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Chronic bronchitis and emphysemaChronic bronchitis and emphysema stop the lungs from working properly, typically causing breathlessness and wheezing. The two conditions lead to similar symptoms and are often referred to as "chronic obstructive pulmonary disease", or COPD for short. What causes COPD?The biggest single cause of COPD is smoking, and the risk increases with the number of cigarettes smoked. Due to industrial smoke and pollutants, it is also more common in people living in cities than in the country, and in people who work in dusty environments. Generally, it is more likely to affect older people and the vast majority of sufferers are aged 70 to 85. Each year, around 28,000 people die from COPD. Chronic bronchitisBronchitis means inflammation of the bronchi the main airways that lead from the trachea (windpipe) into the lungs. This inflammation may be caused by irritants, such as tobacco smoke or by infection. If the bronchitis goes away once the infection responsible has cleared, the condition is termed acute bronchitis. The chronic form of bronchitis develops only after prolonged exposure to irritants, causing abnormalities to develop in the bronchial lining. The chronic inflammation causes excessive amounts of mucus also known as phlegm or sputum to be produced by the bronchi. This mucus then blocks the airways and air sacs (alveoli) reducing the amount of oxygen available to the lungs, causing breathlessness. The condition is often made worse by infections such as colds and flu. Chronic bronchitis is an unpleasant and ongoing condition and a slow deterioration is likely. EmphysemaEmphysema is another form of lung disease. Like chronic bronchitis, it generally occurs as a result of smoking, which damages the elastic supporting structure within the lungs. This leads to breakdown and collapse of some of the airways, which causes air to become trapped and the lungs over-inflated. Long term heavy smokers may get emphysema and bronchitis together. There is one rare inherited form of emphysema called homozygotic alpha-one antitrypsin deficiency where the condition occurs by middle age, even without exposure to the usual irritants such as cigarette smoke. This is due to the deficiency of a protein, found in the serum part of blood, which acts to protect the lungs. DiagnosisThe symptoms of COPD will usually come on in the winter, and are often worse in the mornings. A GP will take a history of symptoms and perform a physical examination. He or she will probably examine the chest with a stethoscope, listening for noises such as wheezing or crackles, and perform a lung function test. This involves blowing into a device that measures how much and how fast air can be exhaled from the lungs. Different lung problems produce different patterns of breathing capability and lung function tests help to differentiate chronic bronchitis from other breathing-related conditions such as asthma. The GP may refer patients suspected of having COPD to hospital for more detailed lung function tests and possibly a chest X-ray. If people are very unwell as a result of their breathing difficulties, the levels of oxygen and carbon dioxide in the bloodstream may be measured. This involves taking a blood sample from an artery usually at the wrist. Alternatively, a pulse oximeter may be used. This is a monitoring device that measures the oxygen concentration in the bloodstream without the need for needles. It simply requires a small clip device to be placed around one finger. More specialised tests such as CT (computed tomography) and MRI (magnetic resonance imaging) scans may also be carried out to clarify the extent of any disease and exclude any other lung problems, such as cancer. TreatmentThere is no cure for COPD and any damage to the lungs is irreversible. The most important step is to stop smoking. It will also help to avoid dusty and smoky environments. This will slow down the progression of the disease. Prompt treatment of any bacterial infection with antibiotics is important. This should ease the symptoms, and may help slow the deterioration of the disease. There are also a few practical steps that can help:
Drug treatmentsAsthma treatmentsSometimes people may have asthma symptoms in addition to COPD. Asthma treatments, such as an inhaler (puffer) may help alleviate some of the symptoms of wheezing and breathlessness. A bronchodilator drug such as salbutamol (eg Ventolin) or ipratropium bromide (eg Atrovent), usually taken via an inhaler or a nebuliser, may be used to relieve the constriction of the airways. SteroidsSteroid medication either by inhaler or in tablet (oral) form has been found to improve the short-term symptoms of chronic bronchitis, though it does not slow down the progression of the disease. Long-term oral steroid treatment also carries the risk of side-effects, such as osteoporosis, diabetes and infections. Oxygen therapyPeople with severe COPD that results in low levels of oxygen in the blood may need long-term oxygen therapy to help relieve their symptoms. Oxygen is inhaled via a mask or nasal cannula (small tube). The oxygen is provided in large tanks for home use, or smaller, portable versions for outside the home. An oxygen concentrator a machine that uses air to produce a supply of more oxygen-rich gas - is an alternative to tanks. Flu jabsPeople who have COPD should have a flu immunisation each year as they are particularly vulnerable to the complications of flu. Also, think about getting an injection against pneumonia this injection protects against the pneumococcus bacterium, and lasts up to ten years. Further informationThe British Lung Foundation - COPD Factsheet The British Thoracic Society
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