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COPD, Emphysema, and Chronic Bronchitis: Obstructive Lung Disease

Linda Crampton is a writer and teacher with a first-class honors degree in biology. She often writes about the scientific basis of disease.

Healthy lung tissue versus lung tissue from a person with chronic bronchitis and emphysema. One or both of these conditions are present in COPD.

Healthy lung tissue versus lung tissue from a person with chronic bronchitis and emphysema. One or both of these conditions are present in COPD.

What Is COPD?

Chronic Obstructive Pulmonary Disease, or COPD, is a condition in which the airways and/or air sacs in the lungs are unable to function properly, making breathing difficult. The airways are the passages that transport air to, through, and from the lungs. The air sacs send inhaled oxygen into the blood and take up carbon dioxide waste to be exhaled. COPD is a progressive disease. The lung deterioration can often be slowed and the symptoms treated, however, improving the quality of life for the patient.

Two major conditions are classified as COPD. Chronic bronchitis and emphysema may occur on their own, but they often occur together. In chronic bronchitis, the airways are inflamed and swollen. They are also partially filled with mucus. Some people experience temporary (acute) bronchitis due to an infection, but long-lasting (chronic) bronchitis is part of COPD. In emphysema, air sacs are damaged and destroyed.

Both the chronic bronchitis and the emphysema components of COPD are often caused by smoking for many years or by exposure to secondhand smoke. Other factors may cause chronic obstructive pulmonary disease, however, including inhaling polluted air or toxins for a long time. Some people have a genetic problem that makes them more susceptible to smoke damage.

Structure of the respiratory system

Structure of the respiratory system

The Respiratory System

The air that we inhale through our nose or mouth enters the back of the throat and travels into the larynx or voice box. From here, the air flows into the trachea, which is also known as the windpipe. The trachea transports the air into two tubes known as the primary bronchi. One primary bronchus goes to each lung, where it branches into narrower bronchi. The branching continues, creating smaller and smaller airways. The tiniest branches of the airways are called bronchioles.

The bronchioles send inhaled air into sacs called alveoli. Oxygen is passed into the bloodstream through the thin walls of the alveoli. Carbon dioxide moves from the blood into the alveoli to be exhaled. The alveoli are covered with blood vessels known as capillaries, which like the alveoli have thin walls that make gas exchange easy.

Inhalation and Exhalation

The diaphragm is a large, sheet-like muscle located under the lungs. It's part of the respiratory system and is the main muscle of respiration. The medulla oblongata in the brain stimulates the diaphragm to contract at regular intervals. As the diaphragm contracts, it moves downwards, causing the lungs to expand. This expansion of the lungs enables air to enter them during inhalation.

When the medulla oblongata stops sending a signal to the diaphragm, the muscle relaxes. As it does so, it moves upwards and pushes air out of the lungs during exhalation.

Obstructive and Restrictive Lung Diseases

COPD, chronic bronchitis, and emphysema are said to be obstructive lung diseases as opposed to restrictive ones. Obstructive diseases primarily affect the passage of air out of the lungs, while restrictive diseases affect the passage of air into the lungs.

In an obstructive lung disease, a person has trouble exhaling all the air from their lungs, either because the lungs are damaged or because the airways have become too narrow. As a result, a large amount of old air remains in the person's lungs. This air has already given up most of its oxygen. In a restrictive lung disease a person cannot fully expand their lungs and therefore cannot obtain enough oxygen during inhalation.

This illustration shows the location of the respiratory system in relation to the abdominal organs. It also show the external appearance of the larynx. The alveoli and diaphragm are not shown in the picture.

This illustration shows the location of the respiratory system in relation to the abdominal organs. It also show the external appearance of the larynx. The alveoli and diaphragm are not shown in the picture.

Chronic Bronchitis

In chronic bronchitis, the bronchi are inflamed. The lining of the bronchi is swollen and produces a large quantity of thick mucus. Mucus is a normal component of the airways and has useful functions, but it becomes a problem if too much is made or if it becomes thick and sticky,

A person suffering from chronic bronchitis coughs frequently in an attempt to get rid of the mucus. The mucus is known as sputum or phlegm when it's coughed up. The person may have a tight feeling in their chest and it may be difficult for them to breathe. They may also wheeze as they breathe.

The definition of "chronic" bronchitis varies slightly according to different opinions, but in general bronchitis is said to be chronic if the person coughs and produces sputum every day—or on most days—for at least three months in a year and for at least two years in a row.

What Is Emphysema?

The alveoli are located close together in the lungs, forming clusters that look something like bunches of grapes. Although alveoli are small, there are so many of them—about 300 million to 400 million in each lung—that the total surface area of all their walls is very large. This feature allows for enough gas exchange between the alveoli and the blood to keep us alive and active.

In emphysema, the walls of some of the alveoli break down. Therefore there is less surface area for gas exchange between the blood and the alveoli. Large, irregularly shaped cavities often appear amongst the alveoli. The walls of the intact alveoli may lose their elasticity. Alveoli normally expand as they fill with inhaled air and then shrink as the air is exhaled. The alveoli may remained stretched in a patient with emphysema. This makes it hard for the patient to expel air.

COPD Symptoms and Flare-Ups

The symptoms of untreated COPD or of either disease component on its own are often worse when a person tries to exercise, since exercise increases the body's oxygen requirement. A person with chronic obstructive pulmonary disease may experience shortness of breath even during a slight exertion. It's very important that the person doesn't ignore his or her symptoms, because the sooner they receive treatment for COPD the better the outlook for their future.

People with COPD may experience times when their symptoms suddenly get worse, even when they're not exercising. These periods are known as flare-ups or exacerbations and can sometimes require an emergency hospital visit. Coughing may increase and more mucus may be released. The mucus may be thicker than usual and have a different color. Breathing may be increasingly difficult. Flare-ups are usually caused by a new irritant to the lungs, such as a respiratory infection or exposure to increased air pollution. A patient needs to form an action plan for dealing with flare-ups in cooperation with their doctor.

The Four Stages of COPD

There are different stages of COPD, ranging from mild to very severe. Ideally, treatment should begin while a person is in the mild stage. An organization called the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies the stages of obstructive lung disease as shown in the table below. The classification is widely used. The ability to exhale is determined by a patient blowing into a device called a spirometer.

Stages of Chronic Obstructive Lung Disease

Stage CoughBreathingOther Symptoms

One (Mild)

Possibly, a chronic cough that brings up mucus

Ability to exhale is 80% of normal

 

Two (Moderate)

A chronic cough that brings up a large amount of mucus

Ability to exhale is 50% to 79% of normal

Shortness of breath, especially during exercise; occasional flare-ups

Three (Severe)

A chronic cough that brings up a large amount of mucus

Ability to exhale is 30% to 49% of normal

Shortness of breath; frequent flare-ups, which may be severe; fatigue

Four (Very Severe)

A chronic cough that brings up a large amount of mucus

Ability to exhale is less than 30% (or less than 50% and accompanied by chronic respiratory failure, which is caused by excess carbon dioxide in the lungs)

Severe shortness of breath; life-threatening flare-ups; cyanosis (a blue color in the skin); edema (fluid buildup in the lower limbs); weight loss

Causes of the Disease

By far the most common cause of chronic obstructive pulmonary disease is smoking for many years or chronic exposure to secondhand smoke. Long-term exposure to other lung irritants such as toxic workplace vapors or dangerous air pollution can also cause COPD.

A fibrous protein called elastin surrounds the airways and is present in the walls of the alveoli. This protein enables structures to return to their original shape after they're stretched. An enzyme called elastase breaks down the elastin. Smoking causes inflammation and stimulates inflammatory cells to releases elastase, which causes deterioration in lung structures.

A few people have a genetic problem that reduces their production of a protein called alpha-1 antitrypsin (AAT). AAT has the ability to block the action of elastase. This means that smokers who also have an AAT deficiency have an increased likelihood of developing COPD. Nonsmokers with an AAT deficiency have an increased risk of developing chronic obstructive lung disease, too.

COPD Treatment: First, Stop Smoking

The first step in treating COPD—which is vital—is to stop smoking. Researchers stress that it's never too late to quit smoking. Once the lungs are no longer exposed to tobacco smoke, the rate of lung tissue deterioration generally slows. However, the lung damage that has already occurred isn't reversed when smoking ceases. If a person continues to smoke, lung deterioration will continue at an accelerated rate and may become life threatening.

Research suggests that from 15% to 25% of smokers develop COPD. Some researchers think that the percentage is actually much higher, since some people don't visit their doctor when breathing becomes difficult and therefore don't get a diagnosis.

Quitting smoking may be difficult for long-term smokers, who are most likely to develop chronic obstructive pulmonary disease. It's very important for reducing lung deterioration, however. A patient should use all the help available to end their smoking habit. Once they no longer smoke, the person may be able to deal with the symptoms that have developed up to that time. Of course, the best plan is to never start smoking or to quit before any symptoms of COPD appear.

A inhaler used to supply a combination of a bronchodilator and a corticosteroid

A inhaler used to supply a combination of a bronchodilator and a corticosteroid

Some Other Possible Treatments

Inhaled forms of medications are frequently prescribed to help relieve symptoms. Bronchodilators expand the airways, allowing more oxygen to reach the lungs. Corticosteroids reduce inflammation. Inhalers containing a combination of these two types of medications are often used. Some other inhaled and oral medications may be helpful as well. AAT may be administered to patients who lack the protein.

A program known as pulmonary rehabilitation may be very helpful for a COPD patient. This program involves a combination of strategies to improve the patient's quality of life. It teaches useful breathing techniques and exercises and includes physical therapy and instructions for the proper use of medications and respiratory devices. An exercise program can be very beneficial for COPD patients, but it's very important to follow a medical professional's advice about exercise type, duration, and frequency.

A person with COPD should ask their doctor whether getting an annual flu vaccine would be beneficial. They may need to inhale supplemental oxygen at night and perhaps during the day as well. In certain cases, surgery may be performed to remove damaged areas in lungs. A lung transplant may be performed if a lung is severely damaged and if a new lung is available.

Hopefully researchers will soon discover new ways to help people with chronic obstructive pulmonary disease. The patient's doctor should know about these if they appear and will be able to offer advice.

References and Resources

  • COPD information from the National Heart, Lung, and Blood Institute
  • Facts about chronic obstructive pulmonary disease from the American Lung Association
  • COPD facts from the CDC (Centers for Disease Control and Prevention)
  • GOLD: Global Initiative for Chronic Obstructive Lung Disease

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: Is chronic bronchitis contagious?

Answer: Chronic bronchitis is very likely not contagious, while acute bronchitis may be. The chronic condition is generally caused by long-term irritation of the airways by smoke, chemicals, or dust of some kind. If no infectious agent is present, the condition isn’t infectious. Acute bronchitis is often caused by an infection, however. The pathogen causing the disorder (a virus or sometimes a bacterium) can be passed to someone else, making them sick.

© 2012 Linda Crampton

Comments

Linda Crampton (author) from British Columbia, Canada on December 10, 2018:

Best wishes to you, Cloud. I hope you succeed in fighting the disease and that you stay as healthy as possible.

Cloud V Farrow on December 10, 2018:

I have been dealing with copd for over 10 years. I fear the common cold and still get them at least once a year. You loose a little more function each time. I'm running out of time. I am 73 years old and wish to live a lot longer. I will never give up. Life is so dear.

Linda Crampton (author) from British Columbia, Canada on June 13, 2018:

Thank you very much for sharing the information, Ruth. It's important that people know about it.

Ruth Coffee from Zionsville, Indiana on June 13, 2018:

I have COPD, my mother and my sisters have it too. None of us smoked and we don't have the alpha-1 antitrypsin link either. But we all had allergies/asthma, and then apparently COPD. People with allergies or asthma need to be sure they are adequately treating these things to try to keep the obstruction from becoming "fixed". Thank you for providing good information, people need to become more aware.

Linda Crampton (author) from British Columbia, Canada on February 22, 2018:

Thank you very much, Dr Ashish.

Hashp from india on February 22, 2018:

It's a nice and comprehensive review of COPD. I found it informative.

Linda Crampton (author) from British Columbia, Canada on February 21, 2018:

I'm sorry about what you're experiencing, Jeff. Disorders that make it hard to breathe are not nice, to put it mildly. I don't know of any secret cure and couldn't advise you if I did, because I'm a science writer, not a doctor. I hope a doctor soon recommends an effective treatment that you can afford.

Jeff Brown on February 21, 2018:

Hi, I have just been diagnosed with acute bronchitis, I live in high altitude and like to hike, hunt, fish, etc. It seems like I can't walk to the gym without being out of breath. My first visit to the hospital my blood was at 30% than a few months later after feeling great back I went and my blood was 61%. They (Dr's) put me on a ton of meds I can't afford and I was wondering if you had a secret cure?

Thank you very much.

Linda Crampton (author) from British Columbia, Canada on December 28, 2017:

I hope your friend visits a doctor to get a diagnosis and treatment, Jackie. The doctor may be very helpful.

Jackie on December 28, 2017:

TY for the info. The man I love has this (I think) and I'm so afraid of what comes next.

Linda Crampton (author) from British Columbia, Canada on October 03, 2012:

Thank you very much, Night Magic.

Night Magic from Canada on October 03, 2012:

Excellent article.

Linda Crampton (author) from British Columbia, Canada on October 02, 2012:

I'm sorry that your friend has developed COPD, teaches. Hopefully he can be treated successfully and can avoid further exposure to the cause of his illness. Thank you for commenting and for the vote.

Dianna Mendez on October 02, 2012:

A friend of mine just recently told me he had this. He believes it developed over time from his exposure from others who smoke (he had never smoked). This is a good hub filled with valuable information and very detailed. Voted up.

Linda Crampton (author) from British Columbia, Canada on October 02, 2012:

Thanks for the visit, the lovely comment and the share, Martie. I appreciate them all very much!!

Linda Crampton (author) from British Columbia, Canada on October 02, 2012:

Thank you very much for the visit and the kind comment, b. Malin!

Martie Coetser from South Africa on October 02, 2012:

Alicia, this is an awesome hub about chronic lung diseases. Well-researched and well-presented.

Voted up, shared and pinned in my personal library :)

b. Malin on October 02, 2012:

Hi Alicia,

Such a well written Hub on a Subject that many of us know little about. This was such an Educational as well as Informative read. The Videos that you presented are Excellent and so easy to understand. Thank You!

Linda Crampton (author) from British Columbia, Canada on October 02, 2012:

Thanks, Tom. I appreciate the comment, the votes and the support!

Thomas Silvia from Massachusetts on October 02, 2012:

Hi my friend, great hub and so very informative i learn a lot here today !

Well done and vote up and more !!!

Linda Crampton (author) from British Columbia, Canada on October 01, 2012:

Thank you very much, Prasetio. Best wishes to you, too!

prasetio30 from malang-indonesia on October 01, 2012:

Alicia, your hub always interesting and I also find many useful things after reading your hub. I'll bookmark this one. Voted up and take care!

Best wishes, Prasetio

Linda Crampton (author) from British Columbia, Canada on October 01, 2012:

Thank you so much for the wonderful comment, drbj, and for the vote too. I appreciate them both!

Linda Crampton (author) from British Columbia, Canada on October 01, 2012:

Thank you, jimmy. I appreciate your visit and comment.

drbj and sherry from south Florida on October 01, 2012:

I commend you, Alicia. I have studied descriptions of pulmonary diseases in the past but none compared with the outstanding summation you have just written. Excellent and the graphics are the finishing touch. Thank you and an Up.

Jimmy the jock from Scotland on October 01, 2012:

Informative and well presented article thanks for sharing.....jimmy