Chronic bronchitis, emphysema and COPD ('smoker's lung')

Reviewed by Dr Dan Rutherford, GP

Medication for COPD
It is important to maintain a positive attitude to treatment of COPD. The condition is not curable but can often be improved, and patients deserve a full trial of potential treatments. The difference between COPD and asthma is that the airway obstruction in asthma is reversible with treatment, whereas in COPD it is largely irreversible.

The small degree of reversibility in COPD should however be exploited, for example using drugs also of benefit in asthma such as bronchodilators (beta-agonists and anticholinergics).

People with moderate to severe COPD should be seen by a specialist in chest medicine with a view to establishing if the patient will benefit from steroid therapy, either by inhaler or by mouth, or from other drugs such as oral theophylline.

COPD patients are prone to have short-term exacerbations of their condition, during which they will feel more breathless. These exacerbations are generally the result of respiratory infections so will usually need treatment with antibiotics. COPD patients should take advantage of annual vaccinations against influenza.

For those patients who have become severely limited by COPD, home oxygen treatment may be required.

Surgery
In some people with COPD, large cysts known as bullae can develop in the lung and hinder lung function. In certain circumstances these can be removed surgically and will allow better inflation of the rest of the lung tissue, but this treatment is suitable for only a minority of patients.

Summary
The main drive in COPD treatment has to be of prevention rather than cure.

COPD does occur in non-smokers but the vast majority of sufferers smoke, and their likelihood of developing the disease is related to the amount they smoke. There is an extra factor – that of individual susceptibility – which cannot be predicted in advance.

Most people with chronic bronchitis caused by smoking do not go to their doctor until they start to also become breathless, by which time much irreversible lung damage has already occurred.

Those with known COPD who continue to smoke suffer more rapid decline in lung function than those who stop completely. The message is clear – smoking is extremely bad for your health, but it is never too late to stop.

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