SOME QUESTIONS AND ANSWERS

What causes COPD?

Most COPD is caused by smoking or exposure to harmful pollutants. Occasionally, it may be the result of inadequate lung development in childhood or damage caused by infections in childhood that affect lung growth and development.

Evidence of airways inflammation has been found in all smokers, although only about 15 per cent are diagnosed by a doctor as having COPD. Smokers diagnosed with COPD have greater airways inflammation than non-smokers, or smokers who have not yet shown signs of the disease.

Research in Sweden and the Netherlands has shown that a much higher proportion of smokers (more than 40 per cent of those aged 61-62 and 50 per cent of those aged 76-77) have COPD, and even a year after stopping smoking, there is clear evidence of continued lung inflammation.

Inflammation caused by smoking results in the airways being invaded by certain types of blood cells and in the release of many enzymes and other substances. These changes provide many possible targets for developing new therapies and are the focus of a lot of research.

Can COPD be inherited?

Only one inherited genetic change has been found that is clearly linked with COPD. A defect in this gene results in a deficiency of a protein called alpha-1 anti-trypsin. It accounts for around two per cent of all cases of COPD. Alpha-1 anti-trypsin inhibits an enzyme which damages the lungs. People with COPD who have alpha-1 anti-trypsin deficiency tend to develop COPD at an earlier age than usual. They are at particular risk of rapid loss of lung function if they smoke.

How is COPD treated?

Since the development and progression of COPD is, in most cases, strongly linked to smoking, the first step is to try to stop smoking. Stopping smoking is the only effective way of preventing further decline in lung function. Nicotine patches or gum, or an oral medication called bupropion, can be used to help this. Joining a support group may also be useful. Some people who have succeeded in giving up smoking found that it needed several attempts and it is important not to be discouraged by an initial lack of success. There is plenty of help available. The British Lung Foundation produces a booklet Stopping smoking that offers helpful advice.

Many people with COPD will already be experiencing breathlessness that requires medical treatment. In mild COPD (for example, where breathlessness occurs only on exercising), an inhaled short-acting bronchodilator – a medicine that makes the airways relax and open up – may be sufficient to control the symptoms. Although bronchodilators do not fully reverse airflow limitation in COPD, they often provide useful relief of breathlessness. If a single bronchodilator is not sufficient, a combination of two types of shortacting bronchodilators may be tried, or a longacting inhaled bronchodilator can be used instead.

In more severe cases of COPD, where regular use of a long-acting bronchodilator is not sufficient to control symptoms, guidelines recommend trying a combination of an inhaled long-acting bronchodilator and an inhaled medicine called a corticosteroid for an initial period of four weeks. If the use of this inhaled bronchodilator + corticosteroid combination is still not sufficient to provide relief, theophylline, which is taken by mouth, may be added. However, this can cause unpleasant side-effects and must be closely monitored.

The medical treatments for COPD, and how they work, as well as new medicines in development, are discussed in greater detail later in this booklet.

Many other therapies can be used to improve the quality of life of people with COPD. Anxiety or depression can be treated by behavioural therapy and medication. Dietary advice can help prevent weight loss and muscle-wasting. Treatment with a mucolytic medicine may ease sputum production. Pulmonary rehabilitation increases exercise tolerance, promoting independence and emotional well-being. Disease flare-ups due to infections such as pneumonia and flu can be prevented by vaccination.

There are many therapeutic possibilities in COPD

In advanced disease, supplemental oxygen may be provided, or surgery considered to alleviate symptoms. Diuretic treatment can reduce fluid retention resulting from heart problems.

COPD is a condition with many treatment possibilities.

Can a decline in lung function be prevented?

Stopping smoking is the only measure that has been conclusively shown to slow further progression of the disease. After stopping smoking, the rate of decline of lung function slows, approaching that in non-smokers. Preventing a sudden worsening (exacerbation) of COPD is also important, as it has been found that frequent events of this kind are associated with a more rapid decline in lung function. Respiratory infections are a common cause of such exacerbations, so vaccination against influenza and pneumonia may help protect against accelerated decline in lung function. Combinations of inhaled steroids and bronchodilators used in more advanced COPD reduce the frequency and severity of exacerbations and also the risk of death.