COPD stands for "chronic obstructive pulmonary disease." It is a condition in which the flow of air through the lungs is limited due to chronic bronchitis or emphysema. In most cases, COPD is caused by smoking. A combination of genetic and environmental factors probably explain why some smokers develop COPD and others do not. Genetic factors may also explain why some non-smokers develop COPD.

COPD is a progressive illness in which symptoms increase gradually over many years. Early symptoms may be limited to a productive cough or shortness of breath with exertion. Later in the course of the disease, intermittent episodes of more severe symptoms, including thickening of sputum, wheezing, and fever, may develop. over time, these episodes increase in frequency and severity. Fatigue and weakness are common. Shortness of breath with minimal exertion, low oxygen levels, weight loss, and headaches from high levels of carbon dioxide in the blood are markers of severe disease. Some people get swelling in the legs or abdominal pain related to abnormalities in the heart brought about by severe lung disease.

The diagnosis of COPD is made by a physician. In general, this requires a history and physical examination, and performance of lung function tests (PFTs). These tests can measure lung function and are the most important means to diagnose COPD and to assess its severity.

SMOKING CESSATION - The first and most important part of any treatment plan for COPD is for the patient to stop smoking. This is true regardless of the duration or severity of the COPD. Studies of patients who already have COPD have shown that further progression of the disease is slowed in patients who stop smoking.

Patients may need to use a number of different strategies before quitting successfully. Nicotine replacement may help decrease nicotine withdrawal symptoms. Nicotine gum and skin patches are available over the counter. Other forms require a physician's prescription. The anti-depressant medication bupropion (Zyban) may be used to decrease the urgency to smoke. Finally, group smoking cessation clinics or other behavioral interventions may benefit some patients.

BRONCHODILATORS - Medications that help open the airways are a mainstay of treatment for COPD. Called "bronchodilators", most of these medicines are given in an inhaled form using a "metered dose inhaler" (MDI) or a dry powder inhaler (DPI). It is important that the patient understand how to use the inhaler properly in order to ensure that the correct dose of medication is delivered.

Common inhaled bronchodilators include albuterol (Proventil, Ventolin), formoterol (Foradil), or salmeterol (Serevent). Ipratropium (Atrovent) is another inhaled medicine that helps keep airways open and decreases secretions. It works by a different mechanism than the other bronchodilators, and is often used in combination with other inhalers. The use of the oral medication theophylline (Theodur, Slo-bid) may benefit certain patients.

STEROIDS - Steroids are not prescribed for everyone with COPD, but they can improve symptoms in some patients. If a patient's symptoms have not improved as much as expected with bronchodilators, steroids given orally or by inhaler may be tried. Steroids given by mouth can have serious side effects, but some patients may require them to keep their lung disease under control.

COUGH MEDICINES AND CHEST THERAPY - Cough medicines to thin the sputum in a patient with COPD are not generally recommended, as they have not been shown reliably to improve the patient's symptoms. Although cough can be a bothersome symptom, cough suppressants are avoided or used with caution, as they may reduce the clearance of secretions and increase the likelihood of infection.

Certain patients with extensive secretions or an ineffective cough may benefit from chest physical therapy. This involves a physical therapist who "claps" the patient's chest and back in an attempt to loosen secretions, and then maneuvers the patient into positions that enhance drainage. It is unclear for which patients this treatment is helpful.

PREVENTION AND TREATMENT OF INFECTION - Patients with COPD are prone to acute episodes of worsening symptoms that often begin with a respiratory infection. Avoiding these infections, or treating them quickly if they occur, are important components of COPD therapy.

All patients with COPD should have pneumococcal vaccination, which helps prevent a certain type of pneumonia. In some patients, the vaccine needs to be repeated every six years.

Patients with COPD should also receive an annual flu shot in advance of flu season. For patients who get the flu, antiviral medications may be prescribed. Antiviral medication may also be used in COPD patients who have not had a flu shot but are at risk for getting the flu.

Antibiotics have been shown to be beneficial in patients with worsening COPD symptoms in the setting of a respiratory infection. A physician may order a sputum analysis to help determine if antibiotics are indicated in a particular case.

OXYGEN - Patients with advanced COPD may have low oxygen levels in the blood. This condition, known as hypoxemia, can occur without the patient being aware of any increase in shortness of breath or other symptoms. Doctors can measure the oxygen level using a device placed on the finger or through a blood test. Patients with hypoxemia are placed on oxygen therapy, which can improve shortness of breath and may prolong life.

Some patients with COPD who travel by air may be prone to hypoxemia during travel because of the changes in air pressure inside the plane. If the physician determines a particular patient is likely to become hypoxemic during flight, in-flight oxygen will be prescribed.

Supplemental oxygen must never be used while smoking. Oxygen is explosive, and smoking while using oxygen can lead to severe facial and airway burns. Fatal fires have resulted from oxygen users attempting to smoke.

NUTRITION - More than 30 percent of patients with severe COPD are malnourished. This can make symptoms worse and increase the likelihood of infection. Some patients may be advised to increase caloric intake by using a nutritional supplement, though the long-term benefits of this therapy have not been shown.

PULMONARY REHABILITATION - Comprehensive pulmonary rehabilitation programs have been shown to improve exercise capacity, decrease hospitalizations, and enhance the quality of life in patients with COPD. A program may include education, exercise training, psychosocial support, and instruction on breathing techniques that can ease symptoms of breathlessness. Patients with severe shortness of breath or frequent hospitalizations for COPD may benefit from a rehabilitation program.

SURGERY - Surgery to correct the abnormal lung expansion (lung volume reduction surgery) has been tried with some success in patients with emphysema. This procedure involves removing the areas of lung that are most abnormal, allowing the remaining lung to expand and function more normally. If studies continue to show significant and sustained benefit from this procedure, it may be an option for some patients who still have severe symptoms after receiving all other routine therapies. Not all patients will benefit from this surgery, and some may be made worse. A special x-ray called a computed tomography (CT or CAT) scan can help determine who might be a potential candidate for this treatment.

Lung transplantation can also be considered in cases of severe COPD. If successful, the operation is likely to result in symptomatic improvement. However, lung transplantation has not been shown to prolong the life of patients with COPD, and not all patients are lung transplantation candidates.

OTHER THERAPIES - Certain patients with COPD may be given various other treatments, including: noninvasive ventilatory support (the use of a special mask and breathing machine to improve symptoms), anti-anxiety or anti-depression medications, or morphine-like medications to reduce shortness of breath.

Your doctor is the best resource for finding out important information related to your particular case. Not all patients are alike, and it is important that your situation is evaluated by someone who knows you as a whole person.

A number of other sites on the internet have information about COPD. The National Institutes of Health, national medical societies, and some other well-established organizations are often reliable sources of information, although the frequency with which their information is updated is variable. See the Links page for more information.

1. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. ATS statement. Am J Respir Crit Care Med 1995; 152:S77.

7. Cooper, JD, Trulock, EP, Triantafillou, AN, et al. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1995; 109:106.

8. Hosenpud, JD, Bennett, LE, Keck, BM, et al. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease. Lancet 1998; 351:24.

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