Chronic Obstructive Pulmonary Disease (COPD)
COPD is a major cause of disability and death. It is the 4th leading cause of death throughout the world (World Health Organisation).
In the UK:
- COPD accounts for more time off work than any other illness;
- A flare-up (exacerbation) of COPD is one of the commonest reasons for admission to hospital;
- COPD is the most common cause of respiratory related death. There are approximately 30,000 deaths each year from the disease in the UK (NICE 2004);
- COPD mainly affects people over the age of 40;
- Around 3 million people may have the disease but only around 1 million have been diagnosed.
COPD is a long term disease where there is obstruction of the flow of air in and out of the lungs. *
(“Chronic” means “long term” and “pulmonary” means “to do with the lungs”).
COPD patients may have features of both chronic bronchitis and emphysema, although one may be more prominent than the other. *
In COPD the airflow obstruction is constant whereas in asthma it is variable. As a result if drugs that cause the airways to open up (bronchodilators) are given to asthmatics, the flow of air in and out of the lungs will increase but in COPD sufferers there will be no or little effect.
Some people have both COPD and asthma and a feature of long-term asthma (especially if it is poorly controlled) can be the development of a degree of fixed airway obstruction.
What’s in a name?
COPD has had many names in the past including; Chronic Obstructive Airways Disease, (COAD); Chronic Obstructive Lung Disease, (COLD); Chronic Airflow Limitation, (CAL or CAFL) and Chronic Airflow Obstruction. It has also wrongly been called chronic asthma. . In the past the term COPD was not commonly used. As a result the term chronic bronchitis was often used to describe both chronic bronchitis and COPD.
All of these names try to describe the nature of the condition.
The lungs and breathing tubes are damaged making it difficult to get air in and out. Walking up a hill, playing football, playing with your grandchildren or - in the more severe stages of the condition – even walking around the house or dressing and undressing without help can become difficult because of shortness of breath.
Other common symptoms include;
- a persistent chesty cough and phlegm
- wheeze
- more frequent and troublesome chest infections
COPD is a slow developing condition: the symptoms tend only to start becoming a problem in mid-life, usually in the late forties onwards.
What causes COPD?
Smoking is the most common cause but exposure to pollutants in the workplace can cause COPD, even in people who don't smoke.
The HSE suggests that for Great Britain: -
- Around 15% of COPD may be caused or made worse by work
- 4000 COPD deaths every year may be related to work exposures
- 4 in every 10 COPD patients are below retirement age
- A quarter of those below retirement age are unable to work at all each year
There is a recognised link between coal mine dust and COPD and thousands of British coalminers have received compensation for COPD.
But COPD is not just a problem for coalminers. Breathing in too much fume and/or dusts in other workplaces could put you at risk of developing COPD.
Exposure to a range of dusts and fumes (notably cadmium and silica) may also increase the risk of COPD.
Occupations at risk include coal miners, construction workers who handle cement, metal workers, grain handlers, cotton workers, workers in paper mills and those exposed to cadmium or silica (please also see silicosis) .
There have been investigations into a link between COPD and welding fume. Whether welding fume causes COPD and/or asthma is controversial.
The risk of developing COPD is greatly increased if you breathe in dusts/fumes in the workplace and you smoke.
There is no cure for COPD but a lot can be done to relieve its symptoms.
You can help stop it getting worse by reducing exposure to the dust, fume and irritating gases at work that are causing the problem, and if you do smoke, by stopping.
The sooner you realise you have lung problems, the quicker you can try to stop smoking and reduce harmful exposures to dusts, fumes and gases. Medical treatments, appropriate exercise and diet may also help.
Despite the huge numbers of patients where COPD has been diagnosed, it may be that the condition is still more common.
The British Lung Foundation estimate that there are around 3 million people in the UK who suffer from COPD but only 1 million of those have received a proper diagnosis of the condition.
Because COPD creeps up slowly, many people do not realise they have the disease. They may think their symptoms are simply due to lack of fitness or to getting older. This means that often the disease does not get diagnosed in the early stages.
Similarly the fact that airways obstruction is a symptom of asthma, many doctors diagnose asthma when the condition is actually COPD. This is readily done if, for instance, a simple lung function test (spirometry) is not performed and repeated after bronchodilators have been taken.
Only if a proper diagnosis is made can sensible – and often very effective – steps be taken to reduce the condition’s effects.
