COPD: Chronic obstructive pulmonary disease fundamentals
Chronic obstructive pulmonary disease (COPD) is a lung disease, that is, a disease involving the lung’s airways, air sacs, or both. Persons with COPD have chronic bronchitis, emphysema or both. Most adults diagnosed with COPD are long-time cigarette smokers, and smoking is a major cause of the disease. Another important cause of COPD is alpha 1-antitrypsin deficiency, an inherited disorder that can interfere with normal lung function.
Some patients with COPD develop primary pulmonary hypertension, a condition in which abnormally high blood pressure develops in the artery that leads from the heart to the lungs. In some cases of severe primary pulmonary hypertension, surgical intervention may be appropriate (e.g., a heart/lung transplant).
The primary COPD symptoms include:
- shortness of breath (i.e., breathlessness or the feeling of needing to "catch your breath")
- production of phlegm or sputum
- a feeling of tightness in the chest.
Management of COPD at Cleveland Clinic
Assessment and diagnosis
Cleveland Clinic offers a spectrum of diagnostic tools and tests for assessment of patients who may have COPD, including: chest x-ray, spirometry, lung volume tests, lung compliance tests, physiologic shunt studies, arterial blood gas testing, pulse oximetry testing, cardiopulmonary stress tests and methacholine challenge tests.
Three classifications or "degrees" characterize the COPD stages: mild, moderate and severe. Once a patient has been thoroughly assessed and a COPD classification determined, treatment begins with patient education and lifestyle changes (risk-factor modification). Examples of COPD risk-factor modification include quitting smoking (one of the most important steps a patient can take), taking up exercise and avoiding airborne triggers or irritants such as vapors, pollution or pollen. Quitting smoking can help prevent COPD from developing, improve COPD symptoms and slow disease progression. Stress management can also play an effective role in COPD management.
In addition to making lifestyle changes and taking up exercise (pulmonary rehabilitation), most patients diagnosed with COPD use medications to manage the disease and its symptoms.
Depending on the COPD stage, treatment could involve administration of medications that help the bronchial muscles relax, thus allowing airways to widen. These include bronchodilators such as anticholinergics and beta agonists. Inhaled or oral corticosteroids reduce lung inflammation associated with COPD. Other medications may help relieve the symptoms caused by COPD.
Patients diagnosed with COPD also are strongly encouraged to receive vaccinations to prevent contraction of the influenza (flu) virus or pneumonia. Flu vaccination should be received every year and pneumonia vaccination at least once during disease management. Both the flu and pneumonia can significantly worsen COPD symptoms and increase the risk of death from COPD .
Patients with COPD who have low blood oxygen levels often require continuous oxygen replacement therapy. This means that during most hours of the day or night, they need fresh oxygen delivered to their lungs to raise blood-oxygen levels. Various delivery systems are used for oxygen replacement therapy. Some systems are stationary (for use in the home), and others are portable, thus allowing patients the freedom to shop, go to restaurants, and participate in a variety of their normal activities. The main components of the oxygen replacement systems include the oxygen source (various sized cylinders and vessels) and the delivery device (nasal cannula, mask or transtracheal apparatus).
Quitting smoking is one of the most important steps in effective COPD management. But quitting smoking can be a challenging proposition for some chronic smokers. Since smoking patterns vary from person to person, there is no "best" method for quitting. The most successful smoking cessation programs offer smokers a range of strategies. Cleveland Clinic has offered smoking cessation programs for more than 15 years. These programs provide education about smoking, guidance about behavior modification to help minimize smoking urges, and numerous coping strategies. Several different methods for changing smoking behavior are explored so that individuals can find approaches that work best for them.
Chronic diseases and disorders of the lungs and airways (like COPD and primary pulmonary hypertension), as well as some of the invasive treatments for them, can take their toll on health and quality of life. Pulmonary rehabilitation programs use education, life-style and behavioral changes, rehabilitation, and aggressive disease management to help reduce the incidence of sickness, disability and death from chronic pulmonary diseases. They also encourage patients to pro-actively manage COPD and other conditions. Rehabilitation objectives for COPD include maximizing independence, reducing severity of symptoms, increasing exercise tolerance, reducing anxiety related to the lung condition, ensuring safe and swift recovery from surgical procedures and improving an individual's ability to participate in day-to-day activities. The Clinic’s comprehensive COPD rehabilitation program is key to achieving these objectives. The program includes patient assessment, patient education and training, special exercise programs, counseling, guidance about disease prevention and treatment follow up. Education goals include teaching patients:
- what COPD is
- how to cope with and manage COPD
- how to effectively use medications
- lifestyle changes and exercise to improve quality of life
- how nutrition and special breathing techniques can help manage COPD symptoms and improve quality of life.
Pulmonary rehabilitation is a multidisciplinary effort that can involve physicians, nurse educators, respiratory therapists, physical therapists, exercise physiologists, occupational therapists, nutritionists, psychologists and social workers. Participants typically attend three 90-minute sessions per week for 8 weeks in these outpatient programs.
Transtracheal oxygen therapy
Transtracheal oxygen therapy delivery is an alternative means of offering continuous flow oxygen replacement therapy. With this system, a flexible tube runs from the oxygen source ("concentrator" or portable tank) directly into the trachea (windpipe). The oxygen tubing can be concealed by clothing, providing mobility and privacy. Preparing a patient for transtracheal oxygen therapy involves surgically creating an opening in the trachea to accommodate placement of a slender oxygen tube. Patients will work with pulmonologists and respiratory therapists. Pulmonologists have specialty training in assessment and treatment of diseases of the airways and lungs. Respiratory therapists are trained to aid physicians in the evaluation, diagnosis and care of patients with heart and breathing problems.
Treatment for emphysema that runs in families
Alpha 1-antitrypsin deficiency is a genetic condition that runs in certain families and leads to the development of emphysema. Alpha 1-antitrypsin is a protein produced by the liver; the protein protects the lungs so they can function properly. In people with the disorder, the liver produces too little or no alpha 1-antitrypsin. Approximately 70,000 to 100,000 Americans have the disorder, but most have not been diagnosed. Common symptoms include cough, difficulty breathing or exhaling, and wheezing. Early diagnosis of this disease is important because the combination of quitting smoking and receiving early treatment can slow disease progression. Treatments include behavioral and lifestyle modification (e.g., smoking cessation, avoiding environmental pollution, pulmonary rehabilitation, adopting a nutrition program, reducing stress), drug therapy (e.g., vaccination for influenza and pneumonia, aggressive treatment of lung infections, bronchodilators, corticosteroids, supplemental oxygen), augmentation therapy (increases circulating levels of the alpha 1-antitrypsin protein), and surgery (e.g., lung volume reduction, lung transplantation).
A small percentage of patients with emphysema may need, or benefit from, lung surgery, which can improve lung function. For these patients, surgical options include bullectomy (removal of a bulla, which is non-functioning lung tissue), possibly lung-volume reduction surgery (removal of diseased lung tissue) and lung transplantation.
A bullectomy is a surgical procedure that involves removal one or more bullae. A bulla is a kind of blister inside the lung that interferes with normal lung function. Removing large bullae can help improve breathing in patients with COPD.
Lung-volume reduction surgery
This intervention, which involves surgical removal of nonfunctioning lung tissue, is an option for some patients with severe COPD. Two procedures are available: median sternotomy, which is similar in ways to open-heart surgery, and video-assisted thoracoscopic surgery, also known as VATS.
Lung transplantation involves surgical removal of a lung and replacement of the organ with a donated lung. One or both lungs can be transplanted, depending on the disease and its severity.
Make an appointment
If you want to learn more about Cleveland Clinic COPD treatment options or make an appointment with a Cleveland Clinic COPD specialist, call Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine at 216/444-6503 or toll free at 800/223-2273, ext. 46503, Monday through Friday, 8:30 a.m. to 4:30 p.m. (Eastern Standard Time).
For more Cleveland Clinic information on COPD:
- National Heart, Lung, and Blood Institute
- American Lung Association
- Alpha-1 Foundation
- Read more about what Cleveland Clinic can offer you
This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.