of the bronchial tubes. The bronchial tubes connect the windpipe to the lungs. When these tubes are inflamed, less air is able to flow to and from the lungs. The airways also become narrowed and clogged with heavy mucus. Chronic bronchitis means you have had bronchitis for three months or longer for two years in a row.

Sometimes called chronic obstructive lung disease (COLD), COPD makes it hard for a person to breathe because the airflow in and out of the lungs is partly blocked. COPD can also cause high blood pressure in the lungs (pulmonary hypertension), which can lead to a form of heart disease called cor pulmonale.

What causes COPD?

Long-term cigarette smoking causes nearly all cases of emphysema and chronic bronchitis. In fact, COPD develops in up to 20% of people who smoke.

The disease is also more common in

  • White people
  • People older than 60
  • People who have jobs that require them to work around chemical fumes and harmful dust that can hurt the lungs
  • People with chronic asthma
  • People with a family history of emphysema

Other factors, such as secondhand smoke, air pollution, low birth weight, and other lung infections, can also make a person more likely to develop COPD.

What are the symptoms?

Many people think that the symptoms of COPD are just a part of getting older and not a sign of something more serious. For this reason, they may have COPD for a long time before the symptoms become enough of a problem that they see a doctor.

People who have COPD usually have symptoms of both emphysema and chronic bronchitis.

In the early stages of COPD, you may have

  • A cough, which usually brings up a large amount of mucus (sputum) from the lungs.
  • Trouble breathing, shortness of breath, and wheezing.
  • A tired feeling, even after simple daily activities.
  • Trouble sleeping because you wake up short of breath or coughing.

In the later stages of COPD, you may have

  • A blue tint to your lips, fingers, and toes (called cyanosis).
  • Fluid buildup in your legs and feet (called edema).
  • Severe shortness of breath that makes it hard for you to do any type of activity.
  • Weight loss.
  • A headache when you wake up in the morning.

How is COPD diagnosed?

It is important that COPD be diagnosed in its early stages. The sooner a person quits smoking and avoids other risk factors that can make COPD worse, the better the chances of slowing the damage to the lungs.

Most doctors can make a tentative diagnosis of COPD by asking about your symptoms and by performing a physical exam. Other tests may include

  • Chest x-rays, which are used to rule out other conditions that have the same symptoms as COPD.
  • Spirometry, which is a lung function test that shows how well air is moving in and out of the lungs.
  • Blood tests (arterial blood gases and oximetry), which tell doctors how much oxygen is in the bloodstream.
  • Electrocardiography (EKG or ECG) and echocardiography, which are used to rule out any heart problems that may be causing your symptoms.

If COPD is suspected in patients who are young or who have never smoked, doctors may test for a blood protein called alpha1-antitrypsin. People who do not have enough of this protein in their blood often develop COPD.

How is COPD treated?

COPD can be treated to ease its symptoms, but there is no cure. Once the airways and the lungs have been damaged, the damage cannot be reversed. Treatment may include lifestyle changes, medicines, and in rare cases, surgery.

Lifestyle Changes

  • If you smoke, quit.
  • Eat a balanced diet and maintain a normal weight.
  • Avoid polluted or smoggy areas.
  • Avoid climates that are cold and dry or hot and humid.
  • Learn the breathing methods that will make breathing easier and more comfortable (called breath training).
  • Stay as active as you can by taking part in a doctor-approved exercise program.
  • Get a flu-shot every year to prevent respiratory infections that can make your COPD worse.


Medicines can help ease the symptoms of COPD. The following medicines are often given to patients with COPD:

  • Bronchodilators, which open your airways. Bronchodilators come in the form of pills, liquids, or inhalers. You may need to take a combination of these medicines for them to work best.
  • Corticosteroids, which reduce swelling and mucus production. Corticosteroid medicines come in the form of pills or inhalers.
  • Antibiotics, which protect your lungs from infection.
  • Oxygen treatments, which raise the oxygen level in the blood. The oxygen is delivered as a gas through a face mask or a nasal cannula.


Surgery is rarely used to treat COPD. In cases where surgery is needed, doctors may recommend either a procedure that removes part of the lung or a lung transplant. These surgeries are never the first treatment option for COPD. Your doctor may suggest surgery only if your condition has not improved with the lifestyle changes and the medicines.