What is Chronic Obstructive Pulmonary Disease?

Do you struggle to catch your breath or have a frequent cough that’s lasted for longer than 3 months? It might be time to visit your doctor. Particularly if you’re a smoker. Learn how to spot the warning signs of Chronic Obstructive Pulmonary Disease, and some helpful tips on how to manage your COPD symptoms.

What is COPD?

Chronic obstructive pulmonary disease, COPD, is an umbrella term that covers a group of chronic, long-term lung conditions — emphysema, chronic bronchitis, chronic asthma (asthma-COPD overlap or ACOS) — that make it difficult to breathe.

COPD is a common lung (and in many cases preventable) condition — around 1 in 7 Australians aged over 40 have some form of COPD — yet as many as half of these people are living with the condition and they don’t even know they have it.

The condition causes narrowing of the bronchial tubes, or airways, which restricts airflow in and out of the lungs, making it very difficult to breathe. This can be caused by mucus blocking the airways, lung damage, and inflammation and swelling of the airway lining.

Symptoms typically include coughing, wheezing, mucus and difficulty breathing.
Whilst it’s a common, progressive and (currently) incurable illness that gets worse over time, with the right diagnosis and treatment plan, the illness is treatable.

There are many things you can do to manage your condition and keep your symptoms under control. Here’s all you need to know about COPD.

What are the different types of COPD?

Emphysema and chronic bronchitis are the two most common types of COPD, and they can often occur simultaneously. The severity of the symptoms varies from person to person.

Emphysema is generally a result of damage to the lungs, from either exposure to cigarette smoke or breathing in irritants such as dust, gas, chemical agents and fumes, or smoke or air pollution.

Exposure to these chemical irritants causes the air passages and air sacs of the lungs become inflamed and damaged. This swelling makes the passageway for air much narrower, causing the air sacs to weaken, lose their elasticity, and eventually break, which reduces the surface area of the lungs and the amount of oxygen that can reach the bloodstream.

People with emphysema find it much more difficult to breathe, particularly when exercising.

Chronic bronchitis is a chronic cough that produces thick mucus, or phlegm, caused by inflammation in the airways. It literally means inflammation of the bronchi. It’s very common among people who smoke, but exposure to chemicals and irritants can also play a part. It’s also more common for people who have a family history of the illness.

Your lungs usually produce a small amount of fluid to stay healthy, but for anyone with chronic bronchitis, their lungs produce more fluid than they need, and this fluid fills airways with thick mucus, which leads to frequent coughing that’s often accompanied by mucus or phlegm.

Usually your airways protect the alveoli (air sacs) from harmful substances, and tiny hair-like fibres called cilia, that are inside your bronchial tubes, help to move this mucus out to the throat, where it can be coughed up or swallowed. With chronic bronchitis, these tiny hairs become damaged, so it’s harder for your body to get rid of mucus. Instead, it builds up in the airways and obstructs your airflow, causing a chronic productive cough.

Asthma is usually considered a separate respiratory disease to COPD, but because they often display similar symptoms, such as chronic coughing, wheezing, and shortness of breath, it’s sometimes mistaken for COPD, and vice-versa. Some are diagnosed with asthma when they actually have COPD.

Most people with asthma don’t develop COPD, and many people with COPD don’t have asthma, but it is possible to have both. Around 20% of people with COPD also have asthma (also known as asthma-COPD overlap or ACOS). It isn't a separate disease, the name refers to the mix of symptoms.

If you suffer with asthma, you are more at risk of developing COPD, and your risk increases as you age, so it’s important to get a thorough diagnosis as early as possible, so you can treat your symptoms effectively.

A patient with asthma-COPD overlap requires specific treatment that differs from asthma or COPD treatment. Although symptoms may not always be severe, this condition is serious and can be fatal if not managed properly. Typically, symptoms include shortness of breath, coughing and heavy mucus.

It’s not clear what causes ACOS, but it’s thought you may be more likely to develop the condition if you have a family history or childhood history of allergies or asthma, had respiratory infections as a child, or if you smoke or have been exposed to chemicals or irritants.

What are the symptoms of COPD?

In the early stages of the illness, you might not even notice any symptoms, or if you do, they may be so mild that you might mistake them for a cold or cough.
Noticeable symptoms don’t usually start until there is significant lung damage, and as the illness progresses, they usually worsen over time, making the symptoms more constant and noticeably more difficult to breathe.

Early symptoms might include:

• wheezing and tightening in the chest
• excess sputum (a mix of salvia and mucus)
• occasional breathlessness, especially after exercise
• mild, recurrent cough
• the need to clear your throat often

As the disease progresses, symptoms tend to get worse, and they are much more obvious. These can include:

• shortness of breath, even after mild exercise or even walking
• a recurrent cough that doesn’t go away
• tight chest
• coughing up mucus
• frequent respiratory infections
• fatigue and lack of energy
• unintended weight loss (in later stages of the illness)
• swelling of the feet, ankles and legs (in later stages)

At times, symptoms can worsen into what’s termed ‘exacerbations’, or flare-ups, that can last for several days. During these episodes, symptoms become much worse than they are day-today. If you smoke, symptoms are likely to worsen even more.

What causes COPD?

Smoking is the leading cause of COPD, making the illness, in most cases, entirely preventable. Other causes are excessive exposure to chemicals, fumes, irritants, dust and pollution, for long periods of time.

The older you are increases your risk factor, so if you’re a smoker, you are more likely to develop the condition the older you get, and the longer you’ve smoked. The illness develops slowly over the years, so obvious symptoms don’t usually start until age 40 or older.

In rare cases, genetics can play a part. A small number of people with COPD are deficient in a protein called alpha-1-antitrypsin. It causes the lungs to deteriorate and can also affect the liver. If you are deficient in this protein, you may be more likely to develop COPD it at a younger age.

Some people who developed asthma in childhood are also more at risk, along with people who experienced early life events such as poor growth in pregnancy, premature birth, and frequent or severe respiratory infections in childhood that prevented lungs from developing properly.

Indigenous Australians are 2.5 times more likely to have COPD than non-Indigenous Australians.

People with COPD are also more at risk of developing heart disease, lung cancer and a variety of other conditions.

When you should see your doctor

If you’ve experienced shortness of breath or wheezing without exerting yourself, or you have a recurrent, chronic cough that doesn’t go away, make an appointment with your doctor. They’ll be able to run a series of tests, including a physical exam and a number of breathing tests. They’ll ask about your symptoms, your medical history and if you smoke, or have been exposed to chemicals, dust, or smoke at work.

They might also order lung function tests, chest X-rays and CT scans to rule out any other lung problems.

COPD is usually diagnosed if you’ve had a productive cough (with mucus) that doesn’t go away for three months or longer out of a year for at least two years. But spotting the early warning signs are essential, to slow the progression of symptoms and reduce the risk of flare-ups. The earlier it’s diagnosed, the less likely it will develop into more severe forms of COPD, and the easier it will be for you to manage.

You should keep your doctor informed if your symptoms do not improve after treatment, or if you notice any changes in your symptoms, like a fever or a noticeable change in sputum.

If you can’t catch your breath, experience severe blueness in your lips or fingernails, have a rapid heartbeat, or feel foggy and have trouble concentrating, seek immediate medical care.

What are the treatments for COPD?

As there’s currently no cure for COPD, treatment aims to ease symptoms and slow down the progression of the disease. If you smoke, the best thing you can do to ease COPD symptoms is stop smoking. Speak to you doctor who will be able to give you advice on how to start the process.

Other treatments might include:

• Inhalers to open the airways – they may be given regularly to prevent or reduce symptoms, and to relieve symptoms during acute flare-ups.
• Corticosteroids (ether inhaled or oral) to reduce inflammation in the lungs.
• Antibiotics to fight bacterial respiratory infections.
• Lung therapies, such as oxygen therapy, to reduce shortness of breath, protect your organs, and enhance your quality of life.
• Exercise training, nutrition advice and counselling.

It’s also important to exercise frequently, maintain a healthy, balanced diet and ensure you get regular vaccinations to protect against pneumonia, influenza and coronavirus. These infections can put people with COPD more at risk.

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