Chronic Obstructive Pulmonary Disease (COPD)

COPD definition and symptoms

The term “chronic obstructive pulmonary disease” is used to refer to two respiratory diseases usually caused by smoking and often associated with chronic bronchitis and emphysema. It is one of the top 5 causes of mortality in North America and a common cause of hospitalizations. The four letters in COPD represent chronic obstructive pulmonary disease. Chronically, it is meant that it is a disease that can not be cured. COPD is a disease that slowly worsens the lungs and airways functions. Nine out of ten who are affected are smokers.

Chronic obstructive pulmonary disease (COPD) is a chronic slow progressive pulmonary disease that is caused by the inflammation that develops in the lungs of smokers. The results of this inflammation are the destruction of the lungs, which in turn leads to a worse lung function.

At COPD, it is common for you to have several of the following symptoms:

  • You feel breathless as you strain
  • You feel tired and less energetic
  • You increasingly need to cough up badly
  • You have wheezing, especially when exercising.
  • You often get infections in the respiratory tract.
  • You lose weight and get swollen feet.

The problem with COPD comes slowly and it is not always safe for you to perceive them as a sign that you are ill. For example, many smokers get used to coughing up mucus, which is one of the most common symptoms of COPD. You may also perceive it as a normal aging that your lungs function worse and you can manage things less effortlessly.

COPD can resemble asthma. It is sometimes difficult to distinguish COPD from asthma. Since both COPD and asthma are common diseases, there are also people who get both of the diseases.

The need for COPD develops slowly, for many years. In asthma, however, you usually notice clearly when asthma begins and you also get more frequent attacks of breathlessness. It is also more common with allergic diseases among people with asthma than those with COPD.

Contact a healthcare center if you suspect you have COPD, if you have COPD and have a respiratory infection, or if you have COPD and have difficulty breathing, do not get better at home treatment.

It is important that you fully understand the information communicated to you by your doctor. In order for you to be part of your care and making decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you do not understand any part of it. You can also ask for information to be printed so that you can read it in peace and quiet.

COPD causes

COPD is caused in the majority of cases by tobacco smoke. In tobacco smoke there are a variety of toxic substances that can cause inflammation of the trachea. The inflammation causes the changes in the lung tissues that are typical of COPD.

However, you can have COPD even if you have never smoked. Getting COPD when you have not been a smoker is unusual. It is sometimes because you have a lack of a protective substance, alpha-1 antitrypsin as a result of a hereditary disease that increases the risk of getting COPD. Being exposed to passive smoking, dust and gases in certain environments for a very long time can also cause COPD in people who have never smoked.

COPD is a common disease. The disease is unusual in persons under 40 years of age. Among people who have smoked for many years now, it is estimated that about half have had COPD at the age of 75.

quick fact:

Today, it can be stated that COPD affects more women than men. There are several reasons behind this. Smoking is the main reason why people get COPD, and studies show that women smoke more than men and that they start smoking earlier. Women also often get a more severe illness with faster progress, more symptoms, more worsening periods, more hospitalizations and poorer quality of life than men. Every year around 10,000 Americans die in COPD and for the first time more women die than men die from the disease.

Everyone can live with COPD if the disease is detected in time. Disease development can slow down, symptoms can be relieved and quality of life can be improved, whether you are female or male. COPD is mostly treated with lifestyle changes like quitting smoking, starting exercise and changing their diets. There is also medical treatment for the actual lung disease and sometimes treatment for depression or depression can also help.

Some are small steps, others bigger. For many, it is difficult to find motivation for implementing changes. Your doctor may help you break down the treatment in small incremental goals. Then it will be easier. Keep close contact with your doctor or COPD to get help and follow your goals.

How is COPD diagnosed?

Often it may suffice to describe your symptoms for a doctor to suspect you have COPD. Then you usually get a body examination. There is usually nothing special about the body examination if you have a mild form of COPD. However, if you have had the disease for a long time and have a more severe form, it often appears clear signs.

For example, it may be that:
  • You breathe fast and with prolonged exhalation even with easier effort
  • You have got an enlarged chest
  • You have lost a lot of weight
  • Your feet and lower legs are swollen.

To complete the body examination, the doctor will do more research. First, the lung function is checked with spirometry after you have breathed the airborne medication. You can also have your lungs X-rayed. You also usually get an ECG test.

Spirometry and reversibility test.

A spirometer is a device that measures the lung function. Through a spirometer survey, your doctor will know a lot of air you can blow out and how fast it passes. If your doctor suspects you have COPD, you may measure the lung function after you have breathed a respiratory drug called a reversibility test.

The study is done as follows: first, breathe in bronchodilator fluid. Then you take in as much air as you can. Then you breathe out as much as possible and as fast as you can in the appliance. If you have COPD, the study always shows a result that differs from the appearance of people with healthy lungs.

COPD stages

There are four stages of COPD. After severity, COPD is divided into four stages, stages 1-4. The lowest stage means that you have a mild form of COPD and stage 4 that you have a very hard COPD. At COPD stage 3, lung capacity is about half of normal and the damage is significantly more extensive. At stage 4, you have less than 30% of normal lung capacity. The earlier the disease is discovered the easier it is to improve its health.

Here are the four stages COPD is divided into, depending on how the lung works, measured with a spirometer:

  1. Stage one, precursor to COPD.
  2. Stadium two, mild COPD.
  3. Stage Three, medium wound COPD.
  4. Stage four, severe COPD.

COPD can cause different problems in different people. Therefore, a more detailed stage division is also used which takes into account the amount of trouble you may have and any worsening periods.

At the beginning of the investigation, the doctor usually takes some blood samples. Blood samples exclude another disease, so it is mainly done to rule out other diseases. There is no specific blood sample that shows if you have COPD or not. If you have a shortage of protein alpha-1 antitrypsin and at the same time smokers, this can lead you to an early stage of COPD. The level of alpha 1 antitrypsin in the blood can be measured in a single blood sample.

The lungs X-ray and computer tomography.

If your doctor suspects you have COPD, you may also make a pulmonary X-ray. It is primarily to exclude other lung diseases. Lung X-ray may show signs that indicate COPD, but the diagnosis can never be determined solely by X-rays. In rare cases there may be grounds for making a layer X-ray, so-called computer tomography. On this one it becomes more detailed how different parts of the lungs have been altered by the disease. An X-ray film is sometimes done for the doctor to be able to provide a more accurate diagnosis. It can also be done if the doctor thinks you would feel better about operating a pulmonary emphysema, which is done in some cases.

ECG.

Patients are also often recommended to do an ECG survey. The purpose is to detect heart disease, which can sometimes give symptoms that are very similar to those of COPD. In addition, the ECG survey can show whether the COPD itself affects the heart.

COPD treatment

The damage that has already occurred on the lungs when you are diagnosed with COPD cannot be repaired. Therefore, the treatment of COPD is attempting to cure a continued deterioration and destruction of the pulmonary alveoli. The earlier you seek help, the better the possibilities for treatment you have. If you have severe COPD, a large part of your care is about finding ways to make your daily life work as normally as possible.

The most important thing is to quit smoking. In the vast majority of cases, the disease depends on smoking and then it is absolutely important to quit smoking and not start again later. Smoking cessation is the only thing that can stop the development of the disease, which otherwise continues to deteriorate. Most people feel better when they quit smoking. But since nicotine dependence is very strong, you often need to smoke different types of supportive substances to succeed.

Healthcare has resources and methods to help people quit smoking. If there are special smoke detector facilities in your vicinity, you can contact them. Nurses and doctors at a healthcare center can also provide good help and guidance when quitting smoking. It may be easier to stop if you have the opportunity to converse with an experienced person about concerns, expectations and problems at smoking cessation.

By using certain medicines that help quit smoking, it is often easier to get rid of the habit. The drugs reduce the absorption of nicotine or block the positive effects of nicotine.

There are two different types of medicines used to assist in smoking cessation:

  • Nicotine drugs. They are used primarily and can be purchased without prescription. They are for example chewing gum, patches, inhaler, nasal spray and tablets.
  • Medicinal products without nicotine. There are tablets that a doctor prescribes.

Another help is the Stop Smoking line or help centers. If you want to quit smoking, you can get advice and support from specially trained staff via the line.

COPD drugs

None of the drugs used in COPD can cure the disease itself. The drugs are used primarily to relieve the daily symptoms, but sometimes you can also get drugs to reduce the number of periods when you get worse. The deterioration periods, also called exacerbations, often cause severe inconvenience when they occur and are a major problem for some people with COPD. The deterioration periods are usually due to respiratory tract infections.

If you have a mild form of COPD, you usually do not notice any symptoms of the disease. Then you do not need to take any medicine at all, except those used for smoking cessation.

The different types of drugs used in COPD:
  • Bronchodilator drugs
  • Cortisone
  • Special drugs against worsening periods
  • Oxygen

Bronchodilator drugs.

If you have mild to moderate COPD and only notice the symptoms sometimes you usually get an bronchodilator that you inhale through an inhaler. It may suffice to use a fast-acting bronchodilator drug if necessary. If you have more problems with COPD, you often also need to breathe in one or two bronchodilator, long-acting medicines daily.

Cortisone.

Cortisone can help when the disease becomes more difficult. In moderate to severe COPD and recurrent periods of deterioration, you often need cortisone in combination with drugs that broaden the airways. The cortisone is inhaled through an inhaler. You can get cortisone in tablet form as short-term treatment in worsening periods. The treatment may shorten such periods. However, you should avoid using cortisone tablets regularly because side effects may be difficult.

Other drugs to improve the periods of worsening.

If you have moderate or severe COPD and have periods of worsening with a severe discomfort, there is a medicine that contains the active substance roflumilast. The drug is called Daxas and can be used in some cases.

Acetylcysteine ​​is a tablet that is dissolved in water. Acetylcysteine ​​has long been considered to have a diuretic effect, but such an effect is not proven when the drug is taken as a tablet. However, in some people acetylcysteine ​​can protect against deterioration periods. Therefore, you can try the drug in some cases.

The importance of staying monitored

It is important that you, together with your doctor, make an evaluation of each drug you are trying to test. Spirometry examination can provide some guidance, but most importantly, how you feel yourself. An important criterion in the assessment is if you get fewer worsening periods. Other important criteria are, for example, how much breathlessness you have, how much you generally eat, how well you sleep at night, and how much the disease affects your everyday activities.

Regularly working out and being in good physical shape is important for stopping the development of the disease. The more physically active you are, the slower the disease develops, no matter how much your lungs are affected. A physical therapist or physiotherapist can advise you on physical activity and exercise. Together, you can work out a plan for how often and in what way you will train or move around.

A physiotherapist or physiotherapist also provides advice on breathing techniques, how to get the most effective respiratory tract and techniques for taking your medication. Coughing a lot often causes great effort for the pelvic floor, which can make you leak urine. The physiotherapist can advise exercises that strengthen the pelvic floor muscles. An occupational therapist can advise you on how to best manage your energy to cope with what you want to do. They can also assess which tools can help you at home.

You may need oxygen treatment at a hospital if you get worse and get temporary oxygen deficiency in the blood. In case of severe COPD with constant acid deficiency in the blood you may need oxygen treatment at home. Oxygen treatment at home can only be used if you do not smoke.

Vaccine can prevent deterioration. A virus infection such as flu can be very serious if you have COPD. Therefore, you should vaccinate against flu every year. To reduce the risk of severe pneumonia, you should also vaccinate against pneumococci.

In many health centers and hospitals there are special COPD receptions, usually associated with asthma reception. At a COPD reception there usually is a doctor, nurse, physiotherapist or physiotherapist, occupational therapist, dietician and curator. The team at the reception is educating about the disease and giving advice on how to live as well as possible with COPD. From the COPD, you can get a treatment plan, which includes information about smoking cessation, diet, exercise and signs of deterioration that you should be alert to.

Pay attention to your inconvenience. By learning to recognize signs that you are in a worsening period, you can prepare yourself early and adjust your treatment. If necessary, contact your healthcare provider. Then you can hopefully shorten the period you get worse. If you feel sick, you may need to go to an emergency room and get treatment.

COPD complications and follow-up diseases

It is common to develop heart disease for people with COPD. During your COPD examination it is important that you get your heart examined and that any heart problems are addressed. You also have a greater risk of osteoporosis. This is because you are often more physically inactive. Side effects of cortisone can be another contributing factor. To reduce the risk of osteoporosis, you will have preventative medicines prescribed. It is also important to move around and not to smoke.

If you are very sick, it is not uncommon for you to have a depression. For support and assistance, you can get support from the healthcare provider at the curator or other suitable healthcare staff. You may also sometimes need antidepressant drugs.

What happens in the body at COPD? There is a number of organs that suffer in the first line. To better understand the interconnected system that becomes affected with COPD, let us have a look at how the lungs work.

As you breathe in, the air passes through all the smaller trachea and eventually ends up in the lunges, the alveoli. In the lungs there are several hundred million pulmonary alveoli. Around each pulmonary alveolus there is a network of small blood vessels, capillaries. They oxygenate the blood with the air you breathe in. At the same time, carbon dioxide and other gases are released from the blood and disappear from the body through the air you breathe out. It is called gas exchange.

In COPD, the lungs cause sore changes in both the lungs and the smaller respiratory tract. Over time, the walls of the lungs are destroyed and larger cavities, so-called pulmonary emphysema, form. As a result, the gas-exchange between air and blood no longer works there. Emphysema means that you can not use the entire lung capacity and you are easily out of breath. Sometimes emphysema is widespread and includes large parts of both lungs. Sometimes emphysema is restricted to certain areas of the lungs.

In the emphysema, the elasticity of the lungs decreases. The small lungs that are the smallest components of the lungs and where oxygen is absorbed occurs, tear apart and form larger cavities. These non-functioning cavities are called emphysema. Normally, the lungs are buzzing, like a balloon, and spring back the air you inhale. The emphysema makes the lungs become more like a plastic bag and you have to help with the abdominal muscles to push the air out of the lungs. When the lung alveoli break, they also lose the ability to oxygenate the blood. This causes the body’s cells to get too little oxygen to their metabolism. You become more easily breathing because the lungs do not manage to give the blood the oxygen needed when you are strenuous.

Chronic bronchitis: is commonly referred to as “smoke cough”. The smoker is more or less bothered daily by coughing. The cough can be of the type of dry cough, but most often the cough is combined with mucus production. In some cases, large amounts of bad mucus are produced which must be coughed up. A physiotherapist can teach a technique to help ease up the mucus.

The problems can be different for different people. For example, a person with a certain reduction in lung function may experience a lot of breathlessness but have a completely normal level of oxygen in the bloodstream. Another person with the same level of lung function may have a reduced level of oxygen, but do not have difficulty breathing.

Inflammation of the mucous membrane.

COPD causes the mucous membrane of the airways to become inflamed. The inner part of the airway becomes swollen, reddened and light-headed and the cells that produce mucus increase in number and activity.

In the respiratory tract there are fine flutter hairs, whose task is to constantly transport the mucus upwards towards the trachea. If you have COPD, they are largely destroyed. This implies that the mucus production is increasing and partly that you have to cough a lot to get rid of the mucus. When the trachea is swollen it becomes even more difficult for the air to flow to the lungs. At COPD, the defense of lower respiratory tract infections is not as powerful as when you are completely healthy. This makes the risk that an infection goes deeper into the airways. Then you get more cough and your breathlessness increases.

The air stays in the lungs.

A healthy lung is elastic, which is necessary to keep the smaller airways open. COPD affects the lungs so that they become less elastic. Between lung and respiratory tract are elastic connections. When the lungs are destroyed, these “rubber bands” also break apart. As a consequence, the airways shrink when you breathe out. The elastic function that causes the trachea to spring back, and thus be held open, is destroyed. Since the lungs become less elastic in COPD, some parts of the lungs are not emptied into air. Even in a healthy person, there is air left in the lungs after maximum exhalation. If you have COPD, the amount of air that is caught increases. This means that you have to widen your chest and lungs abnormally to get enough air. It may feel like you have to fight to get you share of new oxygenated air.

Breathing takes a lot of energy. If you have healthy lungs, breathing work consumes at rest approximately two to three percent of the body’s total energy consumption. For those with severe COPD, breathing is much more energy-intensive. In case of severe COPD, breathing may require so much energy that you actually lose weight. To cope with widening your chest and lungs more often than usual, you often have to use extramuscular surgery as breathing becomes so laborious. Some of these muscles are in the shoulder portion.

The increased amount of entrapped air at COPD leads at the same time to the chest increase permanently in range, especially in depth, that is, the distance between the sternum and the spine increases. Even the lungs are often increased in volume.

Living with COPD

COPD cannot be cured. You can not repair the damage that has occurred on the lungs and respiratory tract. But you can live with COPD, especially if you detect the disease on time. You can slow down the rapid deterioration and you can do a lot to improve your energy and feel better.

Many of those who are told that they have COPD have the disease at an early stage. The trouble you suffer from the disease can be quite small, especially if you manage to quit smoking. However, getting a message about a chronic disease like COPD can still mean you get a crisis response. Knowing that the disease is strongly associated with smoking also makes many feel a shame to themselves have caused their inconveniences. If you feel you need help, you can receive call support from the curator or other healthcare staff.

Everyday life can be affected. But a lot of people live a good life even though they have COPD, but some get harder trouble that affects everyday life. If you have severe COPD, it’s common for simple everyday chores to feel heavy. Since you have limited energy, a lesser body effort can also cause you to get a lot of breathlessness and the need to rest and recover for a while. It may be difficult to not be able to participate in the activities you have previously estimated. But try to think about what works and do what you can to feel as good as possible. Through patient organizations you can connect with others with the disease and share experiences and thoughts. You can also get support from a curator and other occupational groups in your care.

The vital exercise.

The more you move, the better your health becomes. With better cardiovascular system and stronger muscles, you get more energy, you get more mobility and more comfortable life. Next to quitting smoking, exercise is the absolute best you can take to feel better. Exercise, like in other people, makes you improve your fitness, lung capacity, and oxygen absorption ability. You cannot restore the already damaged parts of your lungs, but you can significantly increase your ability to perform. With better fitness follows better, stronger, more elastic muscles, better control of the disease, greater well-being, greater freedom of choice and better quality of life. In addition, it can be both social and fun to exercise.

Use help of a physiotherapist. A physiotherapist can help you with everything from strength and fitness exercises to practical tips. You do not need to do big work, the most important thing when you exercise is that you do a bit more than you do today. Walking, swimming, cycling and Nordic walking are excellent fitness exercises. Start easily and increase as you progress. Keep in mind that you should talk to your doctor before you start exercising, so you do not overestimate yourself at the beginning. Together with your doctor or physician, you will arrive at what level is good to begin with.

Right nutrition means a lot.

Eating properly is an important part of your treatment. A balanced and thoughtful diet does not affect the disease itself, but it affects your energy and your ability to improve your condition.

When weight goes up.

If you lose weight, which is not impossible because you move less, the energy is deteriorating and you get harder to breathe. Start using common sense when you eat. Eat less fatty food and a lot of vegetables. Keep in mind that those who have COPD should never lose weight without first talking to a dietitian.

When weight goes down.

Common dietary advice does not always apply to those who have COPD. Especially not if you have a difficult COPD case. Then it’s common to lose weight. This is partly due to the fact that it is an effort to eat and partly because of the large amount of energy when you constantly use the abdominal and muscles to breathe. If you lose weight, you should consume more calories.

If you have trouble keeping weight, here are some tricks you can try:

When you lose your appetite:

  • Always have food you really like at home
  • Eat often and a bit at a time, making meals easier
  • Eat energy-efficient foods
  • Always eat the most energy-efficient part of the food first

If you get satiated fast:

  • Eat energy and nutritious foods first
  • Do not drink too much before and during the meal
  • Drink an hour after the meal
  • Choose cold dishes, they feel less saturating than hot ones

When you have breathlessness:

  • Rest before meals
  • Take your medicines before meals
  • Eat slowly
  • Have pre-cooked meals for the case of deterioration

When you’re tired:

  • Rest before the meal
  • Choose ready-made, it saves energy

When it gets really hard to breathe. COPD does not suddenly come as an asthma attack. You always feel that you have a little difficulty breathing, but sometimes you may feel worse. You may feel worse in days or weeks, for example, in cold weather. If you engage in a strenuous physical activity or have eaten too much, you may feel it becomes more difficult to breathe.

Then it’s good to know what to do.

  • Try to keep calm. As the pulse goes down, it becomes easier to breathe.
  • Ask someone to stay with you until you feel better.
  • Sitting on a chair with arms on a table. Put a pillow under your arms. In this position there will be less pressure on the lungs.
  • Breathe with punching technique. Breathe in through the nose. Pour the air slowly through your mouth and shape your lips roughly like when you whistle.
  • Take your bronchodilator medicine. If your clothes fit tight around your neck, chest and stomach then change them or loosen them.
  • Ask someone to open a window to get fresh air. Just make sure it’s not too cold or damp outside.
  • Drink something hot that can dissolve the mucous. Do not drink milk.
  • If you do not feel better, call your healthcare provider, your doctor or nurse.
  • If you feel much worse than usual, call 911.

COPD may vary widely from period to period. During certain periods the inconvenience becomes worse than usual, perhaps because of a cold.

These periods are called worsening periods, acute COPD or exacerbations. They usually range between 1-4 times a year and appear in the form of increased breathlessness or increased sense of clogging, you cough more badly than normal, the mucus is colored and that it whistles and worsens more than usual in the respiratory tract. Limbs or other parts of the body may also swell because they absorb fluid. Diffused mind or feeling freaky is not uncommon. This is because the oxygenation of the blood is getting lower.
Aggravation starts often with respiratory tract infections. A worsening period often begins with a respiratory tract infection in the lower respiratory tract. In a few cases, the deterioration of other illnesses or just after fatigue is caused by prolonged increase in respiratory work.

Learn the signals. Get to know your illness properly and you will soon be able to predict your worsening periods in good time before they occur. The deterioration periods may be different. In some cases, you can go to the health center on your own. Then it is enough to adjust the treatment at home to feel better. In other cases, the deterioration may require emergency visits or hospital care.

The deterioration is usually associated with colds. Therefore, it is a good tip to vaccinate you against, for example, flu. Talk to your healthcare center for assistance. One of the goals of your treatment is to avoid the deterioration periods as far as possible, or at least extend the time between them. Your doctor will help you with a complete treatment plan that covers everything from quitting smoking to drug treatment and diet and exercise advice.

COPD self-help

By moving around, you feel better and can reduce the feeling of breathlessness. But it’s common to avoid bodily exhausting activities when it’s hard and heavy to breathe. Too little physical movement causes further impaired work, which causes you to get even worse physical condition and becomes even more breathless. It is therefore important to try to get started in a way that feels fun. It can take the form of everyday activities such as walking, strolling or cycling. Many also manage light athletics.

Physical exercise under the guidance of a physiotherapist is important. It also applies if you have more trouble. But even occasionally just getting up occasionally from a sitting position can be effective if you have severe COPD. It’s important to adjust the pace with effort so you can breathe out between the second day and feel that the activity works with maximal efficiency. Many patients benefit by learning different relaxation exercises. A physiotherapist can give you tips on different exercises.

Eat nutritionally dense food to prevent weight loss. It is common for you to lose weight when the disease has been going on for a long time. In this case what you need is to eat energy-rich food. You may also need to get dietary advice from a dietician before losing weight so much that you become underweight.

In case of severe COPD, it may be more difficult to breathe when you eat a lot and you can also feel satiated very quickly. A good tip is to eat several smaller meals instead of a few large meals.

Facilitate breathing. When it feels hard to breathe, try breathing out with half-lips. Thus a back pressure is created that facilitates breathing.

To get you enough air, you often have to use extra muscles, usually around the shoulders. In such cases it is a good idea to use support for your arms. For example, you can support yourself with the elbows on a table.

Try to avoid infections. For that, avoid close contact with people you know is sick. Wash your hands frequently, especially if you have been in contact with people who are ill. This can reduce the risk of infection with an infection.

Stay out in the sun. Many who have COPD have a low level of vitamin D in the blood. This increases the risk of osteoporosis. Being in the sun is an effective way to increase the body’s ability to form vitamin D.

Learn more about the disease. It’s good if you get acquainted with the disease so you can be more active in your treatment. Use the resources available at COPD, and learn what you can do to get the best possible quality of life. Most COPD experts hold group-based training for people with COPD. Ask if there is any such education where you get your treatment.