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St. Joseph's General Hospital Elliot Lake

Chronic Obstructive Pulmonary Disease

Symptoms of COPD

COPD symptoms often don't appear until significant lung damage has occurred and they usually worsen over time, particularly if smoking exposure continues. 

  • shortness of breath, especially during physical activities,
  • wheezing,
  • chest tightness,
  • a chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
  • frequent respiratory infections,
  • lack of energy,
  • unintended weight loss (in later stages), and
  • swelling in ankles, feet, or legs.

Patients with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than the usual day-to-day variation and persist for at least several days.

Talk to your Doctor or Primary Healthcare Provider if your symptoms are not improving or getting worse with treatment, or if you notice symptoms of an infection, such as fever or a change in mucus. Seek immediate medical care if you can't catch your breath, if you experience severe blueness of your lips or fingernail beds, a rapid heartbeat, or if you feel foggy and have trouble concentrating.

Diagnosis of COPD

Your Doctor or Primary Healthcare Provider will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants – especially cigarette smoke.  

  • lung (Pulmonary) function tests,
  • chest X-ray,
  • CT scan,
  • arterial blood gas analysis,
  • laboratory tests.

The main cause of COPD in developed countries is tobacco smoking. Only some chronic smokers develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions and may be misdiagnosed as having COPD until a more thorough evaluation is performed.

How COPD Affects Your Lungs 

Air travels down your windpipe and into your lungs through two large tubes. Inside your lungs, these tubes divide and separate many times (think of branches on a tree) into many smaller tubes that end in clusters of tiny air sacs. The air sacs have very thin walls full of tiny blood vessels; the oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.

Your lungs rely on the natural elasticity of the tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and over-expand, which leaves some air trapped in your lungs when you exhale.

Cigarette Smoke and Other Irritants

In many patients with COPD, the lung damage that leads to COPD is caused by long-term cigarette smoking. However, there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because not all smokers develop COPD. Other irritants can cause COPD, including cigar smoke, second-hand smoke, pipe smoke, air pollution, and workplace exposure to dust, smoke or fumes.

Risk factors for COPD include:

  • exposure to tobacco smoke,
  • Asthma,
  • occupational exposure to dusts and chemicals,
  • exposure to fumes from burning fuel,
  • genetics.

Respiratory Infections: people with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. 

Heart Problems: for reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack.

Lung Cancer: people with COPD have a higher risk of developing lung cancer.

High Blood Pressure in Lung Arteries: COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

Depression: difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to the development of depression.

Unlike some diseases, COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke – or to stop smoking now.

The most essential step in any treatment plan for COPD is to quit all smoking. Stopping smoking can keep COPD from getting worse and reducing your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful.

Talk to your Doctor or Primary Healthcare Provider about nicotine replacement products and medications that might help, as well as how to handle relapses. Your Doctor or Primary Healthcare Provider may also recommend a support group for people who want to quit smoking. Also, avoid second-hand smoke exposure whenever possible.

For more information on Smoking Cessation, click here [link to the “Smoking Cessation” page].

Occupational exposure to chemical fumes and dusts is another risk factor for COPD. If you work with these types of lung irritants, talk to your supervisor about the best ways to protect yourself, such as using respiratory protective equipment.

Many patients with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, slow progression, reduce your risk of complications and exacerbations and improve your ability to lead an active life such as: 

  • medications,
  • bronchodilators,
  • oral steroids,
  • phosphodiesterase-4 inhibitors,
  • theophylline,
  • antibiotics.

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

  • lung volume reduction surgery,
  • endoscopic lung volume reduction,
  • lung transplant,
  • bullectomy.

Lung Therapies 

Doctors often use these additional therapies for people with moderate or severe COPD.

If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices that 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. Oxygen therapy can improve quality of life and is the only COPD therapy proved to extend life. Talk to your doctor about your needs and options.

Evidence supports in-hospital use of breathing devices such as bilevel positive airway pressure (BiPAP), but some research now supports the benefit of its use at home. A non-invasive ventilation therapy machine with a mask helps to improve breathing and decrease retention of carbon dioxide (hypercapnia) that may lead to acute respiratory failure and hospitalization. More research is needed to determine the best ways to use this therapy.

These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs.

Pulmonary rehabilitation after episodes of worsening COPD may reduce readmission to the hospital, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program.

For more information on Local Pulmonary Rehabilitation Programs: 

Managing Exacerbations 

Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment.

Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing or a change in your mucus, or if you have a harder time breathing.

When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your Doctor or Primary Healthcare Provider can talk with you about measures to prevent future exacerbations, such as quitting smoking; taking inhaled steroids, long-acting bronchodilators, or other medications; getting your annual flu vaccine; and avoiding air pollution whenever possible.