Chronic Obstructive Pulmonary Disease, or simply (COPD) is a common life-long lung health problem that interferes with normal breathing, making it hard to get the required oxygen. COPD refers to a group of diseases, of most formerly called emphysema (damage to the air sacs in the lungs), and chronic bronchitis (long-term inflammation of the airways). COPD is a leading cause of death and disability worldwide.

Cigarette smoking is the primary cause of COPD. Most people who have COPD are smoker or used to smoke. Long-term exposure to other lung irritants - such as air pollution, chemical fumes, or dust - also may contribute to COPD. Rarely, certain genetic factor leads to certain protein deficiency may also play a role by participating in lung damage and COPD pathogenesis.

Many people don't experience symptoms of COPD until later stages of the disease. The most usual complain of COPD is shortness of breath. Other respiratory symptoms - such as coughing, mucus accumulation, and chest tightness - may also develop. These symptoms tend to worsen with time, especially with continuous smoking and exposure to irritants.

It is important to talk with doctor as soon as the person notice these symptoms. Early screening can identify COPD before major loss of lung function occurs. The main test used to assess the respiratory condition and evaluate lung function is spirometry. Imaging tests, such as Chest x-ray and CT scan, can show chest structures and if there are any changes that suggest COPD.

Chronic Obstructive Pulmonary Disease has no cure until now. However, If COPD is confirmed, there are a number of treatments that can improve patient’s symptoms, reduce episodes of flare-ups and improve overall quality of life. Lots of therapies are available for COPD. They are determined based on patient’s situation and the response to treatment.

Many drugs - either inhaled, or ingested - are helpful to facilitate breathing by widening of the airway and/or decrease inflammation inside it. Other treatments, such as oxygen therapy, may give additional benefits, especially for moderate to severe COPD. Sometimes, Surgery may be required to remove severely diseased part of the lung, or the entire of it to be replaced by healthy one from a donor.

COPD is almost preventable disease, as the majority of its cases are related to modifiable risk factors. The best way to prevent COPD is to not start smoking or to quit that deadly habit. Avoiding lung irritants that can lead to COPD is also among actions that can protect the lungs. Work and living environments should be assessed and adjusted as much as possible to monitor and reduce the amount of pollutants that hurt the lungs.

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe life-long, inflammatory and progressive lung diseases, including mainly what were called “emphysema” and “chronic bronchitis”. These diseases cause obstructed airflow from the lungs that lead to breathing difficulties.

How the lungs work?

The air that is breathed goes down the trachea into tubes in the lungs called Bronchi, which branch within the lungs into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run through the walls of these air sacs.

When air reaches the air sacs, oxygen passes through their walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the air sacs. This process is called gas exchange. The airways and air sacs are elastic. When breathing in, each air sac fills up with air like a small balloon. When breathing out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality, the walls between many of the air sacs are destroyed, the walls of the airways become thick and inflamed, or the airways make more mucus than usual, which can clog them.

The more familiar terms “chronic bronchitis” and “emphysema” are no longer used, but are now included within the COPD diagnosis. The disease can be differentiated from asthma as COPD usually develop in mid-life, progresses slowly, and with history of smoking and other irritants exposure. Asthma, on the other hand, often starts in childhood, with a family history of this disease, and the manifestations vary from day to day and tend to worsen at night.

COPD occurs when the lungs and the airway become inflamed, damaged and narrowed. This is mainly caused by:

• Smoking. COPD most often occurs in people 40 years of age and older who have a history of smoking. Those may be individuals who are current or former smokers. Passive smokers also at the risk. While not everybody who smokes gets COPD, most of the individuals who have COPD (about 90% of them) have smoked. Smokers are nearly 12-13 times as likely to die from COPD, compared to who have never smoked.
• Other irritants. COPD can also occur in those who have had long-term contact with harmful pollutants in their workplace. Some of these harmful lung irritants include certain chemicals, dust, or fumes. Heavy or long-term contact with lung irritants in the home, such as using biomass and coal as cooking fuel, may also cause COPD.
• A Genetic condition. Even if an individual has never smoked or been exposed to pollutants for an extended period of time, he/she can still develop COPD. Alpha-1 Antitrypsin Deficiency (AATD) is the most commonly known genetic factor for emphysema. These people may get the disease in their 30s or 40s, particularly if they smoke. However, this is rare condition.

Many people are exposed to the COPD causative agents, which put them under greater risk to develop this chronic illness. From these people:

• Smokers and second-hand smokers. As many as 9 out of 10 cases of COPD are related to smoking. Being exposed to other people's smoke (passive smoking) may also increase the risk of COPD.
• Workers who exposed to certain types of dust and chemicals at work, such as cadmium dust and fumes, grain and flour dust, silica dust, welding fumes, isocyanates, and coal dust.
• People who live in an air polluted area. Indoor and outdoor exposure to unclean air over a long period can affect how well the lungs work and increase the risk of COPD.
• People who have alpha-1-antitrypsin deficiency. Having a close relative with COPD suggests that some people's genes may make them more vulnerable to the disease, especially if they confirmed that they miss the responsible code for producing that protein.
• Aging. COPD develops slowly over years; thus most people are at least 40 years old when symptoms begin. This may be related to increase in the time of exposure to lung irritants and may be affected by aging process.
• Young children who get frequent lower respiratory tract infections. Having multiple infections such as bronchitis and pneumonia in early childhood is associated with higher risk to develop COPD in late adult life.

COPD is a complex condition comprised of airway inflammation, consequent airway structural changes and mucociliary dysfunction.

• Airways inflammation. COPD is characterized by chronic inflammation of the airways, lung tissue and pulmonary blood vessels as a result of exposure to inhaled irritants such as tobacco smoke, which cause inflammatory cells such as neutrophils, CD8+ T-lymphocytes, B cells and macrophages to accumulate. When activated, these cells initiate an inflammatory cascade that triggers the release of inflammatory mediators, which sustain the inflammatory process and lead to tissue damage.
• Structural changes. Airways remodeling in COPD is a direct result of the inflammatory response associated with COPD and leads to narrowing of the airways. Three main factors contribute to this: peribronchial fibrosis, build-up of scar tissue from damage to the airways and over-multiplication of the epithelial cells lining the airways. Destruction of alveoli, alveolar ducts and bronchioles is associated with loss of lung tissue elasticity, which occurs as a result of destruction of the structures supporting and feeding the alveoli (emphysema).
• Mucociliary dysfunction. Smoking and inflammation enlarge the mucous glands that line airway walls in the lungs, causing goblet cell metaplasia and leading to healthy cells being replaced by more mucus-secreting cells. Additionally, inflammation associated with COPD causes damage to the mucociliary transport system which is responsible for clearing mucus from the airways. Both these factors contribute to excess mucus in the airways which eventually accumulates, blocking them and worsening airflow.

In the early stages of COPD, the person may not notice any symptoms and the disease can develop for years without being noticed. The person begins to see the symptoms in the more developed stages of the disease. They include:

• Increased shortness of breath (breathlessness);
•  chronic cough (lasts 3 months during each of 2 consecutive years);
• Phlegm that force to cough, usually at morning;
• Wheezing, particularly during exertion and exacerbations;
• Tightness in the chest;
• Frequent respiratory infections;
• Lack of energy;
• Blueness of the lips or fingernail beds (cyanosis);
• Unintended weight loss (in later stages).

The doctor will diagnose COPD based on signs and symptoms of the disease, medical and family histories, and physical examination. The diagnosis of COPD is by many tests that include:

• Spirometry. Spirometry is the most common lung function test that measure the amount of air can be inhaled and exhaled, and if the lungs are delivering enough oxygen to the blood. In this procedure, the person will be asked to blow into a large tube connected to a small machine that measures how much air the lungs can hold and how fast the person can blow the air out of them. Spirometry can detect COPD even before having symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working.
• Other Pulmonary function tests. Some test may also help to assess lung function and condition. Among these is a peak flow test, which measures how fast the person can breathe out and can help rule out asthma. A Body plethysmography measures how much air is present in the lungs when the person takes a deep breath. Lung diffusion capacity is another test that measures how well oxygen passes from the lungs to the bloodstream.
• Alpha-1-antitrypsin test. Some COPD cases is caused by a deficiency of the Alpha-1 Antitrypsin protein in the bloodstream. Without this protein, white blood cells begin to harm the lungs and lung deterioration occurs. The World Health Organization recommends that every individual diagnosed with COPD be tested for Alpha-1.
• Imaging tests. A chest X-ray can be used to look for emphysema and can also rule out other lung problems or heart failure that can cause similar symptoms to COPD. A computed tomography (CT) scan of the lungs can also help detect emphysema and determine if the person might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer.

Although there is currently no cure for COPD, treatment can help control the symptoms and slow the progression of the condition. From these effective therapies to treat COPD:

• Smoking cessation

The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse and may be all the treatment that's needed in the early stages of COPD. However, it's never too late to stop. Even people with more advanced COPD are likely to benefit from quitting. If the person has difficulty in quitting smoking, he/she may benefit from nicotine replacements after asking the doctor. Support groups are also helpful.

• Drug therapies: Doctors use several kinds of medications to treat the symptoms and complications of COPD. The patient may take some medications on a regular basis and others as needed. They include:
  • Inhaled drugs: These medications are delivered directly to the lungs through special devises. They can help relax the muscles around the airways and/or decrease inflammation. This can help relieve coughing and shortness of breath. Depending on the severity of the disease, the patient may need:
    • Short-acting bronchodilators. For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. These medications make breathing easier by relaxing and widening the airways. There are two types of them: beta-2 agonist inhalers, and antimuscarinic inhalers. Short-acting inhalers should be used when the patient feel breathless, up to a maximum of four times a day. Examples are albuterol (Salbutamol), levalbuterol, and ipratropium.
    • Long-acting bronchodilator. If the person experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended instead. This works in a similar way to the previous group, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day. They also classified into two types; beta-2 agonist inhalers – such as salmeterol, formoterol - and antimuscarinic inhalers, which include tiotropium and aclidinium.
    • Inhaled Steroid. If the patient still getting breathless when taking long-acting inhalers or have frequent flare-ups, the doctor may suggest including a steroid inhaler as part of treatment. Steroids can help reduce the inflammation in the airways and help prevent exacerbations. Side effects may include oral yeast infection (thrust) and hoarseness. Fluticasone and budesonide are examples of inhaled steroids.
    • Combination inhalers. Some medications combine bronchodilators, especially long acting and inhaled steroids, in order to give more and multidirectional effects. Salmeterol with fluticasone, and formoterol with budesonide are examples of combination inhalers.
  • Oral medications:If the symptoms aren't controlled with inhalers, the doctor may recommend taking tablets or capsules as well. The main medications used are described below.
    • Oral steroids. For people who have a moderate or severe acute exacerbation, short course (7-14 days) of oral corticosteroids may prevent further worsening of COPD. Long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection, thus longer courses must be prescribed by a COPD specialist with the lowest effective dose and closely monitoring for side effects.
    • Phosphodiesterase-4 inhibitors. A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast, a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and facilitate breathing. Common side effects include diarrhea and weight loss.
    • Theophylline. This medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, palpitation and tremor. These are dose related, and low doses are recommended. The patient may need to have regular blood tests during treatment to check the level of medication in the blood and adjust the dose to be more effective and less bothersome.
    • Antibiotics. Respiratory infections, such as acute bronchitis and pneumonia, can aggravate COPD symptoms. Antibiotics help treat acute flare ups, but they aren't generally recommended for prevention. The doctor may prescribe a short course of antibiotics if the patient has signs of a chest infection, such as coughing up yellow or green phlegm and a high temperature.
    • Expectorants. If there is a persistent chesty cough with lots of thick phlegm, the doctor may recommend taking a mucolytic medication, such as carbocisteine. These medications make the phlegm in thinner and easier to cough up. They are taken as a tablet or capsule. Examples are acetylcysteine, Guaifenesin.
• Lung therapies: Doctors often use these additional therapies for people with moderate or severe COPD, in order to help the patient to gain more control among their condition. They include:
  • Oxygen therapy. Sometimes, the patient may need supplemental oxygen that is extendedly delivered through nasal tubes or a mask to prevent dropping of oxygen level in the blood to dangerous state. This is the only COPD therapy proven to extend the expected life. Long-term oxygen therapy used for at least 15 hours a day. Some people with COPD use oxygen only during activities or while sleeping. This doesn’t call for worry, as there are several devices to deliver oxygen to the lungs, including lightweight, portable units and with long tubes that could be taken with the patient while moving.
  • Pulmonary rehabilitation program. These comprehensive programs generally combine education, exercise training, nutrition advice, emotional support and counseling. They are designed to help people with lung problems such as COPD. The patient will work with a variety of specialists, who can tailor rehabilitation program to meet the patient needs. Pulmonary rehabilitation may shorten hospitalizations, increase ability to participate in everyday activities and improve quality of life.
  • Non-invasive ventilation (NIV). If the patient is taken to hospital because of a bad flare-up, he/she may have a treatment called non-invasive ventilation (NIV). This is where a portable machine connected to a mask covering the nose or the face is used to support the lungs and make breathing easier.
• Surgical therapies: 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. In this surgery, the surgeon removes a badly damaged section of lung. This creates extra space in the chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and chances of survival.
  • Bullectomy. Pulmonary bullae are large focal regions of emphysema that form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, the doctor removes bullae from the lungs to help improve air flow.
  • Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. It includes removal and replacement of a damaged lung with a healthy one from a donor. Transplantation can improve the ability to breathe and react. However, it has significant risks, such as organ rejection, and usually require taking lifelong immune-suppressing medications.
• Healthy practices: Changing the way of living can carry lots of benefits for the patient. Healthy life style and good behaviors are included in COPD treatment plan and the patient will carry his duties and participate positively in this plan. From these practices:
  • Clearing airways. With COPD, secretions tend to collect in the air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help ease clogged mucus and facilitate breathing.
  • Exercising regularly. It may seem difficult to exercise when the person has trouble breathing, but regular physical activity can improve overall strength and endurance and strengthen respiratory muscles. The type and level of activity should be discuss with the doctor.
  • Eating healthy foods. A healthy diet can help maintain strength. If the patient is underweight, the doctor may recommend nutritional supplements. If he/she is overweight or obese, losing that excess can significantly help breathing, especially during times of exertion.
  • Vaccination. The person has to talk with the doctor about whether and when he/she should get flu (influenza) and pneumonia vaccines. These vaccines can lower the chances of getting these illnesses, which are major health risks for people who have COPD.

Breathing is a fundamental biological process. Without it, for even few minutes, life is not possible. Because COPD interferes with the structure and function of the lungs, the disease may cause the emergence of other related problems that may pose a threat to a person's life and well-being.

• Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make COPD much more difficult to breathe and could cause further damage to lung tissue.
• COPD exacerbation. COPD patients are likely to experience episodes during which their symptoms become worse than usual and persist for at least several days. In many cases, an exacerbation is flare up by an infection in the lungs. If the patient doesn’t receive prompt treatment, the condition can lead to sever suffering and death due to lung failure.
• Heart problems. For reasons that aren't fully understood, COPD can increase the risk of heart disease, including heart attack and heart failure affecting the right side of the heart. It could be related to hypoxemia caused by COPD.
• Other lung problems. People with COPD have a higher risk of developing lung cancer. The disease can also damage the lung's structure and allow air to leak into the chest cavity to cause a collapsed lung (pneumothorax).
• Sleep disorders. Because the affected people with COPD is not getting enough oxygen, they may face insomnia and/or frequent getting up during sleeping time, which could deprive them from adequate rest.

As the main causes and risk factors for COPD are modifiable, much can be done to reduce the risk of having COPD and protect the body from its complications. From this:

• Get away from smoking. Quitting smoking is the single most important thing a smoker can do to live a longer and healthier life. If the person doesn’t smoke, he/she should not start. It also recommended to avoid exposure to second-hand smoke. Home and other closed areas should be free of smoking, which will help protect self and others.
• Awareness of other dangers. The person has to take care to protect him/herself against chemicals, dusts and fumes in his/her home and work. This may require monitoring of air quality, sealing containers of irritants, and wearing protective tools, such as masks, if the job need dealing with lung irritants. Regular checkups for these people may help detect COPD in early stages and prevent it from worsening.
• Fighting for clean air. As good and active civils, all we have to work in our community to maintain healthy environment. Sources of air pollution should be stopped, or at least halted to the lowest emissions possible. Conserving energy is a wonderful practice to reduce bad chemicals ejected in burning fuels. This may be achieved by turning off unused machines, using energy efficient lights and transports, and limiting driving by cars.

COPD develops slowly. Symptoms often worsen over time and can limit the ability to do routine activities. Severe COPD may prevent the person from doing even basic activities like walking, cooking, or caring of self. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease isn't passed from person to person, as it is not communicable disease. However, sharing the same environment means having many same risks to develop that disease.

COPD has no cure yet, and doctors don't know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help to feel better, stay more active, and slow the progress of the disease. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

According to WHO estimates, 65 million people have moderate to severe COPD. More than 3 million people died of COPD in 2012, which corresponds to 6% of all deaths that year. Almost 90% of COPD deaths occur in low- and middle-income countries. Estimates for 2030 show that COPD will become the third leading cause of death worldwide. COPD also is a major cause of disability. It is responsible for about 5% of global disability–adjusted life years, which ranked it as the 9th cause of years lived with disability in 2010.

The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. At one time, COPD was more common in men, but because of increased tobacco use among women in high-income countries and the higher risk of exposure to indoor air pollution in low-income countries, the disease now affects men and women almost equally.