Chronic Obstructive Pulmonary Disease (COPD) and Emphysema

Chronic obstructive pulmonary disease (COPD) refers to a large group of lung diseases that can interfere with normal breathing, causing breathlessness and a decrease in respiratory functioning. COPD develops when there is an obstruction of airflow because the alveoli, or air sacs, are destroyed, narrowed, collapsed, stretched or overinflated. Damage to the air sacs is irreversible and results in permanent “holes” in the tissues of the lower lungs.

According to the American Lung Association, more than 12 million Americans have COPD, and an additional 12 million may have impaired lung function. It is the third leading cause of death in the U.S. The two most common conditions of COPD are chronic bronchitis and emphysema.

The Lung Center's COPD and Emphysema Program at Brigham and Women’s Hospital (BWH) provides specialized services for COPD, including lung volume reduction surgery and video-assisted thoracic surgery (VATS), a safe and effective alternative to open surgery. In collaboration with pulmonologists, chest radiologists and interventional pulmonologists, thoracic surgeons offer innovative endoscopic therapy for tracheomalacia and other complications of COPD and emphysema.

Risk Factors for COPD and Emphysema

The causes of COPD are not fully understood. It is generally agreed that the most important cause of chronic bronchitis and emphysema is cigarette smoking. Other causes are:

Exposure to air pollution (chemical fumes, dust and other substances), especially when combined with smoking)
A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema, or early onset pulmonary emphysema.

Symptoms of COPD and Emphysema

Emphysema does not develop suddenly, but occurs very gradually. Each individual may experience symptoms differently. The following are the most common symptoms for pulmonary emphysema:

Early symptoms may include:

Shortness of breath
Cough

Other symptoms may include:

Fatigue
Weight loss
Anxiety
Depression
Sleep problems
Heart problems

Diagnosis of COPD and Emphysema

In addition to a complete medical history and physical examination, your care team at The Lung Center may request the following tests:

Pulmonary function test measures how well your lungs are functioning as well as the severity of your lung disease.
Blood tests analyze the amount of carbon dioxide and oxygen in your blood.
Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film or digital media.
Sputum culture, a test performed on the material that is coughed up from the lungs to determine if an infection is present.
Chest CT scan
Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (tiny camera) and surgical instruments into the chest.
VATS uses small incisions without any spreading of the ribs. This minimally invasive approach allows patient to experience less pain and a quicker recovery. As well as being used for diagnosis, lung biopsy via VATS allows the surgeon to remove damaged parts of the lung, providing relief from symptoms. View video-assisted thoracic surgery (VATS).

Treatment for COPD and Emphysema

The goals of COPD treatment programs include helping you return to the highest level of function and independence possible, while improving the overall quality of your physical, emotional and social life. Attaining these goals help people with COPD live more comfortably by improving endurance, providing relief of symptoms, and preventing progression of the disease with minimal side effects.

The Lung Center specialists will work in conjunction with your primary care physician and/or pulmonologist to determine specific treatment for your COPD. Treatment includes:

Quitting smoking, which is the single most important factor for maintaining healthy lungs
Antibiotics for bacterial infections
Bronchodilators, an inhaled medication that relaxes the smooth muscles of the airways and relieves constriction of the bronchi
Other medications, inhaled or taken orally
Vaccinations for pneumonia and influenza (these infections can worsen emphysema symptoms)
Exercise for physical conditioning and improved endurance
Breathing exercises to strengthen lung muscles
Supplemental oxygen (portable)
Nutritional support, since patients may experience malnutrition and weight loss

Surgery

In more severe cases of COPD and emphysema, surgery may be necessary.

Minimally invasive surgery options include:

Lung volume reduction surgery, in which a newer, less-invasive technique using a videoscope or sometimes the endoscope removes the damaged area of the lung allowing for the normal lung to expand and improve breathing.

Transplantation

In the rare situation when COPD and emphysema has severely damaged your lungs, organ transplantation may be necessary. The Brigham and Women’s Hospital Lung Transplant Program, the largest in New England, provides the most innovative and compassionate care to our patients with advanced lung disease. Our program has been the source of several transplant milestones, including the first adult lung transplant in Massachusetts and the first bilateral (double) lung transplant in New England. Thoracic surgeons at the BWH Lung Center evaluate patients for single and double lung transplant.

What You Should Expect

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. In addition, you will receive a thorough diagnostic examination where you will receive a recommendation for a therapy tailored just for you based on your specific diagnosis.

Multidisciplinary Care

COPD and emphysema patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, oncologists, pulmonologists, cardiovascular medicine physicians and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any surgery recommended will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with COPD or emphysema.

Appointments and Locations

Resources

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

The Lung Center