How much do you know about chronic obstructive pulmonary disease (COPD)?

“I retired last year due to COPD-related illness. I wanted to see if I could be social again, so I decided to meet an old friend. These days I don't get out much. I use supplemental oxygen on a 24/7 basis. This lunch would be the highlight of my month, and I wanted to feel like things were back to normal, despite my chronic condition.

My friend's total ignorance of my condition and subsequent approach baffled me.”

From 7 Ways to Handle Unwanted Advice on COPD by Barbara Moore, a COPD patient and Life Effects contributor.

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent conditions affecting worldwide health [1]. It's also one of the most misunderstood. 

Have you just been diagnosed with COPD? Do you know someone who has? Or do you want to help friends, family, and co-workers understand the condition?

For World COPD Awareness Day, Life Effects have created a readers’ guide to this common lung disease. At the end of the post, you’ll also find the best advice, tips, and suggestions from contributors who live with and manage COPD.

What is World COPD Awareness Day? 

World COPD Awareness Day first launched in 2002. Established by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), over 50 countries take part in events every year. GOLD strives to raise awareness, share knowledge, and discuss ways to reduce cases of COPD worldwide.

The theme for 2021 is "Healthy Lungs - Never More Important.” Since COVID-19, we've been extra vigilant about protecting our lung health. With all of us on high alert, GOLD aims to redirect some attention to COPD – a disease that remains a global health risk even as the world grapples with the ongoing pandemic.

GOLD says: 

Even in light of COVID, COPD remains a leading cause of death worldwide.

Keeping your lungs healthy can include avoiding cigarettes, air pollution, or occupational exposures, as well as staying active either through regular physical activity or pulmonary rehab. In addition, receiving important vaccines, keeping medical appointments, and taking the correct medications can help keep your lungs healthy![1]

Life with COPD can be difficult, and everyday tasks may prove challenging. But lifestyle changes could ease symptoms if you've been diagnosed, or prevent COPD if you haven't. Knowing all you can about this illness, its signs, and how to cope with flare-ups will help make day-to-day life easier.

What is COPD? 

Chronic: Persisting for a long time or reoccurring.

Obstructive: Causing a blockage or obstruction. In the case of COPD, the narrowing of the airways can lead to breathing difficulties.

Pulmonary: Relating to the lungs.

Disease: An illness affecting people, animals, or plants. Diseases are caused by infection or health failure rather than by accident or injury.[3]

Chronic obstructive pulmonary disease (COPD) isn't a single condition. The term actually refers to a group of lung conditions that cause breathing difficulties[4]. It's also possible to have more than one at the same time. 

The two most common types of COPD are emphysema and chronic bronchitis[5].

Emphysema 

Emphysema affects the air sacs (alveoli) in your lungs[6]. In your respiratory system, the windpipe (trachea) is the largest airway[7]. The trachea then branches, like an upside-down tree, into smaller airways called bronchi and bronchioles[8]. At the end of each bronchiole, there are thousands of tiny, balloon-shaped alveoli[9].

When you breathe in, the thin, muscular walls of the alveoli expand and pull in air. Oxygen passes through these thin walls into the capillaries (the smallest blood vessels in the body)[10]. Likewise, CO2 passes through the alveoli, causing them to spring back when you breathe out[11].

When someone is diagnosed with emphysema, these alveoli aren't working as well as they should. The thin walls struggle to expand and spring back. This can lead to air becoming trapped, even after someone exhales[12]. The inability to expel air stretches the alveoli walls, making them “floppy.”

The alveoli sacs may become so damaged they break apart and merge into one another. In turn, merged alveoli can cause holes to appear in the lungs.

Trapped air in the lungs from floppy, damaged alveoli may lead to hyperinflation in the chest[13]. Many emphysema patients say they find exhaling air more difficult than inhaling[14].

Chronic Bronchitis 

Chronic bronchitis means the "branches" and "twigs" of your respiratory tree - the bronchi and bronchioles - are inflamed[15].

In healthy bronchi and bronchioles, the inside walls are coated with sticky mucus[16]. Although people associate mucus with being ill or reacting to irritants, the body continually produces mucus[17]. Mucus protects the bronchi walls from damage as particles move down into the lungs.

Usually, mucus exits the lungs to the throat via the help of cilia - tiny, hair-like appendages that line the lungs. We often swallow and digest this excess mucus without noticing[18].

People with irritated or swollen bronchi often produce too much mucus. In some cases, the lungs' cilia are also damaged, making it harder for the mucus to reach the throat[19]. The body responds to excess mucus by coughing, which forces the mucus to get expelled from the body[20].

When bronchi become inflamed or swollen, it narrows the space for air to get through, making it difficult to breathe. Excess mucus causes further blockages, and the respiratory system has to work even harder[21].

Symptoms of COPD – Emphysema

Symptoms of emphysema aren't hard to spot, but they can be mistaken for signs of other illnesses. Sometimes, people don’t notice symptoms until 50% or more of the lung tissue is damaged[22].

Symptoms tend to come on gradually and start with tiredness and fatigue. You may also experience: 

• Shortness of breath, especially during light exercise or when climbing stairs
  
  
• Feeling like you can't get enough air 
  
  
• Long-term coughing that doesn't clear after a few weeks 
  
  
• Wheezing - a high-pitched whistling sound when breathing[23]
  
  
• Barrel-shaped chest due to inability to expel air trapped in the lungs[24]

If you have noticed any of these symptoms, please make an appointment with your GP or healthcare team. 

Symptoms of COPD – Chronic Bronchitis

Unsurprisingly, signs of emphysema and chronic bronchitis are similar. If you experience symptoms of COPD, it's vital to make a doctor’s appointment as soon as possible. 

With chronic bronchitis, you may experience: 

• Prolonged coughing - especially if you have a cough that produces mucus for 3 months or longer per year over 2 years[25]
• Wheezing 
• Chest discomfort 
• Bluish fingernails, lips, and skin due to decreased oxygen levels in the body[26]
• Swollen feet and ankles*[27]

*It's important to note that swollen feet and ankles aren't direct results of COPD. Instead, COPD complications, such as pulmonary hypertension (high blood pressure in the lungs), may lead to edema (fluid retention)[28].

Though they are different lung conditions, emphysema and chronic bronchitis can occur together. Though COPD is irreversible, proper treatment may slow down its progression.

What Causes COPD?

In 2016, the World Health Organization (WHO) estimated 251 million people worldwide lived with COPD[29]. However, in 2020, research from the University of Manchester, UK, suggested the number is closer to 550 million[30].

An annual WHO study, "Global Burden of Chronic Respiratory Disease,” found that COPD was the third leading cause of death in 2019, causing 3.23 million deaths[31]. According to the survey, the two prevailing conditions are ischaemic heart disease and stroke[32].

COPD is often referred to as "the smoker's disease.” This isn’t strictly true.

It’s estimated that cigarettes and tobacco are “by far the most common cause of COPD”[33]. However, other COPD risk factors include:

• Long-term exposure to certain chemicals and dust at work (e.g., asbestos, flour dust, welding fumes, coal dust)
  
  
• Air pollution 
  
  
• Lung damage from other, poorly-controlled conditions such as asthma[34]

Rarely, COPD can be a result of genetics. Alpha-1-antitrypsin is a protein that releases infection-fighting agents to prevent tissue damage in the lungs and liver[35]. Up to 5% of people with COPD are thought to have low levels of alpha-1 antitrypsin[36]. Those with an inherited Alpha-1-antitrypsin deficiency may notice signs of lung disease between ages 20-50[37].

Though you can develop COPD without ever smoking a cigarette, smoking is the leading culprit. It's never too late to give up tobacco, even with a COPD diagnosis. Continuing to smoke speeds up the progression of the disease.

Quitting smoking now can slow the progression of COPD and prolong your life. That's the case no matter your age or stage of COPD when you stop. 

Works Cited

American College of Allergy, Asthma & Immunology, acaai.org, n.d. Asthma-COPD Overlap. [Online] Available at: https://acaai.org/asthma/types-of-asthma/asthma-copd-overlap/ [Accessed 21 October 2021].

American Lung Association, Lung.org, 2020. Learn About Alpha-1 Antitrypsin Deficiency. [Online]  Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/alpha-1-antitrypsin-deficiency/learn-about-alpha-1-antitrypsin-defiency [Accessed 21 October 2021].

Cao, X., 2020. COVID-19: immunopathology and its implications for therapy. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7143200/ [Accessed 20 October 2021].

Collins Dictionary , n.d. Collins Online Dictionary. [Online] Available at: https://www.collinsdictionary.com/ [Accessed 25 October 2021].

Columbiasurgery.org, n.d. Chronic Obstructive Pulmonary Disease (COPD) and Emphysema. [Online] Available at: https://columbiasurgery.org/conditions-and-treatments/emphysema-and-chronic-obstructive-pulmonary-disease-copd [Accessed 20 October 2021].

COPD.net, 2015. Experiencing Swelling with COPD. [Online]  Available at: https://copd.net/symptoms/swelling [Accessed 20 October 2021].

Dirk-Jan Slebos, E. M. v. R. W. v. d. B., 2015. Air Trapping in Emphysema. [Online]
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Global Initiative for Chronic Obstructive Lung Disease, 2021. World COPD Day 2021. [Online]  Available at: https://goldcopd.org/world-copd-day/ [Accessed 20 October 2021].

healthcare-in-europe.com, 2020. New research doubles estimate for COPD prevalence. [Online]  Available at: https://healthcare-in-europe.com/en/news/new-research-doubles-estimate-for-copd-prevalence.html [Accessed 20 October 2021].

Healthline.com, 2017. A Look at COPD: Barrel Chest, Blue Lips, and Other Signs. [Online]  Available at: https://www.healthline.com/health/a-look-at-copd#barrel-chest [Accessed 20 October 2021].

Healthline.com, 2017. What Are the Stages of Emphysema?. [Online]  Available at: https://www.healthline.com/health/emphysema-stages [Accessed 20 October 2021].

Healthline.com, 2018. Breathtaking Lungs: Their Function and Anatomy. [Online]
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Healthline.com, 2020. Bronchial Tree. [Online]  Available at: https://www.healthline.com/human-body-maps/lung-trachea-bronchial-tree#1 [Accessed 20 October 2021].

John V. Fahy, B. F. D., 2010. Airway Mucus Function and Dysfunction. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048736/ [Accessed 20 October 2021].

Mayo Clinic, n.d. COPD. [Online]  Available at: https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679 [Accessed 25 October 2021].

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Medlineplus.gov, 2021. Alpha-1 antitrypsin deficiency. [Online] Available at: https://medlineplus.gov/genetics/condition/alpha-1-antitrypsin-deficiency/ [Accessed 20 October 2021].

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The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen. 

NPS-ALL-NP-01150 NOVEMBER 2023