COPD, emphysema and bronchitis
Emphysema and chronic bronchitis are part of COPD
COPD includes two respiratory problems that are generally diagnosed in individuals over the age of 40: chronic bronchitis and emphysema. These two diseases progress slowly and gradually cause an obstruction in the airways that reduces the ability to breathe normally. People with COPD may suffer from emphysema, chronic bronchitis, or both.
Emphysema is a degenerative, insidious, slow-progressing disease that develops when the lung tissue destroys itself and loses its elasticity. Expiration then becomes more difficult and laborious. Under normal conditions, the alveoli are like small elastic bags that look like a bunch of grapes that inflate like a small balloon on inspiration and deflate on expiration.
Emphysema causes the alveoli to dilate and destroys the alveolar wall. Air remains trapped inside the damaged alveoli and the exchange between oxygen (O2) and carbon dioxide (CO2) is diminished, thereby also reducing the amount of O2 available to the body. In other words, the balloons are not as effective as originally and do not empty as quickly as before. This restricted breathing produces a persistent feeling of shortness of breath and fatigue that intensifies over time. Unfortunately, emphysema is often diagnosed at an advanced stage.
Chronic bronchitis is a permanent inflammation of the bronchi often accompanied by excess secretion of mucus, making the passage of air to the lungs difficult. It is recognized when cough and expectorations (sputum) persist for several months and usually last a little longer each time. Obstruction of the bronchi and excessive secretions will cause more and more pronounced shortness of breath over time because the lungs can no longer fully expel air on expiration.
Your doctor may suspect chronic bronchitis if you have a regular sputum-producing cough that persists for more than three consecutive months in at least two consecutive years. Generally speaking, people with chronic bronchitis cough, produce phlegm and experience shortness of breath when exercising or carrying out activities of daily living.
In the vast majority of cases, the development of COPD is linked to smoking, which is the cause in 90% of cases. Other main causes include:
- Air pollution (dust and chemical products).
- Second-hand smoke.
- Alpha-1 antitrypsin deficiency: This is a rare genetic disorder that accelerates the onset of pulmonary emphysema and very severe bronchial obstruction.
- Recurrent pulmonary infections in childhood.
Signs and symptoms
People with COPD generally have one or more of the following symptoms:
- Shortness of breath ranging from being breathless on exertion or too winded to get dressed.
- Chronic cough (especially in chronic bronchitis).
- Production of secretions (especially in chronic bronchitis).
- More frequent respiratory infections (flu, pneumonia) and slower recovery time.
- Unexplained weight loss.
- Reduced ability to perform daily activities.
Some other factors can also exacerbate the symptoms of COPD. The most common ones are:
Respiratory infections (cold, flu, bronchitis, pneumonia)
- Avoid contact with people who have a respiratory infection, meaning people who are contagious.
- Wash your hands frequently.
- Get vaccinated. You and the people in your household should get a flu shot. Your doctor may also suggest the pneumonia vaccine.
Indoor air pollutants (cigarette smoke, household cleaning products, strong odours, dust)
- Quit smoking and avoid second-hand smoke.
- Avoid strong odours.
- Declutter your home so dust doesn’t accumulate.
Outdoor air pollutants (exhaust emissions, industrial fumes, smog)
- Quit smoking and avoid second-hand smoke.
- Avoid strong odours.
- Avoid smog.
- Avoid exhaust emissions and industrial fumes.
Emotions (anger, anxiety, stress)
- Practice your breathing and relaxation techniques.
- Talk about your feelings with your loved ones.
Temperature changes (extreme heat or cold)
When it is COLD:
- Dress warmly and cover your nose with a scarf
When it is HOT:
- Opt for cool air-conditioned places.*
- Drink enough water (unless instructed otherwise by your doctor).
- Avoid overly stenuous activities.
- Wear light-weight clothing and a hat.
To diagnose COPD, your doctor will start by asking about your health history and lifestyle habits, for example:
- Do you smoke or have you ever smoked?
- Do you often have shortness of breath?
- What makes your shortness of breath worse?
- Do you cough? For how long?
- Do you cough up secretions (mucus)?
- Do members of your family have any respiratory conditions?
Then, exams can be performed to make a diagnosis:
Spirometry is the most reliable way to diagnose COPD. You will be asked to blow as long and as hard as you can into a tube attached to a machine. This machine will measure how much air is forcefully expelled from your lungs when you start to exhale and how long it takes to blow out all the air from your lungs.
This test is usually done before the administration of a medication that opens the bronchi and is repeated about 10 minutes later. The difference between the two results will provide the doctor with valuable information to confirm a COPD diagnosis. Spirometry is also a useful tool for measuring disease progression.
This exam uses X-rays to obtain a picture of your lungs so the doctor can detect respiratory infection, bronchial disease, tumour or something else.
Full lung function test or basic work-up
This test is complementary to spirometry and, in some cases, can be performed after a COPD diagnosis for an even more accurate diagnosis.
A full lung function test lasts approximately 45 minutes and is more demanding than spirometry. In particular, it evaluates the diffusion capacity of the lungs, meaning their ability to carry oxygen to the bloodstream and, conversely, to remove another gas, specifically carbon dioxide (CO2), a waste product produced by our bodies.
There is no cure for COPD. However, available treatments are intended to slow down disease progression, prevent complications, reduce symptoms, and improve quality of life.
Smoking cessation is essential in order to slow down the progression of bronchial obstruction and the decline of lung function.
If you want to quit smoking, there are many resources available to help you. The Quebec Lung Association (QLA) offers a number of free smoking cessation services.
You can get support from a respiratory therapist by calling our telephone helpline Monday to Thursday between 8 AM and 5 PM and from 8 AM to noon on Friday.
- 1-888-0768-6669-9, extension 232
- Email: firstname.lastname@example.org
Program Freedom from Smoking
Join the Freedom from Smoking Program through participation in support groups by calling 1-888-768-6669, ext. 222.
Your Guide to Smoking Cessation
A valuable step-by-step guide to help you quit smoking. Download here (french only).
There are also other useful services.
I QUIT NOW (Québec MSSS)
- Call 1-866-527-7383 or visit the Web site.
Quit Smoking Centres (QSC)
- Contact your local CLSC.
The medications used for the treatment of COPD are aimed at maximizing lung function, reducing shortness of breath, and improving exercise tolerance. A number of prescription medications are available, as well as the devices used to take them.
Your doctor is the ideal health professional to decide on the best treatment for you. It is essential that you discuss with your doctor any problems you have using the drug delivery device prescribed for you. Your administration technique will have a direct impact on the drug’s effectiveness. The three main categories of drugs used to treat COPD are listed below:
- Medications used to manage exacerbations or flare-ups (when your condition deteriorates and symptoms worsen)
Bronchodilators are the foundation treatment in COPD because they open the airways and prevent or reduce shortness of breath, especially during exertion. There are three bronchodilator classes.
Bronchodilators work according to the so-called “lock and key” principle, whereby each drug class is like a key that works to open a lock. In this analogy, the lock is a specific receptor. Lastly, within each of these classes, there are medications that have a short duration of action (4 to 6 hours) and others that have a long duration of action (approximately 12 to 24 hours).
Beta2-agonists (also called beta2-adrenergics)
Short-acting: These drugs are considered “rescue medications” and must be kept with you at all times. They work by quickly opening the airways (within 15 minutes). In some cases, the doctor may recommend that they be taken regularly.
- Ventolin® metered-dose inhaler
- Ventolin® Diskus®
- Bricanyl® Turbuhaler®
Long-acting: These drugs are indicated for the maintenance treatment of COPD and are taken regularly. They reduce shortness of breath, flare-ups and, generally speaking, improve quality of life. The effect on the airways lasts between 12 and 24 hours. Their onset of action is, however, slower than that of the short-acting beta2-agonists. Therefore, the following medications should not be used to manage an acute episode.
- Onbrez® Breezhaler®
- Serevent® Diskus®
- Oxeze® Turbuhaler®
Short-acting: Short-acting medications in this drug class are usually taken on a regular basis, namely several times a day every day. They work by opening the airways quickly (within 15 minutes) and, as a result, reduce shortness of breath. In some instances, the doctor may recommend that an anticholinergic be taken on an “as-need” basis.
- Atrovent® metered-dose inhaler
Long-acting: Long-acting medications in this drug class are indicated for the maintenance treatment of COPD and are taken regularly. They reduce shortness of breath, flare-ups and, generally speaking, improve quality of life. The effect on the airways lasts between 12 and 24 hours. Their onset of action is, however, slower than that of the short-acting anticholinergics. Therefore, the following medications should not be used to manage an acute episode.
- Seebri® Breezhaler®
- Tudorza® Genuair®
- Incruse® Ellipta®
- Spiriva® Respimat®
- Spiriva® Handihaler
Bronchodilator combination therapies
Short-acting: This therapeutic combination combines a short-acting beta2-adrenergic drug and a short-acting anticholinergic drug. Generally speaking, it is used as rescue medication but can also be used as COPD maintenance treatment.
- Combivent® Respimat®
Long-acting: This therapeutic combination combines a long-acting beta2-adrenergic drug and a long-acting anticholinergic drug. It is part of a COPD maintenance regimen that reduces shortness of breath, wheezing, and flare-ups, thereby improving quality of life. The effect on the airways lasts between 12 and 24 hours. The onset of action is, however, slower than that of the short-acting combination listed above. Therefore, the following combination drugs should not be used to manage an acute episode.
- Ultibro® Breezhaler®
- Duaklir® Genuair®
- Anoro® Ellipta®
- Inspiolto® Respimat®
These types of anti-inflammatories reduce the frequency of flare-ups. Under no circumstances, however, can they be used as the sole treatment in COPD. They must be taken if a bronchodilator is also used.
- Flovent® metered-dose inhaler
- Flovent® Diskus®
- Pulmicort® Turbuhaler®
Medications combining one or more long-acting bronchodilators with a corticosteroid are also available. The combination of these formulations reduces both the handling of medications and risks of forgetting to take them.
- Advair® metered-dose inhaler
- Advair® Diskus®
- Symbicort® Turbuhaler®
- Breo® Ellipta®
- Trelegy® Ellipta®
Phosphodiesterase (PDE) inhibitors
These medications are taken regularly as tablets or a syrup. They reduce inflammation in the lungs and, as result, shortness of breath. Under no circumstances are they to be taken as emergency medication; they must always be prescribed as complementary medication to an inhaled bronchodilator.
Medicines to treat exacerbations
Cortisone, in the form of tablets or syrup, as well as antibiotics, are primarily used to treat flare-ups and are usually part of the patient’s COPD action plan. A prescription for these medications is provided in advance, so when the patient notices a worsening cough or change in sputum colour, they can take this drug to prevent an exacerbation of symptoms. If you have COPD, ask your doctor for an action plan.
Home oxygen therapy is prescribed to increase blood oxygen levels considered to be insufficient in individuals who meet very specific criteria. Your treating physician can provide you with further information.
People with COPD and their loved ones should get a flu shot every fall. Your treating physician may also recommend a pneumococcal vaccine to protect you from pneumonia.
offer a comprehensive management approach that deals with the psychological, social and physical impacts of the disease. Enrolled individuals participate in sessions conducted by an interdisciplinary team of health professionals who provide interventions in various areas (exercise, nutrition, breathing techniques, energy conservation principles, etc.). An exercise program specifically adapted to the physical condition of the COPD patient will strengthen the respiratory muscles and improve quality of life. The, located at QLA offices, offer a comprehensive pulmonary rehabilitation program at no charge.
Other centres also offer similar programs. To learn more about this program or the location of other such programs near you, call 1-888-768-6669, ext. 236.
Not everyone, however, is fortunate enough to have such a centre close to home or the means of transport to get there. Our team has, therefore, developed an training guide (french only) especially for people with respiratory diseases.
Surgical procedures such as lung reduction and lung transplant are only considered in very specific cases. Research advances in the area of chronic lung disease are being made and we hope will soon yield new treatments.
Did you know
The Quebec Lung Association offers direct services to the population. For more information, visit our Patient Resources section.