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What is Chronic Obstructive Pulmonary Disease (COPD) ?

What is chronic obstructive pulmonary disease (COPD)?

It is a lung disease characterized by chronic obstruction of airflow that interferes with normal breathing. The diagnosis is confirmed by a simple test called spirometry, which measures how deeply a person can breathe and how fast air can move into and out of the lungs.

(Left: normal Airway) (Right: Inflammed airway)

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Signs and symptoms

- Shortness of breath - Morning cough with excessive mucus production - Wheezing - Chest tightness

Risk factors

1. Smoking

Cigarette smoking is the best known risk factor for COPD. About 15% of smokers develop this disease. However, tobacco smoke is the risk factor for as much as 90% of the cases.

Non-smokers may also develop the disease. Other risk factors for COPD are varied.

2. Genes

Severe alpha-1 antitrypsin enzyme deficiency causes panlobular emphysema in both smokers and non-smokers. This rare hereditary disease is most commonly seen in individuals of Northern European origin.

3. Exposure to occupational dusts and chemicals

These exposures include organic and inorganic dusts, chemical agents and fumes. Livestock farmers have an increased risk of chronic bronchitis, COPD and reduced forced expiratory volume (FEV1). Ammonia, hydrogen sulphide, inorganic dust and organic dust may be causally involved, but a role for specific biological agents cannot be excluded. Atopic farmers appear more susceptible to develop farming-related COPD.

4. Indoor air pollution

Biomass and coal are the main sources of energy for cooking and heating in many communities in the Middle East, Africa and Asia. Wood, animal dung, crop residues and coal are burned in poorly functioning stoves, in poorly ventilated rooms and lead to very high levels of indoor air pollution, a well-established risk factor of COPD in women.

5. Outdoor air pollution

The role of outdoor air pollution in causing COPD is unclear, but appears to be small when compared with cigarette smoking. However, air pollution from motor vehicle emissions in cities is associated with a decrease in lung function.

6. Gender

Some studies have suggested that women are more susceptible to the effects of tobacco smoke than men and raise concerns on the increasing number of female smokers in both developed and developing countries.

7. Infection

Both viral and bacterial infections may contribute to the pathogenesis, progression of COPD and the bacterial colonisation associated with airway inflammation. Infection also plays a significant role in exacerbations associated with deterioration in lung function.

COPD can be treated with pharmacological and non-pharmacological therapy. Treatment recommendation should be based on disease severity, symptoms and frequency of COPD exacerbations. Most of the time outpatient therapy is sufficient with medications, including inhaled bronchodilators, corticosteroids or antibiotics. Non-pharmacological treatment like comprehensive pulmonary rehabilitation aims to reduce symptoms, increase participation in physical and social activities, and improve the overall quality of life for patients with chronic lung diseases.

What is pulmonary rehabilitation?

The American Thoracic Society/European Respiratory Society has recently defined pulmonary rehabilitation as ‘‘a comprehensive intervention based on a thorough patient assessment followed by individualized program which is not only limited to exercise training, also including education and behavior change.

1. Management of breathlessness

(a) Forward lean position optimizes the mechanical advantage and pressure-generating capacity of the diaphragm (respiratory muscle). The position utilizes gravity effects to allow accessory muscles to assist your breathing.

(b) Pursed lip breathing relates to a slower respiratory rate in people with expiratory airflow obstruction, it allows for more complete lung emptying when breathing out and less pulmonary hyperinflation.

2. Airway clearance

A typical active cycle of breathing technique (ACBT) consists of breathing control, thoracic expansion exercises, breathing control, and the forced expiratory technique (huffing). The number and frequency of each of the components of the ACBT can be altered, but all components of the cycle must be present, and interspersed with breathing control. Breathing control helps to prevent bronchospasm and oxygen desaturation while the thoracic expansion exercises assist in the loosening and clearance of secretions, and the improvement of collateral ventilation. The huffing is thought to promote secretion movement through changes in thoracic pressures and airway dynamics.

3. Improvement in exercise tolerance

(a) Compared with the continuous method, intensive interval of endurance training leads to a lesser degree of dynamic pulmonary hyperinflation, and this is one of the reasons why it enables a notably longer tolerated training period and a lower degree of shortness of breath. In addition to training on a stationary bicycle, endurance training can also be performed as a walking exercise (on the treadmill or floor).

(b) Strengthen major muscle groups, with the emphasis on the legs, because this is where disease-related muscular atrophy is usually most pronounced. Targeted strength training can be done by using strength training equipment, free weights, or one’s own body weight—at a level that is tailored to the every patient.

Here we have a video version on the explanation of what is COPD:


Hammad Qureshi, Amir Sharafkhaneh and Nicola A. Hanania. (2014). Chronic Obstructive Pulmonary Disease Exacerbations: Latest Evidence and Clinical Implications. Therapeutic Advances in Chronic Disease, 5(5): 212-227.

Ministry of Health Malaysia. (2009). Clinical Practice Guidelines on the Management of Chronic Obstructive Pulmonary Disease 2nd Edition.

Kylie Hill, Loannis Vogiatzis and Chris Burtin. (2013). The Importance of Components of Pulmonary Rehabilitation, Other Than Exercise Training, In COPD. Eur Respir Rev, 22: 405–413.

Lucy K. Lewis , Marie T. Williams, Timothy S. Olds. The Active Cycle of Breathing Technique: A Systematic Review and Meta-Analysis. (2012). Respiratory Medicine, 106(2): 155-172.

Rainer Gloeckl, Tessa Schneeberger, Inga Jarosch, Klaus Kenn. Pulmonary Rehabilitation and Exercise Training in Chronic Obstructive Pulmonary Disease. (2018). Deutsches Ärzteblatt International , 115: 117–123.

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