Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a common long-term lung condition of adults worldwide. There is no cure for COPD but symptoms can be controlled and lung damage can be further prevented. Cigarette smoking is the major cause of COPD. Therefore, the best way to prevent COPD or to delay its progression is to not smoke.

Man suffering from COPD
Chronic Obstructive Pulmonary Disease (COPD), also known as Chronic Obstructive Lung Disease (COLD) is a term used to refer to chronic respiratory diseases including chronic bronchitis and emphysema. In these conditions, there is obstruction to air flow in the airways of the lungs. This interferes with normal breathing.

In chronic bronchitis there is persistent inflammation of the airways (bronchi) of the lungs. In emphysema there is damage to the smaller airways (bronchioles) and air sacs (alveoli) of the lungs. Most people with COPD/COLD have a mix of both emphysema and bronchitis.

Chronic Obstructive Pulmonary Disease (COPD)

Causes and Risk Factors of COPD

Smoking is the main culprit for COPD in most cases. Smoking damages the lining of the airways of the lungs which become inflamed and damaged. Air pollution including polluted work conditions may also contribute or worsen COPD.

People who are deficient of alpha-1 antitrypsin (a protein that protects the lung) are at an increased risk for emphysema.

Signs and Symptoms of COPD

Symptoms of COPD that may be associated with emphysema include the following:
  • ​Chronic cough
  • Chronic shortness of breath or shortness of breath with mild exertion
  • Wheezing
  • Bluish coloration of the skin due to lack of oxygen
  • Dizziness
  • Fatigue
  • Ankle, feet, and leg swelling
  • Unintentional weight loss
People with chronic bronchitis may experience similar symptoms as those with emphysema. However, in chronic bronchitis, the cough is usually associated with production of excessive phlegm. They also complain of shortness of breath, cyanosis (bluish colour of the lips and skin) and oedema (swelling of feet).

Complications Associated With COPD

People with COPD/COLD are at a higher risk of developing recurrent respiratory infections such as pneumonia and are at increased risk for heart failure and heart beat irregularities (cardiac arrhythmias).

Screening and Diagnosis For COPD

When you consult your doctor, he or she will:
  • ​determine if you have the symptoms of COPD/COLD (i.e. cough, excessive sputum and breathlessness)
  • check if you have risk factors for developing COPD/COLD (e.g. cigarette smoking and exposure to certain environmental toxins).
If you have any of the above symptoms together with risk factors, it makes the diagnosis of COPD/COLD highly likely.


Pulmonary (Lung) Function Testing

This is the most important tool used to confirm COPD/COLD. It can detect COPD/COLD in the early stages when the patient does not have any symptoms.

During the test, the patient is asked to blow hard into a machine called the spirometer. The readings from the spirometer will help confirm the presence of COPD/COLD and assess its severity. This test is also useful in monitoring the patient's progress over time and to review effectiveness of treatment.


Chest X-ray

A chest X-ray is useful to rule out other conditions which may seem like COPD/COLD. It is also useful in detecting the complications of COPD/COLD. However, by itself, a chest X-ray cannot confirm the diagnosis of COPD/COLD.

Treatment

Currently, there is no cure for COPD/COLD. However, medications are available that can help treat the symptoms and complications. Lifestyle changes can also make a significant impact on the progression of the condition.


Bronchodilators

Bronchodilators are medicines that relax the muscles around the airways in your lungs, allowing them to dilate. Air flow in and out of the airways is therefore improved and symptoms associated with COPD are reduced.

There are three types of bronchodilators - beta-agonists, anticholinergics and theophyllines. Your doctor will discuss with you which of these medications or combination works best for you.

Corticosteroids

Corticosteroids ("steroids") help reduce airway inflammation and decrease mucus production. Inhaled corticosteroids and oral corticosteroid pills are the two main types used to treat COPD/COLD.

Corticosteroid pills are sometimes prescribed for acute worsening of symptoms (acute episodes) while inhaled corticosteroids are usually used for those who have severe COPD/COLD with frequent acute episodes.

Antibiotics

Your doctor may prescribe a short course of antibiotics for an acute episode to treat any underlying infection.

Oxygen therapy

This may help some people with severe symptoms. Your specialist doctor may order some blood tests and lung function tests to assess whether oxygen therapy will be useful for you. If prescribed, you need to be on oxygen therapy for at least 15 hours a day for it to be beneficial. If you are found to be suitable for oxygen therapy, regular use can help decrease symptoms and prolong life. Remember that you must not smoke while on oxygen therapy as it can lead to fatal fires.

Surgery

The specialist doctor may offer surgery as a possible treatment option in a small number of people with COPD/COLD. For example, in some, removing a section of lung that has become useless may improve symptoms; a few may even be considered for lung transplantation.

Self-care For COPD


Pulmonary Rehabilitation

Those who are assessed by their doctors to be suitable for pulmonary rehabilitation will be referred for a comprehensive, structured programme that includes education, exercise training, psychosocial support and instruction on breathing techniques. Benefits include improvement in the ability to exercise, relief of breathlessness and fatigue resulting in an overall improvement in the quality of life.​

It is important to note that even if you are not on any formal rehabilitation programme, you should try and be as active as possible.


Nutrition

Poor nutrition can make COPD/COLD symptoms worse and increase the likelihood of getting an infection. Eat a well balanced diet. If chewing and swallowing interfere with breathing, take small, frequent meals.​

Try to maintain an ideal Body Mass Index (BMI). The recommended BMI is between 18.5kg/m2 to 23kg/m2.

BMI = Weight (kg)/ [height (m) x height (m)]


Living with COPD

Vaccination

Two types of vaccination may be given for COPD:
  • Yearly influenza vaccination (as you are at higher risk of complications like pneumonia if you suffer from influenza).
  • Pneumococcal vaccination (for protection against pneumococcal infection that can cause pneumonia). There is, however, less established evidence on the usefulness of this vaccine.
Your doctor will advise you regarding these vaccinations.


Plan ahead (for advanced COPD/COLD)

Planning for end-of-life circumstances is necessary if you have advanced COPD/COLD. Discuss end-of-life concerns with your doctor as well as your family members. Consider talking to your doctor about an Advance Medical Directive - this legal document will help ensure your wishes are respected even when you are too ill to communicate them.

Preventive Actions Against COPD

Quitting smoking can be beneficial for preventing and  those suffering from COPD

Quitting smoking​

If you smoke, quitting is the single most important step you can take and it will make a huge difference to the rate at which your disease progresses. While the damage already done to your airways cannot be reversed, quitting smoking helps to prevent the progression of COPD and its associated complications. 

It is never too late to stop smoking at any stage of the disease. Even if you have fairly advanced COPD/COLD, you are likely to benefit and prevent further progression of the disease. However, do bear in mind that the earlier you quit, the smaller is the degree of permanent damage to your lungs.​
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Chronic Obstructive Pulmonary Disease (COPD)

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