Understanding COPD

Chronic obstructive pulmonary disease (COPD) is a group of chronic and progressive lung conditions that result in increasing difficulty breathing over time. The two most common disease included in this group are emphysema and bronchitis.

In emphysema the alveoli – the small air sacs where oxygen is absorbed and carbon dioxide leaves the body – break down forming fewer larger air sacs. The larger air sacs have relatively less surface area which leads to less exchange of gases between the blood stream and the air we breathe. The poor exchange of oxygen and carbon dioxide make it more difficult to breath. The bronchi are a series of branching tubes that carry air from the mouth to the alveoli. In bronchitis, there is a swelling in the walls of these tubes that narrows them causing more resistance to air flow and reduced delivery of oxygen to the alveoli and the blood stream. Again this condition makes it more difficult to breathe.

When breathing is more difficult, less oxygen is taken in and less carbon dioxide can be removed. Failure to get oxygen interferes with the body’s ability to burn calories and produce energy. Failure to eliminate carbon dioxide causes it to build up in the blood causing the blood to become more acidic which make you feel ill.

Common symptoms of COPD include: shortness of breath with activity; increased breathlessness even without activity; wheezing and chest tightness. Chronic coughing is also a common symptom, especially of bronchitis. The cough often produces mucous which is created by the inflammation in the bronchi.

Cigarette smoking is the most common cause of COPD. Inhaling tobacco smoke (from cigarettes, cigars or pipes) introduces irritants in the bronchi and alveoli that irritate them are break them down. Inhaling any kind of fumes, chemicals or dust have similar adverse effects on the lungs. You may be exposed to the irritants in your home, work or in the atmosphere.

Your healthcare provider can test use for COPD by using a spirometer. A spirometer is a device that measures your ability to blow air out of your lungs.

The device measures the amount of air you exhale in the first second of blowing and then over the entire time that you forcefully exhale. The FEV1 (Forced expiratory volume in 1 second) is typically more than 70% of the total amount that you exhale. If this value is less than 70%, you are considered to have COPD. If it is less than 50%, the COPD is considered to be severe.

Once alveoli are lost in emphysema, they cannot be recreated. If the cause of the loss can be identified and stopped, then further damage can be slowed. Most treatment efforts focus on the bronchi.

Medicines are used to relax the muscles around the bronchi, or reduce swelling and mucus production in the bronchi. These actions allow air to flow more freely relieving shortness of breath. Medicines are delivered in pill form and through inhalers. Your healthcare provider will direct your choice of medicine.

Dr. Samuel Abbate is a physician practicing in Wasilla.