What is COPD?

Chronic Obstructive Pulmonary Disease

At least another 2 million middle-aged Canadians likely have COPD but are not yet diagnosed.

COPD, or Chronic Obstructive Pulmonary Disease, is a lung condition that includes chronic bronchitis and emphysema. COPD is an incredibly common condition with over 2 million Canadians aged 35 years and older diagnosed. It’s estimated that at least another 2 million middle-aged Canadians likely have COPD but are not yet diagnosed.

What’s in a name?
Did you know that COPD is an acronym, which means that each letter represents a specific word? Here is what each letter stands for:

C is for Chronic
When we talk about a chronic illness, this disease is persisting for a long time or constantly reappearing.

O is for Obstructive
Obstructive means that there is a blockage. Since we are talking about lungs, obstructive is related to the blockage of airflow.

P is for Pulmonary
This type of illness is affecting your lungs.

D is for Disease
A disease is an illness of the body or mind.

Most people with COPD have both chronic bronchitis and emphysema. These conditions are called “obstructive” because something is blocking the smooth flow of air in and out of the lungs. While chronic bronchitis affects the tubes that carry air, emphysema affects the small air sacs within the lungs.

 

Let’s learn more about these 2 diseases.

Chronic Bronchitis

is a lung disease marked by swelling and irritation of the lining of the bronchial tubes—the small passages that carry air from the mouth to the lungs. “Chronic” simply means that it is a long-term condition, as there are also “acute” or short-lived forms of bronchitis.

When the bronchial tubes become inflamed, mucus starts to build up in the lung’s airways. Over time, this buildup of mucus creates airway blockages. As these blockages worsen, people with chronic bronchitis develop more symptoms and complications.

Emphysema

is a lung disease that damages the air sacs in the lungs (alveoli). These air sacs are responsible for transferring oxygen to the bloodstream.

Over time, the fragile tissues between air sacs are destroyed, causing air pockets in the lungs. Air gets trapped in these pouches of damaged tissue. As these pockets enlarge, it becomes harder to breathe and less oxygen can be passed into the bloodstream.

Symptoms

COPD can cause many symptoms:

• Shortness of breath or breathlessness (called dyspnea)

• Mucus and phlegm production (called sputum)

• Persistent cough

• Chest tightness

• Wheezing

• Fatigue

• Frequent lung infections

• Smaller appetite

 

At first, people with COPD usually have mild symptoms. Often, the disease starts with a persistent, wet cough that won’t go away. People usually notice they have more phlegm and are often out of breath.

 

Sometimes, people mistake these symptoms as signs of something else, such as a lingering cold or a heart condition. Unlike a cold, however, symptoms of COPD typically worsen over time and should not be ignored.

Causes

The main cause of COPD is smoking. In fact, 85% of people with COPD are current or ex-smokers. But smoking is not the only cause; work environments—such as mines, sawmills, farms, and construction sites—can cause COPD. Inhaling smoke from indoor wood or coal fires is also a major cause of COPD. In all these cases, toxic particles in the air build up in the lungs over time and cause irritation, swelling, and mucus production. Even fit athletes can develop COPD due to environmental factors.

 

In some cases, COPD can be caused by severe untreated asthma or childhood breathing disorders. A few people—less than 1%—have COPD because of a genetic condition called alpha-1 antitrypsin deficiency.

 

Interestingly, some Canadian towns or regions have much higher rates of COPD than others. Usually, this is due to higher smoking rates or factory work in these areas. Also, immigrants from countries where burning biofuels is common may get COPD quite young.

Diagnosis

A diagnosis of COPD is generally first suspected from a person’s symptoms—especially if there is a history of smoking. A physical exam and chest x-ray can offer clues to whether a person has COPD. The doctor may also measure a person’s oxygen levels and request blood work.

 

The gold standard to confirm the diagnosis of COPD is spirometry—a test to see how well a person’s lungs work. People with COPD cannot empty their lungs of air as quickly as normal. During the test, a patient will breathe into a small machine that measures the amount of air they are breathing in and out, as well as the speed of their breaths. Spirometry tests can be ordered by a family doctor, nurse practitioner, or lung specialist.

 

Most people with COPD are diagnosed in their late 50s or early 60s, although they may have had symptoms for years. Many people think that their symptoms (e.g., shortness of breath) are just part of getting older and may be surprised to learn that they have a serious disease. In fact, doctors estimate that half of the people who have COPD have not yet been diagnosed.

Progression of COPD

There is no cure for COPD, but there are treatments to slow it down. Since it’s a progressive disease—one that tends to get worse over time—people who have been diagnosed with COPD should take their prescribed medications, exercises, and oxygen (if needed) regularly to slow down the disease as much as possible.

In the early stages of COPD, symptoms are mild and increase in severity as the disease progresses into later stages.

COPD Exacerbations

A flare-up of COPD means suddenly having worse symptoms than usual, often due to a viral or bacterial infection. These events, called acute exacerbations of COPD (or AECOPD), can be mild, moderate, or severe. People with a COPD exacerbation often note worsening cough, mucus production, and shortness of breath, requiring them to use their rescue puffer more often. They may need additional puffers, steroid medications, antibiotics, oxygen, or even a stay in hospital for more advanced treatment.

 

The number of COPD exacerbations a person has had can help doctors determine how well their condition is being treated. It is vital to prevent these flare-ups since studies show that one COPD exacerbation often leads to another one—and all of these worsen the underlying COPD. A COPD action plan is a useful tool in identifying flare-ups quickly.

Treatment Options

People with COPD typically start with lifestyle changes and inhaled medications and then gradually add therapies as needed. COPD treatment options include:

The #1 way to slow the progression of COPD is to quit smoking.

Another important first step is to stop breathing “bad air”—including second-hand cigarette smoke—and avoid exposure to environments with poor air quality.

Light endurance-building exercises can maximize breathing ability.

Vaccines are recommended to prevent lung infections like influenza and pneumonia.

Education about puffers, triggers, and healthy lifestyle changes is key.

Quick-relief medications—a.k.a. “rescue puffers,” short-acting bronchodilator inhalers, or SABAs—can help manage bouts of shortness of breath and chest tightness.

These are taken when needed and should be kept handy.

Long-acting bronchodilator inhalers, or LABAs, are used to relax the muscles surrounding the airways for easier breathing. These puffers work differently than rescue puffers as they are taken every day according to a doctor’s instructions.

This therapy is in addition to other inhalers to help manage symptoms and reduce exacerbations. It’s not meant for fast relief.

These specialized programs combine education and supervised exercise sessions to improve a person’s breathing ability and stamina.

Sometimes pills—including steroids such as prednisone or methylprednisolone, as well as antibiotics—are prescribed to help control severe symptoms.

Doctors can order tests to determine whether a person needs to be on extra oxygen (or “home” oxygen). Oxygen is given via nasal cannula or a mask and prevents blood oxygen levels from becoming too low.

This type of machine (e.g., myAIRVO 2™) delivers heated and humidified air through a nasal cannula. A doctor may prescribe this machine to help loosen mucus and help with coughing and the feeling of breathlessness.

A doctor may recommend breathing machines to help open the airways and it can help reduce breathlessness. This therapy is usually worn overnight with a mask.

Some people with COPD will have surgery to remove damaged portions of the lungs, or have valves implanted to help with oxygen flow.

For people with advanced COPD, lung transplant surgery may be recommended.

Want to know more?

Learn more about the 4 stages of COPD here.

FAQ

Frequently Asked Questions

What can I do today about my COPD so that it doesn’t get worse?

If you currently smoke, the best thing you can do is quit or cut back. Talk to your doctor or medical team about making a plan to quit and learn about treatment options that can help. There are nicotine replacement therapies as well as medications to help quit smoking and handle cravings.

Stick to your doctors’ suggestions and take all of your prescribed medications. Some people with COPD have a hard time sticking to their medication schedule—but doing so is the best way to help improve your symptoms. Discuss with your medical team whether there is a different medication schedule or type of puffer that may work better for you.

Staying active is very important. COPD can create exercise anxiety and avoidance since people are afraid it will make their breathing worse. Actually, gentle exercises such as walking, biking, or aqua fitness are key to maintaining your ability to breathe for as long as possible. In the early stages, weightlifting can also be helpful to prevent muscle loss.

How is chronic bronchitis different from acute bronchitis?

Chronic bronchitis is progressive and does not go away.

While regular (or “acute”) bronchitis can be fixed with antibiotics, chronic bronchitis cannot.

Unfortunately, people with chronic bronchitis are more likely to also get acute bronchitis (or COPD exacerbations), since they have damaged airways, which can lead to more mucus production as well as a system that isn’t as efficient at getting rid of the mucus.

Mucus is actually a defense mechanism meant to trap viruses and bacteria, so the inability to clear mucus effectively can lead to a higher risk of infection.

Will I need to be hospitalized?

Maybe. In the later stages of COPD or during a severe exacerbation, some people may need to be hospitalized to treat extreme shortness of breath or lung infections. Patients can generally expect a hospital stay of seven days for each acute infection.

Will COPD affect my appetite?

Shortness of breath makes eating less pleasant, so it’s common for people with later stages of COPD to undereat and lose weight.

At the same time, all of the extra energy required to breathe means that people with COPD actually need an extra 500 calories per day!

Therefore, it’s key to maintain a high caloric intake to prevent muscle wasting. Talk to a dietitian or other qualified health care practitioner to ensure you are getting enough calories.

What is a mucus plug and is it dangerous?

People with COPD commonly experience mucus dysfunction, which is an increased production of mucus, and the inability to properly clear it out of the lungs.

This can lead to a mucus plug forming in the lung’s airways. This plug can partially or completely block airflow to one or more air passages.

Mucus plugs can lead to serious consequences, including portions of the lung collapsing and recurrent infections.

What is a COPD action plan?

A COPD action plan is a written plan that can be placed on the fridge or in a noticeable spot to help people remember what to do at the first sign of worsening COPD symptoms. This helps people with COPD act quickly and get the right treatment.

A COPD action plan contains personalized details about symptoms and medications (such as puffers, steroids, antibiotics, and oxygen therapy), as well as when to call the doctor, go to emergency, or call 9-1-1.

The patient as well as their doctor should have a copy so that everyone knows the plan. If the doctor and patient have discussed it beforehand, the patient may often be prescribed medications with refills that they can pick up in case of a flare-up.

What is pulmonary rehab?

Pulmonary (or lung) rehab programs are available across Canada. COPD is a complicated disease and these programs are designed to help educate people with COPD about ways they can manage their disease and improve their quality of life.

Programs detail ways to breathe to reduce shortness of breath and anxiety; exercises to strengthen the muscles, heart, and lungs; proper technique for using puffers; how to cough properly to clear phlegm and mucus from the lungs; ways to ensure proper nutrition; and strategies to improve mental health while living with a chronic illness.

What are COPD triggers?

Triggers are anything that can make COPD symptoms flare up. Many people, not just those with COPD, find that these irritants can affect their breathing.

Triggers may include smoke, pollution, smog, high humidity, cold air, perfumes, aerosols, paint fumes, and more.

Other factors that can trigger a COPD flare-up (exacerbation) include bacterial or viral infections, allergies, emotional stress, or another underlying medical condition. COPD flare-ups should be treated quickly.