Pulmonary Disease -- January 26, 2009 -- Dr. Aaron Milstone - NewsChannel5.com | Nashville News, Weather & Sports

Pulmonary Disease -- January 26, 2009 -- Dr. Aaron Milstone


What is COPD?

COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes or dust, also may contribute to COPD.

To understand COPD, it helps to understand how the lungs work. The air you breathe goes down your windpipe into tubes in your lungs called bronchial tubes, or airways. The airways are shaped like an upside-down tree with many branches. At the end of the branches are tiny air sacs called alveoli. The airways and air sacs are elastic. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sac deflates and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

  • The airways and air sacs lose their elastic quality.
  • The walls between many of the air sacs are destroyed.
  • The walls of the airways become thick and inflamed.
  • The airways make more mucus than usual.

In the United States, the term "COPD" includes two main conditions-emphysema and chronic obstructive bronchitis. In emphysema, the walls between many of the air sacs are damaged, causing them to lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones.

In chronic obstructive bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic obstructive bronchitis. Thus, the general term "COPD" is more accurate.



COPD is a major cause of disability, and it's the fourth leading cause of death in the United States. More than 12 million people currently are diagnosed with COPD. An additional 12 million likely have the disease and don't even know it.

COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking or taking care of yourself.

Most of the time, COPD is diagnosed in middle-aged or older people. The disease isn't passed from person to person-you can't catch it from someone else. COPD has no cure yet, and doctors don't know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active and slow the progress of the disease.

Risk factors

The main risk factor for COPD is smoking. Most people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to get the disease if they smoke.

Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include air pollution and chemical fumes and dust from the environment or workplace.

Most people who have COPD are at least 40 years old when symptoms begin. Although it isn't common, people younger than 40 can have COPD.

Signs and symptoms

The signs and symptoms of COPD include:

  • An ongoing cough or a cough that produces large amounts of mucus (often called "smoker's cough")
  • Shortness of breath, especially with physical activity
  • Wheezing (a whistling or squeaky sound when you breathe)
  • Chest tightness

These symptoms often occur years before the flow of air into and out of the lungs declines. However, not everyone who has these symptoms has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD.

If you have COPD, you may have frequent colds or flu. If your COPD is severe, you may have swelling in your ankles, feet or legs; a bluish color on your lips due to low levels of oxygen in your blood; and shortness of breath.

COPD symptoms usually slowly worsen over time. At first, if symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become bad enough to see a doctor. For example, you may get short of breath during physical exertion.

How severe your symptoms are depends on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. In severe COPD, you may have other symptoms, such as weight loss and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You should seek emergency care if:

  • You're having a hard time catching your breath or talking.
  • Your lips or fingernails turn blue or gray. (This is a sign of a low oxygen level in your blood.)
  • You're not mentally alert.
  • Your heartbeat is very fast.
  • The recommended treatment for symptoms that are getting worse isn't working.


Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. He or she may ask whether you smoke or have had contact with lung irritants, such as air pollution, chemical fumes or dust. If you have an ongoing cough, your doctor may ask how long you've had it, how much you cough, and how much mucus comes up when you cough. He or she also may ask whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds.

You also may need one or more tests to diagnose COPD.



COPD has no cure yet. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease. Quitting smoking is the most important step you can take to treat COPD. Talk to your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke.

Other treatments for COPD may include medicines, vaccines, pulmonary rehabilitation, oxygen therapy, surgery and managing complications.

The goals of COPD treatment are to:

  • Relieve your symptoms
  • Slow the progress of the disease
  • Improve your exercise tolerance (your ability to stay active)
  • Prevent and treat complications
  • Improve your overall health



•·         Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.

  • Inhaled steroids are used for some people who have moderate or severe COPD. These medicines may reduce airway inflammation.
  • Vaccines

•o        The flu can cause serious problems for people who have COPD. Flu shots can reduce your risk for the flu.

•o        The pneumococcal vaccine lowers your risk for pneumonia and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. Talk with your doctor about whether you should get this vaccine.


Pulmonary Rehabilitation

Pulmonary rehab is a medically supervised program that helps improve the health and well-being of people who have lung problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program aims to help you stay more active and carry out your day-to-day activities.


Oxygen Therapy

If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you're given oxygen through nasal prongs or a mask.

You may need extra oxygen all the time or just sometimes. For some people who have severe COPD, using extra oxygen for most of the day can help them:

  • Do tasks or activities, while having fewer symptoms
  • Protect their hearts and other organs from damage
  • Sleep more during the night and improve alertness during the day
  • Live longer



In rare cases, surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines. Surgeries for people who have COPD that is mainly related to emphysema include bullectomy and lung volume reduction surgery. A lung transplant may be done for people who have very severe COPD.


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