COPD - Chronic Bronchitis & Emphysema

Chronic bronchitis and emphysema are common long-term lung diseases that cause shortness of breath. Each condition
can occur on its own, but many people have a mixture of the two problems. The terms "Chronic obstructive airways
disease" (C!"# or "chronic obstructive pulmonary disease" (C$"# are often used to refer to these conditions.
"Chronic" has nothing to do with severity but simply means that the problem has been going on for a long time.
%n !ustralia, chronic bronchitis and emphysema usually occur in people who have smo&ed or continue to smo&e
cigarettes. nce you stop smo&ing you gradually reduce your chances of getting these diseases. ! small proportion of
cases of emphysema are caused by an inherited problem called alpha-'-antitrypsin deficiency. This condition is made
worse by smo&ing cigarettes.
To understand what happens to the airways and lungs of people with Chronic (ronchitis and emphysema it is useful to
&now how healthy lungs wor&.
How the lungs work?
Each time you breathe, air is drawn, via the nose and mouth, into the windpipe or trachea. The windpipe is a tube about
')-'* centimetres long in adults and splits into two smaller tubes that go to the left and right lungs. Each of these tubes
is called a bronchus. They divide into smaller and smaller airways, and together they are called bronchi. The air passes
down the bronchi in each lung, dividing another '+-*+ times into smaller and smaller airways called bronchioles. The
smallest airways end in tiny air sacs called alveoli. %t is here that the oxygen from the air is absorbed into tiny blood
vessels called capillaries which criss cross the walls of the alveoli.

nce it passes into the blood stream, oxygen is carried all around the body, and at the same time a waste product,
called carbon dioxide, comes out of the capillaries bac& into the alveoli ready to be breathed out. %f you could loo& inside
your lungs, you would see a mass of fine tubes and air poc&ets, all loo&ing rather li&e a giant sponge.
What happens in emphysema?
%n emphysema, the alveoli or airsacs in the lungs are gradually destroyed so people have difficulty absorbing enough
oxygen. The bronchi becomes floppy and narrow so that it becomes harder to breathe in and out.

These days, the most common cause of emphysema is cigarette smo&ing. %ndustrial pollutants may also cause
emphysema.
What happens in chronic bronchitis?
(ronchitis means inflammation of the bronchi. !s a result mucus which is normally made in the airways to &eep them
moist, is produced in excessive amounts. This leads to cough and sputum production. The bronchi may also become
narrow and floppy (ma&ing them narrower# and therefore it is harder for air to get in and out of the lungs. (reathlessness
results.

,ost adults have a bout of -acute- or short-term bronchitis at some time in their lives, lasting a wee& or two at the most.
%n chronic bronchitis, however, people produce a lot of mucus, sometimes called phlegm and they cough and are
breathless for months or even years.
How do people feel?
%n mild forms of these diseases, breathlessness may occur wal&ing up hills or stairs, but in severe cases, breathlessness
can occur wal&ing slowly along flat ground. .ormally daily activities become more difficult as the disease gets worse.

%t is not surprising that people with chronic bronchitis and emphysema may become frustrated, anxious and depressed,
ma&ing breathing problems worse. $eople who feel more positively toward life tend to do better.

!dapting to the limitations placed on lifestyle, together with the care and support of family and friends, can do a lot to
relieve anxiety and lift depression.
Other problems
$eople with chronic bronchitis and emphysema are more prone to chest infections and pneumonia and occasionally
re/uire admission to hospital for intensive treatment of their disease. "uring these episodes they may have a low
oxygen level in the blood and develop swollen an&les because of inade/uacy of the pumping action of the heart.
Tests
(reathing tests enable your doctor to measure the rate at which air can move out of your lungs. ! breath-holding test
can also be used to see how severe your emphysema is. 0ometimes the oxygen level in the blood stream is measured
either through the s&in or from the blood itself.

(lood tests are sometimes necessary as examination of the phlegm in the laboratory may show infection with a germ,
for which the best antibiotics can be chosen. ! chest 1-ray may help in the diagnosis of emphysema and chronic
bronchitis. These are especially useful during acute infections to detect the presence of pneumonia.
Treatment
! lot can be done to improve function and relieve symptoms associated with the two conditions, but unfortunately it is
not possible to reverse the processes which have already ta&en place. 2ou can improve your breathlessness and other
symptoms and reduce the rate of progression of the disease by giving up smo&ing. %f you stop smo&ing, this alone with
help improve the cough and phlegm and slow down the rate at which breathlessness will increase.

Cough mixtures and expectorants may be helpful, but you should discuss these with your doctor. %n some cases, drugs
can reduce some of the inflammation in the airways and ma&e them wider so that it is easier to breathe.

"rugs which ma&e the airways wider are called bronchodilators, usually ta&en in the form of an inhaler. %f you are
prescribed an inhaler, ma&e sure that you are using it properly by chec&ing your delivery techni/ue with your doctor.
ccasionally tablets are also used as bronchodilators. (ronchodilators can also be delivered by electrically driven
pumps (nebulisers# which may be useful in emergencies but are not usually necessary for routine daily use.
Chest infections ma&e chronic bronchitis and emphysema worse, so these should be treated with antibiotics. %deally,
they should be ta&en at the first signs of infection - usually an increase in the amount of mucus or a change in its colour.
"uring infections, inflammation in the airways may be treated with a corticosteroid or -cortisone- medication as well.
"iscuss with your doctor whether it is worth &eeping a small supply of these medications ready at home.

The annual influen3a vaccination in autumn is also worthwhile. 2our doctor may also recommend a vaccination against
the commonest germ causing chest infection. This vaccination is called $neumovaxT,.
%t is important to &eep as active as possible. 2our doctor may refer you for a special programme of exercises called
$ulmonary 4ehabilitation. This may help relieve some of the breathlessness and enable you to be even more active.
0ome patients with emphysema may be suitable for an operation on their lungs called "5ung 6olume 4eduction
0urgery". !lthough this is still an experimental procedure it may help breathlessness in some patients. 2ou would need
to discuss this with your doctor to see if it was a suitable procedure for your situation.
What about oxygen?
,ost attac&s of breathlessness in chronic bronchitis and emphysema are best treated with antibiotics, corticosteroids
and bronchodilators. 0ome people, on the other hand, may benefit from oxygen treatment. Those who had a low level of
oxygen in their blood between attac&s of infection and who sometimes get swollen an&les may benefit from small
amounts of extra oxygen given for '+ or more hours per day.

To find out if oxygen can help, you will need a referral to a specialist respiratory physician who may order additional
tests. These will include breathing tests, measurement of the amount of oxygen in the blood and possibly a simple
exercise test. %f the amount of oxygen in your blood is found to be very low, and you have stopped smo&ing for good, the
specialist may arrange to have an oxygen supply at home. This is usually a machine called an oxygen concentrator but
oxygen cylinders are sometimes used.

The oxygen concentrator is an electrically driven machine which extracts the oxygen from the air in your home, and is
more convenient and cheaper than using oxygen cylinders. 2ou breathe the added oxygen at a rate set by the specialist
through nasal prongs or cannulae (small soft plastic tubes that fit 7ust inside your nostrils#. 8earing nasal prongs for long
periods can ma&e the nasal tissues dry out, but this can be helped by a small device called a humidifier which moistens
the oxygen. The oxygen supply tube from the concentrator can be metres long, so you will be able to move about your
home whilst having your oxygen treatment. 2our specialist will usually as& you to use the oxygen for at least '+ hours
per day because there are few benefits from using it for less than this time.
$ortable oxygen cylinders are sometimes recommended if you get very breathless when wal&ing. These cylinders
contain enough oxygen for an hour or so and can be placed on a shoulder pac& or in a small hand-pushed trolley to
ma&e shopping or travelling easier.

$lease .ote9 This information is intended by The !ustralian 5ung :oundation to be used as a guide only and is not an
authoritative statement. $lease consult your family doctor or specialist respiratory physician if you have further /uestions
relating to the information provided here.
:or details of patient support groups in !ustralia please call 1800 !" #01
$age last updated "ec *))*
; *))< The !ustralian 5ung :oundation