What is COPD? What Are the Symptoms? How Is It Diagnosed and Treated?

COPD, which is seen in one out of every five adults over the age of 40, is a serious lung disease that requires you to have accurate information about COPD treatment. This condition, which can develop in approximately 20-25% of smokers, progresses insidiously. Therefore, it is of great importance to understand the symptoms of COPD, the causes of COPD, and the treatment options for COPD. In this article, we will address everything you need to know, from the question of whether there is a cure for COPD to methods for treating COPD exacerbations.

What is COPD?

COPD is a lung disease in which the air entering your lungs cannot easily exit. This condition, which is an abbreviation for Chronic Obstructive Pulmonary Disease, causes narrowing and obstruction in your airways. Seen in two out of every ten adults and one out of every four smokers, this disease is actually much more common than estimated.

The disease usually occurs with the coexistence of two fundamental conditions. Damage occurs in some parts of the lung tissue, mucus clogs the airways, and inflammation begins in the airway lining. All of these processes make breathing increasingly difficult.

The difference between chronic bronchitis and emphysema

There are two main forms of COPD, and each affects your lungs differently. Chronic bronchitis is the inflammation and narrowing of the airways called bronchi that lead to the alveoli. Individuals who have a complaint of phlegm production for at least three months each year for two consecutive years are diagnosed with chronic bronchitis.

In this case, the bronchi become permanently inflamed, swollen, and produce excessive amounts of thick mucus. The accumulation of mucus mechanically narrows the airways and makes it difficult for you to breathe.

In contrast, emphysema develops with damage to the air sacs (alveoli) in your lungs. These microscopic bubbles, where oxygen exchange takes place, have their walls torn and turn into large, non-functional spaces. These sacs, which normally have a flexible structure, lose their elasticity, and air trapping occurs in the lung.

As a result, your lungs become unable to exhale the dirty air they have inhaled. Emphysema is more severe than chronic bronchitis, and untreated chronic bronchitis can turn into emphysema over time.

The effects of COPD on the body

COPD affects not only your lungs but your entire body system. The disease makes breathing difficult and creates serious challenges in performing your daily activities. Even simple movements like walking or climbing stairs can tire you out.

In later stages, symptoms of wheezing and rapid fatigue appear. High pressure may develop in the pulmonary arteries, and this condition puts pressure on the right ventricle of the heart. Signs of heart failure such as swelling in the legs and prominence in the neck veins may also be added.

Furthermore, COPD patients become more prone to additional health problems such as diabetes, osteoporosis, cardiovascular occlusions, and muscle inflammation. Therefore, early diagnosis and treatment of COPD are of great importance.

What are the symptoms of COPD?

COPD symptoms usually do not manifest until serious damage has occurred in your lungs. Due to the insidious progression of the disease, many people consider the symptoms a natural result of aging and delay consulting a doctor.

Early-stage symptoms

In the initial stage of the disease, coughing and phlegm production, which are more pronounced in the mornings, are observed. The phlegm is usually white, sticky, and thick. Many patients label this condition as a smoker's cough and normalize it.

Having a complaint of phlegm production for at least three months each year for two consecutive years may be a sign of chronic bronchitis. In young people, daily life is not negatively affected by these symptoms due to sufficient lung capacity. However, occasional mild coughing and shortness of breath should definitely be taken seriously.

Experiencing shortness of breath during physical activities is one of the important signs of the early period. This shortness of breath felt while climbing stairs or walking uphill can make it difficult for you even to walk on flat ground as the disease progresses.

If smoking continues and the disease progresses, the cough intensifies, and the amount of phlegm increases gradually. Patients begin to produce phlegm at all hours of the day, and sometimes coughs severe enough to cause choking occur.

Advanced-stage COPD symptoms

In advanced stages, shortness of breath becomes a daily problem. Feelings of chest tightness, wheezing, and general fatigue symptoms increase. Susceptibility to respiratory infections increases, and the recovery process for these infections takes longer than normal.

With the drop in oxygen levels in your body, cyanosis may develop on the lips, nails, and around the tongue. This condition, called cyanosis, is a serious indicator of oxygen deficiency in the blood. Swelling in the ankles and legs may also indicate that heart failure has been added.

In the final stage, severe and constant shortness of breath is experienced even at rest. Due to a significant decrease in lung function, you have difficulty performing daily activities. Weight loss, muscle wasting, and the need for frequent hospitalizations due to severe exacerbations emerge.

Symptoms during an exacerbation period

A COPD exacerbation manifests itself with a significant increase in symptoms such as shortness of breath, cough, and phlegm. Triggers such as air pollution, infection, and tobacco smoke can initiate this moment of crisis.

During an exacerbation, there is a serious increase in the amount of phlegm, and its color changes from transparent or white to yellow or green. This change usually indicates an infection. A rapid increase in shortness of breath is the most important indicator of an exacerbation.

Wheezing or whistling sounds from the chest become prominent, and general weakness and fatigue in the body increase. A rise in fever indicates that an infection is accompanying it. In severe cases, mental confusion, excessive sleepiness, or disorientation may develop. These symptoms indicate that oxygen in the blood is decreasing and carbon dioxide is rising, requiring emergency intervention.

COPD causes and risk factors

Multiple factors play a role in the development of the disease, and the combination of these factors significantly increases the risk. Causes of COPD include environmental, genetic, and lifestyle-related factors.

Smoking and tobacco use

Approximately 80-85% of COPD cases are caused by either smoking or exposure to smoke. The disease develops in approximately 20-25% of smokers. However, COPD occurs in less than 50% of even heavy smokers throughout their lives. This situation shows the importance of genetic factors and individual susceptibility.

Starting smoking at an early age and smoking large amounts for a long time causes the disease to progress more severely. Symptoms appear slowly over an average process of 15-20 years. The rate of progression of the disease may vary depending on the number of cigarettes you smoke daily.

Pipes, cigars, hookahs, and electronic cigarettes cause the same effect. It has been demonstrated that electronic cigarettes also cause lung damage and disease. Passive smoking contributes to respiratory symptoms and the development of COPD. Especially being exposed to cigarette smoke during childhood can increase your risk of COPD in later years.

Your mother smoking during the prenatal period creates a risk by affecting your intrauterine lung development and the development of your immune system. Even if you quit smoking, those who have smoked and quit before should be aware of shortness of breath symptoms.

Environmental and occupational exposure

Dust and chemical substances in the workplace environment, and indoor air pollution caused by organic fuels used for cooking and heating in poorly ventilated homes are other proven causes. The World Health Organization estimates that 400,000 people die each year due to COPD caused by exposure to smoke from organic fuels.

Working in professions such as mining and metalworking, the transportation sector, wood and paper manufacturing, cement, grain, and textile work poses a risk. Exposure to substances such as coal dust, silica, asbestos, metal and metal components, and inorganic dust causes a loss in your lung functions.

It has been shown that exposure to coal dust causes a 3 mL annual loss in FEV1. It has been determined that there is a 24 mL drop in FEV1 in 1 year in workers exposed to silica dust. Occupational etiology is reported in the literature at rates of up to 30% in the development of COPD.

Genetic factors and alpha-1 antitrypsin deficiency

Alpha-1 antitrypsin deficiency is a hereditary genetic disorder that can be passed from parents to their children. In this case, levels of a protein called AAT, which protects the lungs, are low. In Europe and the United States, approximately 100,000 people in each country are affected by this condition.

This genetic disorder, seen in 1% of the population, can trigger emphysema even if there are no other risk factors. Alpha-1 antitrypsin deficiency accounts for 1-3% of COPD cases. The Z allele in homozygous form causes severe deficiency along with early-onset emphysema (in the 30s and 40s).

It is estimated that more than 3 million people worldwide have allele combinations associated with severe alpha-1 antitrypsin deficiency. When the deficiency is not diagnosed, patients receive standard COPD treatment and are deprived of treatment that changes the course of the disease.

COPD diagnostic methods

The diagnostic process begins in individuals who have been exposed to risk factors and are experiencing COPD symptoms. In patients with complaints of cough, phlegm, and shortness of breath, the doctor first evaluates your medical history and performs a physical examination. However, confirmation with respiratory function tests is essential for a definitive diagnosis.

Spirometry test and lung function tests

The spirometry test is the gold standard for COPD diagnosis. This test measures how well your lungs are working and definitively reveals the presence of the disease. During the test, a device called a spirometer is used, and you are asked to breathe in and out of your mouth with a special apparatus on your nose.

First, you take a deep breath and hold it. Then, with the device placed in your mouth, you blow out the held breath forcefully. This process is repeated on average 4-5 times, and the test is completed within 15-30 minutes.

The spirometry test measures two basic values: FEV1 and FVC. FEV1 shows the amount of air you can forcefully exhale in the first second. FVC determines the total volume of air you can exhale after taking a deep breath. The most reliable parameter is FEV1, and the degree of airway obstruction is determined by this value.

An FEV1/FVC ratio of less than 70% is accepted as the main criterion for a COPD diagnosis. When this ratio is below 88%, the disease is diagnosed, and the severity of the disease is determined according to the FEV1 value. Furthermore, test results are used in creating the COPD treatment plan and in the follow-up of the disease.

Blood tests and oxygen level measurement

Arterial blood gas analysis checks oxygen and carbon dioxide levels in the blood. This test evaluates how effectively the lungs are working, especially in advanced-stage patients. Oxygen saturation measurement provides information about hypoxia and plays an important role in detecting respiratory failure in COPD patients.

Blood gas tests are performed when the FEV1 value is below 40%, when oxygen saturation measured by an oximeter is 92% or below, and when clinical findings of respiratory failure appear. A complete blood count evaluates the infection status.

Imaging methods

A chest X-ray is a supportive method in the diagnosis of COPD. The X-ray can show differences caused by emphysema or bronchitis, but it is more supportive than diagnostic. In mild COPD, the X-ray may be found to be normal.

When a more detailed examination is required, computed tomography is used. High-resolution CT shows structural changes in lung tissue in detail and evaluates the extent of damage in the lung parenchyma. CT observes low-density areas due to emphysema. Imaging methods also play a role in the diagnosis of complications such as pneumonia and pneumothorax.

How is COPD treated?

COPD is a preventable and treatable disease. The treatment has two main goals: to reduce complaints and improve quality of life, as well as to slow the progression of the disease. However, there is no treatment that will eliminate COPD. For successful treatment, you need to stay away from risk factors and use your medications regularly.

Drug treatment and inhalers

The first method in treatment is the use of bronchodilator drugs that increase oxygen intake by dilating the bronchi. Quitting smoking and not being in dusty and smoky environments are the primary treatment interventions. When smoking is quit, the severity of deterioration in the airways and lungs slows down.

The main treatment is drugs that open narrowed airways. Expectorant drugs and antibiotics are given within the scope of treatment if an infection occurs. The doses of drugs used via inhalation are very low. However, since the drugs reach the respiratory tracts directly, their effects are very strong. Their side effects are negligible.

Inhalation drugs are not addictive and do not harm the teeth or lungs. For the treatment to be effective, it is necessary to choose the right device and use it regularly. If medications are not used regularly, the disease progresses and hospitalizations increase.

Oxygen therapy

Oxygen therapy becomes mandatory in patients who develop severe hypoxemia. Long-term oxygen intake, at least 15 hours a day, reduces the feeling of shortness of breath in patients at this stage, improves their quality of life, and extends their lifespan. Oxygen therapy is applied long-term, including at home, only in hospitalizations due to exacerbations and in those with severe hypoxemia.

Pulmonary rehabilitation

Respiratory rehabilitation is the only treatment method that can break the vicious cycle in problems such as respiratory distress, tension, and inactivity. The rehabilitation program should be applied for at least 8 weeks, two or three sessions per week, for a total of 16-24 sessions.

Providing patients with personalized physical exercise and breathing exercise training, providing psychological support, and arranging an appropriate diet form the basis of the rehabilitation program.

Surgical treatment options

Surgical treatment options include lung volume reduction surgery, bullectomy, and lung transplantation. In recent years, especially emphysema and chronic bronchitis forms can be treated with bronchoscopic, volume-reduction methods. By entering the respiratory tracts with a bronchoscope, the volume of the inflated lungs is reduced by placing a valve or coil.

COPD exacerbation treatment

In the treatment of acute exacerbation, short-acting inhaled beta2-agonists are recommended alone or in combination with short-acting anticholinergics. Systemic corticosteroids can improve lung function and shorten the recovery time. The duration of treatment should not exceed 5-7 days. If there is an increase in phlegm purulence, the use of antibiotics is recommended. Oxygen saturation should be titrated to be 88-92%.

Frequently asked questions about COPD

There are topics frequently wondered about by patients and their relatives regarding the disease. The answers given to these questions help you form accurate expectations during the COPD treatment process.

At what age does COPD start?

The disease usually begins to show symptoms after the age of 40. Although some sources state that it becomes noticeable after the age of 35, the age of most diagnosed people is over 50. In our country, the prevalence in adults over 40 is between 15-20%. That is, one in every 5 people over 40 in our society has COPD.

Smoking causes the disease to appear after approximately 20 years of smoking one pack a day. If more than one pack of cigarettes is smoked per day, this period is even shorter. In individuals with alpha-1 antitrypsin deficiency, which has genetic factors, the disease can start early in the 30s and 40s.

Does a COPD patient recover?

There is no cure for COPD. However, the disease is preventable and treatable. There is no treatment with any option for the irreversible form change that occurs in the lungs. However, early diagnosis and quitting smoking can prevent the progression of the disease.

When the patient quits smoking, the course of the disease is positively affected. A 10% improvement in respiratory functions is seen within at least two months after quitting smoking. With regular medication use and appropriate lifestyle changes, symptoms are alleviated, and the worsening of the disease is prevented.

Is COPD contagious?

COPD is not contagious. The disease occurs due to reasons such as tobacco use, occupational and environmental exposure, and genetic factors. Since COPD patients frequently experience respiratory tract infections, these infections can be contagious. Therefore, it is necessary to pay attention to hygiene rules and avoid contact with sick people.

What should COPD patients pay attention to?

You need to stay away from smoky, dirty, and dusty environments where smoking occurs. Consuming plenty of fluids is very important. It is recommended that you get a flu shot every year and get a pneumonia vaccine. Doing regular exercise allows your muscles to strengthen and reduces shortness of breath.

Meals should be eaten in small amounts and frequently. You should avoid fried foods, carbonated drinks, excessive salt, dairy products, and processed meats. Being at your ideal weight helps the disease progress more mildly.

In summary, COPD

Although COPD is a serious disease, it is undoubtedly preventable and controllable. This condition, which affects one in every 5 people over the age of 40, develops especially due to smoking. For early diagnosis, you need to pay attention to symptoms of cough, phlegm, and shortness of breath. After a definitive diagnosis is made with a spirometry test, regular medication use and lifestyle changes slow the progression of the disease.

Quitting smoking is the first step. Using your inhaler medications regularly and not neglecting your doctor's check-ups allows you to live successfully with the disease. Take the symptoms seriously and take action without being late.