Chronic obstructive pulmonary disease (COPD)
Also known as: COPD, emphysema, chronic bronchitis
Progressive, largely irreversible airflow obstruction caused by damage to the airways (chronic bronchitis) and destruction of alveoli (emphysema), almost always from smoking.
Overview
Years of inhaled smoke inflame the small airways and dissolve the alveolar walls, so air is trapped and the surface for gas exchange shrinks. Breathlessness on exertion creeps up over decades and is often blamed on age; flare-ups triggered by infections drive hospital admissions. COPD is the third leading cause of death worldwide.
Causes
- Tobacco smoking (85 to 90% of cases)
- Biomass and cooking-fire smoke
- Occupational dust and fumes
- Alpha-1 antitrypsin deficiency (inherited)
Risk factors
- Pack-years of smoking
- Childhood respiratory infections and poor lung growth
- Air pollution
- Asthma
Symptoms
What a clinician may find
- Barrel chest, pursed-lip breathing
- Wheeze and reduced breath sounds
- Cyanosis and ankle oedema in advanced disease
Complications
- Exacerbations, often needing hospital care
- Respiratory failure
- Pulmonary hypertension and right heart failure (cor pulmonale)
- Lung cancer
- Osteoporosis, muscle wasting, depression
Diagnosis
Spirometry showing an FEV1/FVC ratio below 0.7 that does not fully reverse with a bronchodilator, in someone with symptoms and a smoking or exposure history. Chest X-ray and CT exclude other causes and grade emphysema.
Treatment
Stopping smoking is the only measure that slows decline. Long-acting bronchodilator inhalers (with inhaled steroids for frequent exacerbators), pulmonary rehabilitation, vaccinations, and oxygen at home for low oxygen levels. Exacerbations are treated with steroids and often antibiotics.
Prevention
Never smoking, or stopping at any stage; clean cooking fuels; workplace dust control; vaccination against flu, pneumococcus and COVID-19.
When to seek care
Urgent review for worsening breathlessness with more or discoloured sputum, fever, or confusion and drowsiness (a sign of carbon dioxide retention).