COPD

Chronic Bronchitis and Emphysema are the two most common conditions that contribute to COPD.  Chronic Bronchitis is inflammation of the lining of the bronchial tubes, that would lead to excessive sputum or phlegm production making it harder for the patient to breath.  Emphysema is a condition in which the air sacs (alveoli) at the air passages are destroyed because of the damaging exposure.

Symptoms do not usually appear until significant lung damage has occurred, and continue to worsen over time.  When you have COPD:

• You have a cough that won’t go away.
• You often cough up mucus.
• You are often short of breath, especially when you exercise.
• You may feel tightness in your chest.
• Weight loss
• Lack of energy

COPD exacerbation

Many people with COPD have attacks called flare-ups or exacerbation. This is when your usual symptoms quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may have to go to the hospital.

Symptoms include:

• Coughing up more mucus than usual.
• A change in the color or thickness of that mucus.
• More shortness of breath than usual.
• Greater tightness in your chest.

These attacks are most often caused by infections-such as acute bronchitis and pneumonia-and air pollution.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Try not to panic if you start to have a flare-up. Quick treatment at home may help you manage serious breathing problems.

DIAGNOSIS

To diagnose COPD, your doctor will probably do the following tests:

• Medical history and physical exam. These will give your doctor important information about your health.
• Lung function tests. Lung function tests, including an FEV1 test. These tests measure the amount of air in your lungs and the speed at which air moves in and out. Spirometry is the most important of these tests.
• Chest X-ray. This helps rule out other conditions with similar symptoms, such as lung cancer.

Tests done as needed

• Arterial blood gas. This test measures how much oxygen, carbon dioxide, and acid is in your blood. It helps your doctor decide whether you need oxygen treatment.
• Oximetry. This test measures the oxygen saturation in the blood. It can be useful in finding out whether oxygen treatment is needed, but it provides less information than the arterial blood gas test.
• Electrocardiogram (ECG, EKG) or echocardiogramechocardiogram. These tests may find certain heart problems that can cause shortness of breath.
• Transfer factor for carbon monoxide. This test looks at whether your lungs have been damaged, and if so, how much damage there is and how bad your COPD might be.

Tests rarely done

• Alpha-1 antitrypsin (AAT) test. AAT is a protein your body makes that helps protect the lungs. People whose bodies don’t make enough AAT are more likely to get emphysema.
• A CT  scan. This gives doctors a detailed picture of the lungs.

Regular checkups

Because COPD is a disease that keeps getting worse, it is important to schedule regular checkups with your doctor. Checkups may include:

• Spirometry
• Arterial blood gas test
• X-rays or ECGs

Tell your doctor about any changes in your symptoms and whether you have had any flare-ups. Your doctor may change your medicines based on your symptoms.

Early detection

The sooner COPD is diagnosed, the sooner you can take steps to slow down the disease and keep your quality of life for as long as possible. Screening tests help your doctor diagnose COPD early, before you have any symptoms.

Talk to your doctor about COPD screening if you:

• Are a smoker or an ex-smoker.
• Have had serious asthma symptoms for a long time, and they have not improved with treatment.
• Have a family history of emphysema.
• Have a job where you are exposed to a lot of chemicals or dust.

RECOMMENDED MEDICATIONS

Medicine for COPD is used to:

• Reduce shortness of breath.
• Control coughing and wheezing.
• Prevent COPD flare-ups, also called exacerbations, or keep the flare-ups you do have from being life-threatening.

Most people with COPD find that medicines make breathing easier.

Some COPD medicines are used with devices called inhalers or nebulizers. It’s important to learn how to use these devices correctly. Many people don’t, so they don’t get the full benefit from the medicine.

Medicine choices

• Bronchodilators are used to open or relax your airways camera.gif and help your shortness of breath.
  • Short-acting bronchodilators ease your symptoms. They are considered a good first choice for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). They include:
    • Anticholinergics (such as ipratropium).
    • Beta2-agonists (such as albuterol or levalbuterol).
    • A combination of the two (such as a combination of albuterol and ipratropium).
  • Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away (persistent symptoms). They include:
    • Anticholinergics (such as aclidinium, tiotropium, or umeclidinium)
    • Beta2-agonists (such as formoterol or salmeterol).
    • A combination of the two, or a combination of a beta2-agonist and a corticosteroid medicine.
• Phosphodiesterase-4 (PDE4) inhibitors are taken every day to help prevent COPD exacerbations. The only PDE4 inhibitor available is roflumilast (Daliresp).
• Corticosteroids (such as prednisone) may be used in pill form to treat a COPD flare-up or in an inhaled form to prevent flare-ups. They are often used if you also have asthma.
• Other medicines include methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects, so they are not usually recommended.

Tips for using inhalers

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This doesn’t always mean that the medicine won’t help. Try the medicine for a while before you decide if it is working.

Many people don’t use their inhalers right, so they don’t get the right amount of medicine. Ask your health care provider to show you what to do. Read the instructions on the package carefully.

Most doctors recommend using spacers with metered-dose inhalers. But you should not use a spacer with a dry powder inhaler.