Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease
SynonymsChronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic bronchitis, emphysema, pulmonary emphysema, others
Centrilobular emphysema 865 lores.jpg
Gross pathology of a lung showing centrilobular-type emphysema characteristic of smoking. This close-up of the fixed, cut lung surface shows multiple cavities filled with heavy black carbon deposits.
SpecialtyPulmonology
SymptomsShortness of breath, cough with sputum production.[1]
ComplicationsAcute exacerbation of chronic obstructive pulmonary disease[2]
Usual onsetOver 40 years old[3]
DurationLong term[3]
CausesTobacco smoking, air pollution, genetics[2]
Diagnostic methodLung function tests[4]
Differential diagnosisAsthma[3]
PreventionImproving indoor and outdoor air quality[3]
TreatmentStopping smoking, respiratory rehabilitation, lung transplantation[2]
MedicationVaccinations, inhaled bronchodilators and steroids, long-term oxygen therapy[2][5]
Frequency174.5 million (2015)[6]
Deaths3.2 million (2015)[7]

Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow.[1][8] The main symptoms include shortness of breath and cough with sputum production.[1] COPD is a progressive disease, meaning it typically worsens over time.[9] Eventually everyday activities, such as walking or getting dressed, become difficult.[3] Chronic bronchitis and emphysema are older terms used for different types of COPD.[3][10] The term "chronic bronchitis" is still used to define a productive cough that is present for at least three months each year for two years.[1]

Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.[2] In the developing world, one of the common sources of air pollution is poorly vented heating and cooking fires.[3] Long-term exposure to these irritants causes an inflammatory response in the lungs, resulting in narrowing of the small airways and breakdown of lung tissue.[5] The diagnosis is based on poor airflow as measured by lung function tests.[4] In contrast to asthma, the airflow reduction does not improve much with the use of a bronchodilator.[3]

Most cases of COPD can be prevented by reducing exposure to risk factors.[11] This includes decreasing rates of smoking and improving indoor and outdoor air quality.[3] While treatment can slow worsening, no cure is known.[3] COPD treatments include smoking cessation, vaccinations, respiratory rehabilitation, and often inhaled bronchodilators and steroids.[2] Some people may benefit from long-term oxygen therapy or lung transplantation.[5] In those who have periods of acute worsening, increased use of medications and hospitalization may be needed.[2]

As of 2015, COPD affected about 174.5 million (2.4%) of the global population.[6] It typically occurs in people over the age of 40.[3] Males and females are affected equally commonly.[3] In 2015, it resulted in 3.2 million deaths, up from 2.4 million deaths in 1990.[7][12] More than 90% of these deaths occur in the developing world.[3] The number of deaths is projected to increase further because of higher smoking rates in the developing world, and an aging population in many countries.[13] It resulted in an estimated economic cost of $2.1 trillion in 2010.[14]

Signs and symptoms

The most common symptoms of COPD are sputum production, shortness of breath, and a productive cough.[15] These symptoms are present for a prolonged period of time[16] and typically worsen over time.[5] It is unclear whether different types of COPD exist.[2] While previously divided into emphysema and chronic bronchitis, emphysema is only a description of lung changes rather than a disease itself, and chronic bronchitis is simply a descriptor of symptoms that may or may not occur with COPD.[9]

Cough

A chronic cough is often the first symptom to develop. When it persists for more than three months each year for at least two years, in combination with sputum production and without another explanation, it is by definition chronic bronchitis. This condition can occur before COPD fully develops. The amount of sputum produced can change over hours to days. In some cases, the cough may not be present or may only occur occasionally and may not be productive. Some people with COPD attribute the symptoms to a "smoker's cough". Sputum may be swallowed or spat out, depending often on social and cultural factors. Vigorous coughing may lead to rib fractures or a brief loss of consciousness. Those with COPD often have a history of "common colds" that last a long time.[15]

Shortness of breath

Shortness of breath is often the symptom that most bothers people.[17] It is commonly described as: "my breathing requires effort," "I feel out of breath," or "I can't get enough air in".[18] Different terms, however, may be used in different cultures.[15] Typically the shortness of breath is worse on exertion of a prolonged duration and worsens over time.[15] In the advanced stages, or end stage pulmonary disease it occurs during rest and may be always present.[19][20] It is a source of both anxiety and a poor quality of life in those with COPD.[15] Many people with more advanced COPD breathe through pursed lips and this action can improve shortness of breath in some.[21][22]

Other symptoms

In COPD, breathing out may take longer than breathing in.[23] Chest tightness may occur,[15] but is not common and may be caused by another problem.[17] Those with obstructed airflow may have wheezing or decreased sounds with air entry on examination of the chest with a stethoscope.[23] A barrel chest is a characteristic sign of COPD, but is relatively uncommon.[23] Tripod positioning may occur as the disease worsens.[16]

Advanced COPD leads to high pressure on the lung arteries, which strains the right ventricle of the heart.[5][24][25] This situation is referred to as cor pulmonale, and leads to symptoms of leg swelling[15] and bulging neck veins.[5] COPD is more common than any other lung disease as a cause of cor pulmonale.[24] Cor pulmonale has become less common since the use of supplemental oxygen.[16]

COPD often occurs along with a number of other conditions, due in part to shared risk factors.[2] These conditions include ischemic heart disease, high blood pressure, diabetes mellitus, muscle wasting, osteoporosis, lung cancer, anxiety disorder, sexual dysfunction, and depression.[2][26] In those with severe disease, a feeling of always being tired is common.[15] Fingernail clubbing is not specific to COPD and should prompt investigations for an underlying lung cancer.[27]

Exacerbation

An acute exacerbation of COPD is defined as increased shortness of breath, increased sputum production, a change in the color of the sputum from clear to green or yellow, or an increase in cough in someone with COPD.[23] They may present with signs of increased work of breathing such as fast breathing, a fast heart rate, sweating, active use of muscles in the neck, a bluish tinge to the skin, and confusion or combative behavior in very severe exacerbations.[23][28] Crackles may also be heard over the lungs on examination with a stethoscope.[29]

Other Languages
Bân-lâm-gú: Hì-that-pēⁿ
беларуская (тарашкевіца)‎: Хранічная абструктыўная хвароба лёгкіх
Boarisch: Rauchabeischl
Frysk: COPD
interlingua: Emphysema pulmonar
Nederlands: COPD
नेपाली: सीओपीडी
ਪੰਜਾਬੀ: ਸੀ ਓ ਪੀ ਡੀ
srpskohrvatski / српскохрватски: Hronična opstruktivna bolest pluća