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In general, symptoms of COPD don't appear until significant lung damage has occurred, and they usually worsen over time. People with COPD are also likely to experience episodes called exacerbations when their symptoms suddenly get much worse.

Signs and symptoms of COPD can vary, depending on which lung disease is most prominent. Most people have more than one of these signs and symptoms at the same time.

• Shortness of breath
• Wheezing
• Chest tightness
• Chronic cough

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COPD primarily refers to obstruction in the lungs caused by chronic asthmatic bronchitis and emphysema. Many people with COPD have both.

Chronic asthmatic bronchitis
Chronic asthmatic bronchitis causes inflammation and narrowing of the airways that lead into your lungs. This may cause you to cough and wheeze. Chronic asthmatic bronchitis also increases mucus production, which can further block the narrowed tubes.

Emphysema
Emphysema damages the tiny air sacs in your lungs (alveoli) in two main ways. Alveoli are clustered like grapes and emphysema gradually destroys the inner walls of these clusters, reducing the amount of surface area available to exchange oxygen for carbon dioxide. In addition, emphysema also makes the alveoli walls weaker and less elastic, so they collapse with exhalation — trapping air in the alveoli. Shortness of breath occurs because the chest wall muscles have to work harder to expel the air.

Cigarette smoke and other irritants
COPD is typically caused by long-term exposure to airborne irritants, such as:

• Tobacco smoke
• Dust
• Chemical fumes
• Air pollution

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Risk factors for COPD include:

• Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and people exposed to large amounts of secondhand smoke also are at risk. Chronic inhalation of marijuana smoke also can be injurious.
• Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts can irritate and inflame your lungs.
• Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
• Genetics. A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of a few cases of COPD. Researchers suspect that other genetic factors may also make certain smokers more susceptible to the disease.

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Complications of COPD include:

• Respiratory infections. When you have COPD, you're more likely to get frequent colds, the flu or pneumonia. Plus, any respiratory infection can make it much more difficult to breathe and produce further irreversible damage to the lung tissue.
• High blood pressure. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). This puts great strain on the right ventricle of your heart and may cause your ankles and legs to swell.
• Heart problems. COPD also increases your risk of heart disease, including heart attack. This is in addition to the adverse effects of nicotine on the coronary arteries.
• Depression. Difficulty breathing can keep you from doing activities that you enjoy. And it can be very difficult to deal with a disease that is progressive and incurable. Talk to your doctor if you feel sad, helpless or depressed.

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If your primary care doctor suspects that you have COPD, you'll likely be referred to a pulmonologist, a doctor who specializes in lung disorders.

What you can do
Before your appointment, you might want to write a list of answers to the following questions:

• What symptoms are you experiencing? When did they start?
• What makes your symptoms worse? Better?
• Does anyone in your family have COPD?
• Have you had any treatment for COPD? If so, what was it and did it help?
• Have you ever taken beta blockers for your high blood pressure or heart?
• Are you being treated for any other medical conditions?
• What medications and supplements do you take regularly?

You might want to have a friend or family member accompany you to your appointment. Often, two sets of ears are better than one when you're learning about a complicated medical problem such as COPD. Take notes if this helps.

What to expect from your doctor
Your doctor may ask some of the following questions:

• How long have you had a cough?
• Do you get short of breath easily?
• Have you noticed any wheezing when you breathe?
• Do you or have you ever smoked cigarettes?
• Would you like help in quitting?

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If you have symptoms of COPD and a history of exposure to lung irritants — especially cigarette smoke — your doctor may recommend some of the following tests.

Imaging tests

• Chest X-ray. In a few people, a chest X-ray can show emphysema — one of the main causes of COPD. More importantly, an X-ray can help rule out other lung problems, such as lung cancer, or heart failure.
• Computerized tomography (CT). CT scans combine X-ray images taken from many different angles to create detailed, cross-sectional images of internal organs. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD.

Lab tests

• Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. The blood is usually drawn from an artery in your wrist.
• Sputum examination. Analysis of the cells in the mucus you cough up, which is known as sputum, can help identify the cause of your lung problems and help rule out some lung cancers. If you have a productive cough, identifying a bacterial pathogen and treating it before it causes pneumonia is good preventive medicine.

Pulmonary function tests
Spirometry is the most common lung function test and the most important in diagnosing COPD and its stage. During this test, you'll be asked to blow into a large tube connected to a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. By repeating it at intervals, this test can also be used to track the progression of disease and to monitor how well treatment is working.

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There's no cure for COPD, and you can't undo the damage to your lungs. But COPD treatments can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Stop smoking
The most essential step in any treatment plan for smokers with COPD is to stop all smoking. It's the only way to keep COPD from getting worse — which can eventually result in losing your ability to breathe. But quitting smoking is never easy. And this task may seem particularly daunting if you've tried to quit before. Talk to your doctor about nicotine replacement products and medications that might help.

Medications
Doctors use several basic groups of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

• Bronchodilators. These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both.
• Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better. But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. They're usually reserved for people with moderate or severe COPD.
• Antibiotics. Respiratory infections — such as acute bronchitis, pneumonia and influenza — can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are recommended only when necessary.

Therapy

• Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time.
• Pulmonary rehabilitation program. These programs typically combine education, exercise training, nutrition advice and counseling. If you are referred to a program, you'll probably work with a range of health care professionals, including physical therapists, respiratory therapists, exercise specialists and dietitians. These specialists can tailor your rehabilitation program to meet your needs. Exercising regularly can significantly improve the efficiency of your cardiovascular system.

Surgery
Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone:

• Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently. The surgery has a number of risks, and long-term results may be no better than for nonsurgical approaches.
• Lung transplant. Single-lung transplantation may be an option for certain people with severe emphysema who meet specific criteria. Transplantation can improve your ability to breathe and be active, but it doesn't appear to prolong life and you may have to wait for a long time to receive a donated organ. So the decision to undergo lung transplantation is complicated.

Managing exacerbations
Even with ongoing treatment, you may experience times when symptoms suddenly get worse. This is called an acute exacerbation, and it may cause lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, a change in outdoor temperatures or high air pollution levels. Seek medical attention if you notice more coughing or a change in your mucus or if you have a harder time breathing.

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If you have COPD, you can take steps to feel better and slow the damage to your lungs:

• Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing more efficiently throughout the day. Also be sure to discuss breathing positions and relaxation techniques that you can use when you're short of breath.
• Clear your airways. In COPD, mucus tends to collect in your air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help.
• Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular exercise can improve your overall strength and endurance and strengthen your respiratory muscles.
• Eat healthy foods. A healthy diet can help you maintain your strength. If you're underweight, your doctor may recommend nutritional supplements. If you're overweight, losing weight can significantly help your breathing, especially during times of exertion.
• Avoid smoke. In addition to quitting smoking, it's important to avoid places where others smoke. Secondhand smoke may contribute to further lung damage.
• Get vaccinated. Respiratory infections can worsen your COPD symptoms. The annual flu shot helps reduce your chances of catching respiratory flu. The pneumonia vaccine lowers your risk of developing pneumonia.
• Avoid crowds and cold air. If you must go out into a crowd, use a surgical mask to help prevent germs from reaching your lungs. Cold air can trigger bronchospasm and shortness of breath. Put on a cold-air face mask before you go outdoors.

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Living with COPD can be difficult — especially as it becomes more and more difficult to catch your breath. You may have to give up activities that you previously enjoyed. And your family and friends may face significant changes and challenges in an effort to help you. You may also find yourself facing some tough questions, such as how long you have to live and what you will do if you no longer can take care of yourself.

It can help to share your fears and feelings with your family, friends and doctor. You may also want to consider joining a support group for people with COPD. And you may benefit from counseling if you feel depressed or overwhelmed.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Unlike some diseases, COPD usually has a clear cause and a clear path of prevention. The vast majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to quit smoking.

If you're a longtime smoker, these simple statements may not seem so simple, especially if you've tried quitting — once, twice or many times before. But it's critical to find a tobacco-cessation program that can help you kick the habit for good. It's your best chance for preventing damage to your lungs.

Occupational exposure to chemical fumes and dust is another risk factor for COPD. If you work with this type of lung irritant, talk to your supervisor about the best ways to protect yourself, such as wearing a mask.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.