Chronic coughing and breathing difficulties: Chronic obstructive pulmonary disease (COPD)

What is COPD?

When we breathe in, our lungs provide us with oxygen. COPD (chronic obstructive pulmonary disease) is a condition in which the lungs have become permanently damaged and the airways are constantly narrowed. This makes it difficult to breathe.

 

People with COPD have a chronic inflammation in the bronchi of their lungs (chronic bronchitis) or the air sacs in their lungs are damaged (emphysema). They often have both at the same time.

If bronchi are chronically inflamed, they become swollen and less air can pass through them. A persistent cough and mucous congestion are often signs of an inflammation.

If the small air sacs in your lungs become damaged, the blood flowing through your lungs can no longer absorb as much oxygen or freely get rid of carbon dioxide, the waste product of breathing.

 

 

What are the signs of COPD?

The first signals and symptoms of COPD are often not considered to be signs of a serious illness. This is mostly because COPD in the early stages hardly affects daily life.

Typical symptoms are:

• Daily coughing over a longer period of time
• Coughing up phlegm (mucus, medical term: sputum)
• Breathlessness during physical activity
• Breathing sounds such as wheezing and rattling
• Frequent colds or flu

The first most common sign of COPD is coughing. Many people get used to their coughing however. Smokers in particular often regard it as a supposedly harmless “smoker’s cough”.

When they experience breathing difficulties, breathlessness and shortness of breath some people have the feeling that they have to exhale with force or that their throat tightens. Sometimes their breathing is accompanied by wheezing or rattling noises. In more severe breathlessness people might tend to avoid physical activities such as climbing stairs or going for longer walks.

These can be signs of COPD. To make a diagnosis, the doctor will ask about other symptoms and your history of previous diseases, do a physical examination and test your lung function. But coughing and breathing difficulties could also be symptoms of other diseases, such as asthma or lung cancer, for example. Therefore you should talk to your doctor to find out whether you really have COPD.

What is the difference between COPD and asthma?

COPD and asthma are different diseases, which also require different treatments. People can have both diseases at the same time, however. In order to distinguish between asthma and COPD, special medical examinations are necessary.

Typical signs of COPD:

• The disease first starts in adulthood.
• Breathing difficulties are brought on by physical exercise, later on they persist at rest as well.
• The symptoms increase slowly and gradually.
• The person smokes or used to smoke.
• The person comes or used to come in contact with harmful dusts or gases at work.

 

Typical signs of asthma:

• The disease starts in childhood or adolescence. It is possible for asthma to start at any age, however.
• There are periodic attacks of breathlessness, particularly at night or early in the morning and they vary in degree from day to day.
• The person has an allergy, hay fever or eczema at the same time.
• Other family members such as parents or siblings have asthma too.

 

What are exacerbations?

An exacerbation is an episode where the disease suddenly gets much worse. During these exacerbations, people often have acute breathing difficulties, more coughing and colored phlegm. People can have more than one exacerbation.

Exacerbations make the disease worse and can be life-threatening in severe COPD. It therefore makes sense to try and prevent exacerbations as much as possible and to react appropriately should one occur, by changing medication for example.

Exacerbations are fairly often triggered by colds or other airway infections, but smoke or extreme weather conditions may also favor a worsening of the disease.

How does the disease progress?

Symptoms like coughing and breathing difficulties usually get worse as the disease progresses. In an advanced stage, COPD can even be deadly. How quickly COPD progresses varies from person to person and can hardly be predicted.

Any damage to the lungs is irreversible. So the treatment of COPD aims to limit further damage as much as possible by avoiding harmful substances like smoke, certain gases or dust, and by fully complying with the treatment.

What is life with COPD like?

Many people with COPD manage their disease well and are quite content with their lives despite COPD. They try to make the best of their situation and cope actively with the disease. How much their daily activities are limited depends very much on the stage of the disease, though.

In advanced COPD, daily activities such as walking, getting washed and dressed, and eating take more effort. Sometimes people with COPD will then need to be helped by other people.

Many people with COPD can no longer sleep well at night so that they are constantly tired and exhausted. They often find it harder to concentrate or become forgetful. Some people cannot go to work anymore.

They may also lose contact with their friends and family and participate less in social life.

These changes in life can be frustrating or make life seem worthless or boring. Many people with COPD have depression, which is often not recognized.

There are many possibilities for adapting to the disease and to the changes in daily activities it brings with it. They range from breathing and relaxation techniques to changing attitudes towards life. Some people find it easier to cope with the disease when they adapt their lives to their physical needs. They replace physically demanding activities with less straining ones, or they change priorities to have more energy to do things they enjoy. To save energy they plan their daily activities ahead of time and organize their homes so that they can do many things when they are sitting. Some people find it helpful to go to self-help groups and talk to other people with COPD.

Is it normal to be anxious?

Anxiety and even panic are natural reactions to breathlessness or serious breathing difficulties. For people with a chronic disease like COPD, looking into the future can also be frightening. How will the disease progress? What will it be like to die? Some people are afraid of becoming a burden or of depending on the help of others.

There are different ways to deal with anxiety. These include psychological counseling or treatments including behavioral therapy and relaxation techniques, comprehensive rehabilitation programs with physical exercise, as well as different drugs.

It is not known, however, which treatment for anxiety or panic really helps people with COPD. Behavioral therapy or relaxation techniques might nevertheless help in severe anxiety, especially during a severe attack of breathlessness.

What are the treatment options?

There are various treatment options for COPD, which we are only going to describe briefly here. They all aim to make daily life easier for people with COPD, to reduce symptoms, to prevent attacks of breathlessness and to improve quality of life. There is no treatment yet to cure COPD. But if the disease is not treated it can continue to get worse.

Treating COPD is not easy and does not always show immediate effect. That is one of the reasons why some people underestimate the long-term benefit of treatment. In order to take responsibility for managing their disease it is therefore important that people with COPD understand their condition and why it needs to be treated. The kind of treatment always depends on the severity of the disease, too.

Different treatment options for people with COPD are listed below. You can talk to your doctor to find out more about their possible benefits and risks.

• Quitting smoking: There are various things that can help you quit smoking, for example information material, counseling, support from other people, stop-smoking programs (alone or in a group), nicotine replacement therapy (for example patches, chewing gums or tablets) and other medications
• Physical exercise, for example in special lungs sport groups
• Breathing techniques and physiotherapy: different breathing and coughing techniques, body postures and exercises as well as different medical devices
• Inhalation
• Drugs: Some drugs are taken every day, others only as needed, for example during physical exercise or in acute breathlessness
• Vaccinations like influenza and pneumococcal vaccinations
• Patient education
• Dietary counseling in advanced COPD
• Oxygen therapy in advanced COPD: Oxygen is breathed in during several hours a day or night, or during physical activity. This is usually done using a thin tube which leads from the nose over both ears to an oxygen tank
• Lung surgery/transplantation in advanced COPD
• Rehabilitation: Rehabilitation is usually made up of different treatment components such as reviewing medication, physical training, education and counseling, breathing therapy and physiotherapy as well as smoking cessation. Your doctor can help you to apply for rehabilitation.
• Disease management program (DMP): comprehensive, structured treatment program offered in Germany by some health insurance funds 

Can emergency plans help in exacerbations?

Emergency plans list symptoms that indicate an exacerbation. They also describe when it makes sense to change the kind or dosage of your medication, or to go to the doctor or hospital.

Emergency plans can help to recognize exacerbations early and to treat them appropriately. They can help you to take the right drugs, for example. You can talk to your doctor about setting up an emergency plan for you and your relatives.

Is there support for care?

When people with COPD can no longer manage their daily lives without help, they can apply for supportive care services. The doctor, the long-term care insurance or the social services department can help with the application. An assessor will then make an on-site visit to see whether the person with COPD needs help and, if so, how much. If the assessor finds that there is need for nursing care, you can claim financial support, service or a combination of both.
 

© IQWiG (Institute for Quality and Efficiency in Health Care)