What is COPD?

Chronic Obstructive Pulmonary Disease

COPD is an “umbrella term” for a group of pulmonary diseases that can be categorized as OBSTRUCTIVE in nature.

Respiratory diseases are usually classified as either restrictive or obstructive, depending on the presentation of symptoms.

When we describe a respiratory disease as being OBSTRUCTIVE,

this indicates that the primary issue for air limitation

is seen when the patient is EXHALING.

In short, they cannot get all of the air OUT of their lungs due to the inflammation.

(Imagine taking a deep breath, and then trying to take another breath on top of that one! Feel’s like an elephant is sitting on your chest, right?)

By contrast, a RESTRICTIVE disease like Pulmonary Fibrosis or Sarcoidosis would be identified when the patient has difficulty during INHALATION; or trying to inhale.

Inflammation in bronchial tube

MDI Bronchodilator /Albuterol Inhaler

COPD patients have air flow limitation from inflammation that is NOT completely reversible with treatment or medication, like bronchodilators.

However, maintenance drugs are often prescribed to offset future breathing issues.

The inflammation can be aggravated by allergies and triggers; including pollen, dust, animals, and noxious gas fumes.

Issues can often flare when a COPD patient contracts an upper respiratory virus or infection, such as the flu.

The airway inflammation leads to decreased flows and a decreased FVC/FEV1 during spirometry, or pulmonary function testing.

COPD difficulties often results in a condition known as AIR TRAPPING, when the patient has so much trouble exhaling due to INFLAMMATION that the inhaled air remains trapped inside the airways.

This can be challenging to treat as a clinician, as the patient must cannot usually tolerate oxygen therapy at anything but a low, slow rate.

Variations of COPD include:

CYSTIC FIBROSIS: Chronic inflammation of the bronchial airways from an inherited mutation of chromosome 7 that affects the exocrine glands.  Patients are prone to continually contracting respiratory infections are a result.

BRONCHIECTASIS: Chronic dilation of one or more bronchi with copious amounts of bronchial secretions (excessive mucus)

ASTHMA: Chronic inflammatory non-contagious airway disease with levels of severity that affect the small airways; episodes may occur when patient is exposed to a specific trigger

CHRONIC BRONCHITIS:  Chronic productive cough for more than 3 months; in 2 or more consecutive years

EMPHYSEMA: Chronic permeant enlargement of spaces near the terminal bronchioles, and destruction of the alveolar walls without fibrosis

Each of the COPD types can also have an acute episode where the symptoms become dangerous, also known as an exacerbation.

This is seen quite often with asthma, which can lead to severe symptoms and hospitalization.