What are 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.

What are the 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.

What are the 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

How are COPD and emphysema diagnosed?

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).

What are the treatment options 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

What are the surgical treatments available for COPD and emphysema?

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

Minimally invasive surgery options include:

Lung volume reduction, in which a newer, less-invasive technique using a videoscope (that is, lung volume reduction surgery) or sometimes the endoscope (that is, bronchoscopic lung volume reduction using endobronchial valves) removes or deflates a diseased area of the lung, allowing for the remainder of the lung to expand and improve breathing.