Who has COPD?

Chronic lower respiratory disease, primarily COPD, was the fourth leading cause of death in the United States in 2018.1 Almost 15.7 million Americans (6.4%) reported that they have been diagnosed with COPD.2 More than 50% of adults with low pulmonary function were not aware that they had COPD,3 so the actual number may be higher. The following groups were more likely to report COPD in 2013.2

• Women.
• People aged 65 to 74 years and ≥75 years.
• American Indians/Alaska Natives and multiracial non-Hispanics.
• People who were unemployed, retired, or unable to work.
• People with less than a high school education.
• People who were divorced, widowed, or separated.
• Current or former smokers.
• People with a history of asthma.

COPD Among Women

In the past, COPD was often thought of as a man’s disease, but things have changed in the past couple of decades. Since 2000, more women than men have died from COPD in the United States.4 In 2018, chronic lower respiratory disease, primarily COPD, was the fourth leading cause of death among US women.4 The age-adjusted death rates for COPD have dropped among US men, but death rates have not changed for women.5 More women than men are also living with COPD in the United States.5

There are several reasons why COPD might affect women differently than men.6 Women tend to be diagnosed later than men, when the disease is more advanced and treatment is less effective. Women also seem to be more vulnerable to the effects of tobacco and other harmful substances, such as indoor air pollution. For example, tobacco smoke is the main cause of COPD in the United States, but women who smoke tend to get COPD at younger ages and with lower levels of smoking than men who smoke. There also appear to be differences in how women and men respond to different treatments.

https://www.cdc.gov/copd/basics-about.html

 

World Key facts

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019 [1].
Over 80% of these deaths occurred in low- and middle-income countries (LMIC).
COPD causes persistent and progressive respiratory symptoms, including difficulty in breathing, cough and/or phlegm production.
COPD results from long-term exposure to harmful gases and particles combined with individual factors, including events which influence lung growth in childhood and genetics.
Environmental exposure to tobacco smoke, indoor air pollution, and occupational dusts, fumes, and chemicals are important risk factors for COPD.
Early diagnosis and treatment, including smoking cessation support, is needed to slow the progression of symptoms and reduce flare-ups.

The impact of COPD on daily life
Common symptoms of COPD develop from mid-life onwards, including:

• breathlessness or
• difficulty breathing,
• chronic cough, often with phlegm,
• tiredness.

As COPD progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness. There may be a considerable financial burden due to limitation of workplace and home productivity, and costs of medical treatment.

During flare-ups, people with COPD find their symptoms become much worse – they may need to receive extra treatment at home or be admitted to hospital for emergency care. Severe flare-ups can be life-threatening.

People with COPD often have other medical conditions such as heart disease, osteoporosis, musculoskeletal disorders, lung cancer, depression and anxiety.

Reducing the burden of COPD

There is no cure for COPD but early diagnosis and treatment are important to slow the progression of symptoms and reduce the risk of flare-ups.

COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed.

There are several actions that people with COPD can take to improve their overall health and help control their COPD:

stop smoking: people with COPD should be offered support to quit smoking;
take regular exercise; and
get vaccinated against pneumonia, influenza and coronavirus.
Inhaled medication can be used to improve symptoms and reduce flare-ups. There are different types of inhaled medication which work in different ways and can be given in combination inhalers, if available.

Some inhalers open the airways – they may be given regularly to prevent or reduce symptoms, and to relieve symptoms during acute flare-ups. Inhaled corticosteroids are sometimes given in combination with these to reduce inflammation in the lungs.

Inhalers must be taken using the correct technique, and in some cases with a spacer device to help deliver the medication into the airways more effectively. Access to inhalers is limited in many low- and middle-income countries – in 2019 salbutamol inhalers were generally available in primary care public health facilities in approximately half of low-income countries [2].

Flare-ups are often caused by a respiratory infection – people may be given an antibiotic or steroid tablets in addition to inhaled or nebulised treatment as needed.

People living with COPD must be given information about their condition, treatment and self-care to help them to stay as active and healthy as possible.

https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

COPD flare-ups

COPD weakens your lungs, making it harder for your body to fight off colds or protect itself from smoke or air pollution damage. Over time, you may notice your symptoms get worse because of certain triggers, such as smells, cold air, or poor air quality. Or your symptoms may get worse because of a cold, flu, or lung infection. This sudden worsening of symptoms is called a flare-up or an exacerbation.

During a flare-up, you may have a much harder time catching your breath. You may also have chest tightness, more coughing, changes in the color or amount of your sputum (spit), and a fever.

Call your doctor right away if your symptoms worsen suddenly. They may prescribe antibiotics to treat an infection, along with other medicines, such as bronchodilators and inhaled or oral steroids, to help you breathe. Some severe symptoms may require treatment in a hospital.

How serious a flare-up is depends on the amount of lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Take steps to keep yourself healthy to help prevent a flare-up.

When to call the doctor

Don’t wait for your symptoms to become serious. As soon as you notice symptoms of COPD in yourself or a loved one, make an appointment to see a doctor.

A flare-up may require treatment in a hospital. You — or, if you are unable, your family members or friends — should call 9-1-1 if you are experiencing unusual events:

You are having a hard time catching your breath or talking.
Your lips or fingernails have turned blue or gray, a sign of a low oxygen level in your blood.
People around you notice that you are not mentally alert.
Your heartbeat is very fast.
The recommended treatment for your symptoms is not working.

https://www.nhlbi.nih.gov/health/copd

 

Chronic obstructive pulmonary disease (COPD) includes one or more of three separate diseases:

Emphysema
Chronic bronchitis
Chronic obstructive asthma
They all make it harder to breathe and get worse over time.

The three key symptoms of COPD are:

• Shortness of breath
• A cough that doesn’t go away
• Coughing up thick, often colored mucus (phlegm)

If you notice any combination of these symptoms, you should talk to your health care provider.

Early Symptoms

Many people don’t notice any symptoms of chronic obstructive pulmonary disease (COPD) in the early stages. In some cases, this may be because there aren’t any. In others, though, there are subtle early signs that you might notice if you pay attention.

For example, you might find that you simply can’t do the daily tasks of life as easily as you used to, like walking up the stairs, gardening, or bringing your groceries inside. This could be because you’ve gained weight, stopped exercising, or gotten the flu. But if there’s no obvious cause and the symptoms seem to stick around, it’s time to see your doctor for an evaluation.

They can do a series of tests on your breathing (spirometry) that could help rule out or diagnose COPD.

Other Symptoms
Symptoms typically get worse over time, and you may have serious lung damage before you even notice them, especially if you’re a smoker. Make an appointment if you have any of these other possible signs of COPD:

• Wheezing
• Blue lips or fingernails
• Fatigue (extreme tiredness) most or all of the time
• Frequent colds
• Losing weight without trying
• Swollen feet, ankles, or legs
• Having to clear your throat a lot
• Chest tightness

When to Call a Doctor
These symptoms can mean that you have an infection or your COPD is getting worse. Call your doctor within 24 hours if you notice:

• You’re out of breath or coughing more than usual.
• Being out of breath affects your daily routine.
• You’re coughing up more gunk than normal. The gunk is yellow, green, or rust-colored.
• You have a fever over 101 F.
• You feel dizzy or lightheaded.

Call 911 or go to the emergency room if you’re still out of breath after using the medicines your doctor has prescribed for your COPD.

https://www.webmd.com/lung/copd/what-are-symptoms-of-copd

 

COPD diagnosis

To diagnose chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, your doctor will evaluate your symptoms, ask for your complete health history, conduct a health exam and examine test results.

Health History

Your doctor will want to know if you:

Smoke or have a history of smoking
Are exposed to secondhand smoke, air pollution, chemicals or dust
Have symptoms such as shortness of breath, chronic cough or lots of mucus
Have family members who have had COPD

Testing for COPD

Spirometry: If you are at risk for COPD or have symptoms of COPD, you should be tested through spirometry. Spirometry is a simple test of how well your lungs work. For this test, you blow air into a mouthpiece and tubing attached to a small machine. The machine measures the amount of air you blow out and how fast you can blow it.

Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.

Other tests: Your doctor may also want you to have a chest X-ray and/or other tests, such as an arterial blood gas test, which measures the oxygen level in your blood. This test can show how well your lungs are able to move oxygen into your blood and remove carbon dioxide from your blood.

What Causes COPD?

Over time, exposure to irritants that damage your lungs and airways can cause chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. The main cause of COPD is smoking, but nonsmokers can get COPD too.

Smoking
About 85 to 90 percent of all COPD cases are caused by cigarette smoking. When a cigarette burns, it creates more than 7,000 chemicals, many of which are harmful. The toxins in cigarette smoke weaken your lungs’ defense against infections, narrow air passages, cause swelling in air tubes and destroy air sacs—all contributing factors for COPD.

Your Environment
What you breathe every day at work, home and outside can play a role in developing COPD. Long-term exposure to air pollution, secondhand smoke and dust, fumes and chemicals (which are often work-related) can cause COPD.

Alpha-1 Deficiency
A small number of people have a rare form of COPD called alpha-1 deficiency-related emphysema. This form of COPD is caused by a genetic (inherited) condition that affects the body’s ability to produce a protein (Alpha-1) that protects the lungs.

COPD Risk Factors

Smoking is the biggest risk factor for chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. It increases your risk of both developing and dying from COPD. Approximately 85 to 90 percent of COPD cases are caused by smoking. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked; male smokers are nearly 12 times as likely to die from COPD as men who have never smoked.

Other risk factors for COPD include:

• Exposure to air pollution
• Breathing secondhand smoke
• Working with chemicals, dust and fumes
• A genetic condition called Alpha-1 deficiency
• A history of childhood respiratory infection

5 Steps to Reduce Your Risk for COPD

If you are concerned about getting COPD, there are steps you can take to protect yourself.

If you are a smoker, STOP SMOKING. Quitting smoking is the single most important thing a smoker can do to live a longer and healthier life. The American Lung Association has many programs to help you quit for good.
If you don’t smoke, don’t start. Smoking causes COPD, lung cancer, heart disease and other cancers.
Avoid exposure to secondhand smoke. Make your home smokefree. You’ll not only protect yourself, but your family too. Learn about your rights to a smokefree environment at work and in public places.
Be aware of other dangers. Take care to protect yourself against chemicals, dust and fumes in your home and at work.
Help fight for clean air. Work with others in your community to help clean up the air you and your family breathe.

https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/symptoms-diagnosis

 

COPD Therapy

There’s currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms.

Treatments include:

stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
inhalers and tablets – to help make breathing easier
pulmonary rehabilitation – a specialised programme of exercise and education
surgery or a lung transplant – although this is only an option for a very small number of people
A doctor will discuss the various treatment options with you.

Stop smoking
If you smoke, stopping is the most effective way to prevent COPD getting worse.

Although any damage done to your lungs and airways cannot be reversed, giving up smoking can help prevent further damage.

This may be all the treatment that’s needed in the early stages of COPD, but it’s never too late to stop – even people with more advanced COPD will benefit from quitting.

If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to a GP about the stop smoking treatments available to you.

Find out more about stop smoking support or find a stop smoking service near you.

Inhalers
If COPD is affecting your breathing, you’ll usually be given an inhaler. This is a device that delivers medicine directly into your lungs as you breathe in.

A doctor or nurse will advise you on how to use an inhaler correctly and how often to use it.

There are several different types of inhaler for COPD. The main types include:

Short-acting bronchodilator inhalers
For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.

Bronchodilators are medicines that make breathing easier by relaxing and widening your airways.

There are 2 types of short-acting bronchodilator inhaler:

beta-2 agonist inhalers – such as salbutamol and terbutaline
antimuscarinic inhalers – such as ipratropium
Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day.

Long-acting bronchodilator inhalers
If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended.

These work in a similar way to short-acting bronchodilators, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day.

There are 2 types of long-acting bronchodilator inhaler:

beta-2 agonist inhalers – such as salmeterol, formoterol and indacaterol
antimuscarinic inhalers – such as tiotropium, glycopyronium and aclidinium
Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic.

Steroid inhalers
If you’re still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups (exacerbations), a GP may suggest including a steroid inhaler as part of your treatment.

Steroid inhalers contain corticosteroid medicines, which can help to reduce the inflammation in your airways.

Steroid inhalers are normally prescribed as part of a combination inhaler that also includes a long-acting medicine.

Tablets
If your symptoms are not controlled with inhalers, a doctor may recommend taking tablets or capsules as well.

Theophylline tablets
Theophylline is a type of bronchodilator. It’s unclear exactly how theophylline works, but it seems to reduce swelling (inflammation) in the airways and relax the muscles lining them.

Theophylline comes as tablets or capsules and is usually taken twice a day.

You may need to have regular blood tests during treatment to check the level of medicine in your blood.

This will help a doctor work out the best dose to control your symptoms while reducing the risk of side effects.

Possible side effects include:

feeling and being sick
headaches
difficulty sleeping (insomnia)
noticeable pounding, fluttering or irregular heartbeats (palpitations)
Sometimes a similar medicine called aminophylline is also used.

Mucolytics
If you have a persistent chesty cough with lots of thick phlegm, the doctor may recommend taking a mucolytic medicine called carbocisteine.

Mucolytic medicines make the phlegm in your throat thinner and easier to cough up.

Carbocisteine comes as tablets or capsules and is usually taken 3 or 4 times a day.

If carbocisteine does not help your symptoms, or you cannot take it for medical reasons, another mucolytic medicine called acetylcysteine is available.

This comes as a powder that you mix with water. Acetylcysteine powder has an unpleasant smell, like rotten eggs, but this smell should go away once you mix it with the water.

Steroid tablets
If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.

A 5-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as:

weight gain
mood swings
weakened bones (osteoporosis)
Your doctor may give you a supply of steroid tablets to keep at home to take as soon as you experience a bad flare-up.

Longer courses of steroid tablets must be prescribed by a COPD specialist. You’ll be given the lowest effective dose and monitored closely for side effects.

Antibiotics
Your doctor may prescribe a short course of antibiotics if you have signs of a chest infection, such as:

becoming more breathless
coughing more
noticing a change in the colour (such as becoming brown, green or yellow) and/or consistency of your phlegm (such as becoming thicker)
Sometimes you may be given a course of antibiotics to keep at home and take as soon as you experience symptoms of an infection.

Pulmonary rehabilitation
Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD.

It can help improve how much exercise you’re able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing.

Pulmonary rehabilitation programmes usually involve 2 or more group sessions a week for at least 6 weeks.

A typical programme includes:

physical exercise training tailored to your needs and ability – such as walking, cycling and strength exercises
education about your condition for you and your family
dietary advice
psychological and emotional support
The programmes are provided by a number of different healthcare professionals, including physiotherapists, nurse specialists and dietitians.

The British Lung Foundation has more information about pulmonary rehabilitation.

Improving muscle strength
If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.

This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.

Other treatments
If you have severe symptoms or experience a particularly bad flare-up, you may sometimes need additional treatment.

Nebulised medicine
Nebulised medicine may be used in severe cases of COPD if inhalers have not worked.

This is where a machine is used to turn liquid medicine into a fine mist that you breathe in through a mouthpiece or a face mask. It enables a large dose of medicine to be taken in one go.

You’ll usually be given a nebuliser device to use at home after being shown how to use it.

Roflumilast
Roflumilast is a new medicine that can be used to treat flare-ups.

It is recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers.

Roflumilast comes as tablets and the medicine helps reduce inflammation inside the lungs and airways.

Side effects of roflumilast include:

feeling and being sick
diarrhoea
reduced appetite
weight loss
headache

Long-term oxygen therapy
If COPD causes a low level of oxygen in your blood, you may be advised to have oxygen at home through nasal tubes or a mask.

This can help stop the level of oxygen in your blood becoming dangerously low, although it’s not a treatment for the main symptoms of COPD, such as breathlessness.

Long-term oxygen treatment should be used for at least 16 hours a day.

The tubes from the machine are long, so you will be able to move around your home while you’re connected. Portable oxygen tanks are available if you need to use oxygen away from home.

Do not smoke when using oxygen. The increased level of oxygen is highly flammable and a lit cigarette could cause a fire or explosion.

Ambulatory oxygen therapy
Some people with COPD will benefit from ambulatory oxygen, which is oxygen you use when you walk or are active in other ways.

If your blood oxygen levels are normal while you’re resting but fall when you exercise, you may be able to have ambulatory oxygen therapy rather than long-term oxygen therapy.

Non-invasive ventilation (NIV)
If you’re taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation (NIV).

This is where a portable machine connected to a mask that covers your nose or face is used to support your lungs and make breathing easier.

Surgery
Surgery is usually only suitable for a small number of people with severe COPD whose symptoms are not controlled with medicine.

There are 3 main operations that can be done:

bullectomy – an operation to remove a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
lung volume reduction surgery – an operation to remove a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
lung transplant – an operation to remove and replace a damaged lung with a healthy lung from a donor
These are major operations done under general anaesthetic, where you’re asleep, and involve significant risks.

If your doctors feel surgery is an option for you, speak to them about what the procedure involves and what the benefits and risks are.

https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/

 

Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the third leading cause of death in this country. [1] Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma or a combination of the above

Trial of Nocturnal Oxygen in Chronic Obstructive Pulmonary Disease
BACKGROUND
Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain.

METHODS
We designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population.

RESULTS
Recruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, −3.0 percentage points; 95% confidence interval, −15.1 to 9.1).

CONCLUSIONS
Our underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628. opens in new tab.)

The New England Journal of medicine

 

INTRODUCTION

Long-term oxygen therapy (LTOT) increases survival and improves the quality of life of hypoxemic patients with chronic obstructive pulmonary disease (COPD) and is often prescribed for patients with other hypoxemic chronic lung disease [1-15]. Each year, approximately 1.5 million patients in the United States receive LTOT [13].
In this topic, the potential benefits and indications for LTOT and practical issues including reimbursement, documentation of need, and the process of prescribing LTOT are reviewed. High-flow nasal cannula, portable oxygen delivery, and oxygen conserving devices are discussed separately. (See “Continuous oxygen delivery systems for the acute care of infants, children, and adults” and “Portable oxygen delivery and oxygen conserving devices”.)

BENEFITS

Five randomized trials have evaluated the effect of long-term oxygen therapy (LTOT) on mortality in patients with COPD.
●Two of the trials, the Nocturnal Oxygen Therapy Trial (NOTT) and the Medical Research Council (MRC) trial, demonstrated improved survival among patients that received LTOT (figure 1 and figure 2), including correlation between survival and the average daily duration of oxygen use [1,2].

●In contrast, two trials (nocturnal oxygen therapy [NOT] and supplemental oxygen for moderate hypoxemia), found no effect of LTOT on survival [4,16].

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