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We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

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Chronic Obstructive Pulmonary Disease (COPD)

Overview

Chronic obstructive pulmonary disease (COPD) is preventable and treatable. If you have COPD, you may feel short of breath and find it hard to breathe because less air flows into and out of your lungs. Your breathing tubes can swell and produce excess mucus. COPD can cause other changes in your lungs that cannot be reversed. In severe cases, you may need oxygen therapy. COPD can lead to respiratory failure.

There are 2 main types of COPD:

  • Chronic bronchitis causes a productive cough (brings up phlegm) for 3 months in 2 consecutive years.
  • Emphysema creates an abnormal enlargement of the part of the lung where the blood exchanges carbon dioxide for oxygen. Some of the normal lung tissue is destroyed, leading to fibrosis or thickening of the tissue.

Some people with COPD also have asthma. Some people will have a mix of both types of COPD and asthma. COPD can be prevented and treated, but asthma is not preventable.

Causes and Risk Factors

Smoking is a major cause of COPD. We do not fully understand what causes COPD. While many factors may increase your risk of developing COPD, about a fifth of people with the condition have no known risk factors.

Common risk factors include: 

  • Smoking. Smoking tobacco or marijuana increases your risk. Most people with COPD are smokers.
  • Genetics. History of COPD in your family can increase your risk for developing COPD.
  • Exposure to environmental agents or to secondhand smoke. 
  • Allergies. Allergies to hay fever, grass, tree pollen, and/or house dust can increase your risk.
  • Preterm birth is associated with newborn chronic lung disease, also known as bronchopulmonary dysplasia.

Prevention

Here are steps to take to reduce your risk of COPD:

  • Avoid smoking tobacco or marijuana or secondhand exposure to both.
  • Avoid exposure to dust, gases, or fumes.
  • Get physical exercise.

Symptoms

The symptoms of COPD vary. Some people may have no symptoms, and we may find COPD during a routine chest X-ray or with other tests. Others may not recognize symptoms because they do not exercise enough to cause shortness of breath.

Common symptoms of COPD include:

  • Shortness of breath, usually with exercise, at the onset of COPD. It can worsen over time so that shortness of breath occurs even at rest.
  • Chronic cough with sputum production, beginning in the morning, and then with time, progressing throughout the day.
  • More frequent respiratory infections, including acute chest infections like a bad cold or other infection. These can cause the cough to get worse or result in sputum production that is often yellow-green in color, wheezing, and more shortness of breath.

Diagnosis

The diagnosis of COPD may be difficult to make since many people have no obvious symptoms. For those who are diagnosed, the symptoms are:

  • Chronic cough
  • Chronic sputum production
  • Shortness of breath with exercise or at rest

Physical examination does not usually show any abnormalities until COPD is fairly advanced. At that point, the findings on examination are: 

  • Increased size of the chest cavity
  • Decreased breath sounds when a stethoscope is used to listen to the lungs
  • Wheezing
Lung function test: Spirometry

For an accurate diagnosis, we may recommend lung function testing, or spirometry. Spirometry is the most accurate way to diagnose COPD because there are other health conditions that can mimic the symptoms of this condition.

Spirometry checks your lung function. It looks at how air flows into and out of your lungs, and how oxygen goes back and forth between your lungs and your blood.

Here it is how it is done: 

  • You blow into a mouthpiece attached to a machine (spirometer).
  • The machine measures the rate of flow and volume of the air in your lungs.
  • We may give you inhaled medication during the test.

Your response to this medication will help us determine if you have asthma or COPD.

The information from this test is much better than a chest X-ray for finding out if you have asthma or COPD. It is also more accurate than using a peak flow meter or listening for wheezing to check your lung function. The results of this test will tell us whether medication will be helpful in treating your condition. It should not take more than an hour of your time.

Pulse oximetry

Before a chest X-ray, your level of oxygen saturation is measured at rest or with exertion depending on your situation. it is used to determine if you need home oxygen therapy.

Chest X-ray

Chest X-ray may be helpful in the diagnosis of moderate to severe COPD.

Treatments

The treatment of COPD must be tailored to the individual. There are treatments for chronic COPD and treatments for flare-ups of COPD. The goals are to decrease symptoms and to improve your ability to enjoy your life. We specifically want to decrease the possibility of flare-ups and increase your ability to exercise.

Medications

Commonly used medications include:

  • Beta-agonists or anticholinergics to help keep your breathing tubes open.
  • Inhaled glucocorticoids or corticosteroids to help reduce or prevent inflammation of the lungs.
  • Combinations of beta-agonist, anticholinergic, and glucocorticoid medications can also be used to control COPD.
  • Oral steroids may be used in severe cases. They can cause problems including thinning of the bones, increase in blood sugar levels, cataracts, and an increased susceptibility to infection.
  • Theophylline is rarely used because it is metabolized by the liver, side effects are common, and it interacts with other drugs that you may take.
  • Mucolytics or medications that thin or break down mucus are not very effective, so they are not often prescribed.

If you are at risk for heart disease, we may also recommend that you take a statin drug (medication to reduce cholesterol).

Vaccinations are important to prevent flare of COPD:

  • Annual influenza vaccine is highly recommended.
  • Pneumonia vaccine is advised for all COPD patients.

Other Treatments

Oxygen. Prescribed for patients with severe COPD who have low oxygen blood levels. It can improve lifespan and quality of life.

Surgery. People with emphysema, mainly in the upper part of the lungs, who have a low ability to exercise, may benefit from lung volume reduction surgery.

Lung transplant. This is reserved for people with COPD with severe symptoms of emphysema due to an inherited disorder called alpha-1 antitrypsin deficiency.

Treatment of Flare-ups

These episodes are caused most often by exposure to viruses and bacteria. Less often they may be due to an environmental pollutant, and in a few cases, no cause is found. Other medical conditions such as heart problems or blood clots in the lungs called pulmonary emboli may worsen with COPD.

An Emergency Department visit is sometimes needed during a flare-up. The treatment  may include medications and oxygen.

Lifestyle Management

Quitting smoking is an important part of your treatment. We can help you find resources that will work for you.

It is important for you to stay active in order to maintain and increase your lung function. Comprehensive pulmonary rehabilitation, which includes exercise training, may be helpful to improve ability to exercise, decrease shortness of breath, and increase self-care.

Good nutrition is important. Supplements or appetite stimulants may be needed to increase protein and calorie intake.

 

Additional References:

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.



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