Chronic obstructive pulmonary disease

Also known as emphysema & chronic bronchitis

Chronic obstructive pulmonary disease (COPD) is a term for damage to the lungs which makes breathing difficult. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs; nearly all COPD in New Zealand is smoking-related. There is no cure for COPD, so prevention (ie, not smoking) is best. The term COPD includes emphysema, chronic bronchitis, certain types of bronchiectasis, and sometimes asthma.

Key points

  • Although often undiagnosed, COPD affects about 1 in 7 adults aged over 45 years (at least 200,000 New Zealanders) and is common in older age groups.
  • It is a common cause of hospitalisation, especially in winter, and is the 4th most common cause of death in NZ after cancer, heart disease and stroke. 
  • The number of people with COPD is increasing due to high rates of smoking.
  • By the time someone develops symptoms of cough, wheeze and shortness of breath, over half their lungs are damaged beyond repair.
  • At any stage, quitting smoking is the most important step to treat COPD.

How does COPD affect the lungs

The lungs, the airways (bronchial tubes) and air sacs (alveoli) are elastic and stretchy. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

There are two main conditions that cause COPD – emphysema and chronic bronchitis.

  • Emphysema affects the air sacs, which are balloon-like spaces in the lungs. Over time the air sacs are slowly destroyed, which reduces air exchange in the lungs. 
  • Chronic bronchitis affects the large and small airways, where they become inflamed, narrower and produce more mucus. making it harder to breath.

Most people with COPD have both these conditions.

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What causes COPD?

Long-term exposure to substances that irritate and damage the lungs is the main cause of COPD.

  • In high and middle-income countries like New Zealand, tobacco smoke is the biggest risk factor.
  • In low-income countries, exposure to indoor air pollution (from open fires for cooking and heating), is a major cause.

Damage can also be caused by cannabis use, chemical fumes, recurrent chest infections or inherited factors (for example, alpha-1 anti-trypsin deficiency).

What are the symptoms of COPD?

A morning 'smokers cough' is often the first symptom of COPD. As the disease gets worse, coughing, mucus, wheezing, chest tightness and shortness of breath increase, and can be serious enough to limit daily activities. 

Common symptoms of COPD include:

  • Cough with or without mucus or phlegm. Over time, the cough gets worse and occurs throughout the day.
  • Shortness of breath. At first, this happens only during exertion or exercise such as walking, but as the disease gets worse, breathing becomes difficult even at rest.
  • Wheezing
  • Getting chest infections more often.

What is a 'flare-up' of COPD?

COPD is a chronic (ongoing) disease. At times, it can suddenly get worse due to infections, air pollution or for other unknown reasons. This sudden worsening is called a flare-up or exacerbation, and if not managed well, it can result in a hospital stay. The effects can be lessened if you learn to recognise flare-ups, try to prevent them and help yourself get over them.

Signs you might have a flare-up:

  • more breathlessness
  • more mucus (thicker and perhaps green/yellow)
  • wheezing
  • sometimes swollen ankles.

You should ring your doctor or practice nurse if you think your condition is getting worse.

How is COPD diagnosed?

To diagnose COPD, a range of lung function tests (spirometry), imaging tests, and blood tests are used. Imaging tests such as X-rays are not so good at picking up COPD but may be used to rule out other possible causes of breathing problems.

Spirometry is the most commonly used test.

  • This test measures the amount of air you are able to breathe in and out and how quickly you are able to breathe air out.
  • Usually, when you have COPD, you will take longer to breathe all of your air out.
  • Read more about spirometry NZ Asthma Foundation.

What can I do to ease the symptoms?

If you have COPD and you smoke, the most important action you can take is to stop smoking. Quitting smoking is the only thing that has been proven to stop COPD getting worse.

Other things you can do to improve your symptoms include: 

See also: Self care for COPD

What medications are used for COPD?

There is no cure for COPD, but, alongside the self care measures above, a number of different medications can be helpful to ease the symptoms and help you breathe more easily. These include:

Most COPD medication are available as inhalers, which come in different shapes and sizes, such as:

You can decide on the inhaler that suits you best by talking with your doctor or COPD educator. You may want to try a range of devices before choosing the one with which you are most comfortable. To get the most benefit from your inhaler you need to be using the correct technique and take it at the right time.

Read more about medication for COPD

Learn more

What is COPD?  the Asthma & Respiratory Foundation (NZ)
What is COPD? National Heart, Lung and Blood Institute
COPD and smoking Centre for Disease Control and Prevention (US)
COPD – the essentials NHS Choices
COPD – frequently asked questions NIH Senior Health
COPD – multicultural fact sheets Health Translations Directory  (AU)
COPD World Health Organization

References

Credits: Health Navigator. Reviewed By: Dr J Bycroft