Division of Pulmonary & Critical Care Medicine
As part of the Department of Medicine, our intensivists work closely with other specialists to offer world-class patient care, research programs and education and training opportunities.
Chronic Obstructive Pulmonary Disease (COPD) Care
Comprehensive care and treatment for COPD
Comprehensive COPD Care
If you have COPD, you can receive advanced care at the Center for Chronic Obstructive Pulmonary Disease at Lahey Clinic.
At Lahey, we believe that COPD is a reversible and treatable disease. You get early and ongoing treatment.
Your care team includes experts from many specialties. Your doctors create a comprehensive disease management plan just for you. This approach helps you maintain your health and improve your quality of life.
What is COPD?
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease. COPD affects your breathing and respiratory health.
When you have COPD, airflow out of your lungs is restricted. This makes breathing difficult.
Two closely related lung diseases cause COPD: chronic bronchitis and emphysema. These conditions often occur together. You may feel more symptoms from one condition than the other.
Chronic Bronchitis
Chronic bronchitis occurs when your airway tissue is inflamed, and your lungs produce excess mucus. These symptoms cause a persistent, productive cough. Your cough lasts for several months each year.
Over time, some of your large and small lung airways can narrow. The lining in the airways may become scarred. This makes it hard for you to move air in and out of your lungs so feel shortness of breath.
Emphysema
When you have emphysema, the walls between the tiny air sacs in your lungs lose their ability to stretch. Over time, these walls can weaken and break.
As your lung tissue becomes less elastic, air gets trapped inside the air sacs. This impairs the exchange of oxygen and carbon dioxide.
Your COPD Care Team
COPD affects you and your family, so we make sure your treatment plan addresses everyone’s concerns. Your care team will be accessible and responsive to the needs of you, your patients, family and your primary care givers.
To achieve this, your care team emphasizes:
- Patient and physician education and collaboration
- Advanced COPD therapy
- Ongoing communication with you and your primary care doctor
- Evaluation for bronchoscopic or surgical lung volume reduction
- Participation in clinical trials
More About COPD Care
Causes & Risk Factors
You can get COPD with or without risk factors. The more risk factors you have, the more likely you are to develop COPD.
It’s estimated that more than 12 million Americans are living with COPD but don’t know they have the condition. If you have multiple risk factors for COPD, talk to your doctor about how to reduce your risk.
COPD risk factors include:
Cigarette Smoking
Smoking is the greatest risk factor for COPD. Between 80% and 90% of COPD cases are caused by cigarette smoking. However, not all smokers develop COPD. This suggests your environment or genetic make-up may contribute to the development of COPD. Research shows if you are chronically exposed to second-hand smoke, you are at a higher risk for COPD.
Genetic Factors
COPD usually develops in older people with a long history of cigarette smoking. However, one type of emphysema has a genetic component that can cause COPD to occur in your 30s or 40s. This condition is caused by a hereditary deficiency of a blood component called alpha-1-protease inhibitor (alpha-1-antitrypsin, AAT). AAT deficiency:
- Accounts for 1% to 3% of COPD cases.
- Affects about 70,000 Americans.
- Is more common in people of northern European descent.
If you have close relatives who developed COPD by early middle age, talk to your doctor about your risk. You can take a blood test to see if you have the genetic anomaly for AAT deficiency.
Age
You are more likely to develop COPD as you get older, but this is partly related to the number of years of cigarette smoking.
Medical Conditions
If you had frequent lung infections as a child, you are at higher risk of developing COPD. Multiple infections can cause scarring of lung tissues. This reduces lung elasticity and can lead to COPD.
Gender
COPD more common in men than women. This could be because of a higher rate of smoking among men. The number of COPD-related deaths among women has increased as more women smoke.
Exposure to Pollutants
If you are regularly exposed to certain environmental or occupational pollutants, you are at risk for COPD. Breathing substances like chemicals, dust, gases, ozone, sulfur dioxide or traffic exhaust fumes can increase your risk and worsen symptoms of COPD.
Symptoms & Complications
Your COPD symptoms will be mild at first. As the disease progresses, your symptoms become more severe and debilitating.
Early signs of COPD include:
Cough
A daily cough with clear sputum (mucus) is one of the first signs of COPD. You are likely to notice this during the winter months. Your cough may get worse during a cold or respiratory infection. The mucus may turn yellow or green.
Wheezing
You may hear a prolonged whistling or a rustling sound when you exhale. Wheezing gets worse with a cold or respiratory infection.
Shortness of Breath
As COPD gets worse, you will experience shortness of breath. At first, you may have trouble catching your breath only with physical exertion. As your COPD advances, you may become short of breath after modest activity. When COPD becomes severe, you will feel short of breath even at rest.
Severe Shortness of Breath and Chronic Cough
Even mild activity makes you feel significant shortness of breath. Repeated bouts of coughing with sputum production may become disabling. Nighttime coughing can interfere with your sleep. You may feel a choking sensation when you lay flat. You may purse your lips or lean forward when sitting or standing to breathe more comfortably.
Fatigue and Mental Changes
You are likely to have repeated bouts of coughing. Your advanced condition causes poor oxygen exchange within the lungs. These symptoms cause fatigue, headache and mental changes, such as irritability, anxiety, or difficulty sleeping and concentrating.
Heart Problems
COPD makes your heart work harder. The right side of your heart pumps blood to the lungs. When the heart works harder, its walls grow thicker. This can alter the normal rhythm of your heart. Low oxygen levels in your blood give your skin, nails and lips a bluish tinge. This is called cyanosis.
Fluid Accumulation
The extra strain on your heart’s right side can slow down blood circulation. This condition is right-sided heart failure (cor pulmonale). Reduced circulation can cause large veins and the liver to hold onto fluid. Over time, fluid may leak into the abdomen, legs and ankles. This is called edema (swelling).
Increased Chest Size
COPD destroys the normal lung structure. When this happens, you cannot fully exhale and air gets trapped in your lungs. This leads to hyperinflation. Your chest expands and this “barrel chest” condition becomes permanent.
Increased Risk of Serious Lung Infections
As mucus and fluid accumulate in the lungs, your risk of infection increases. Bacteria and viruses prefer the moist environment. Lung infections during advanced COPD can become serious, causing you more breathing difficulty.
Diagnosing COPD
No existing diagnostic test can detect COPD before irreversible lung damage occurs. However, the earlier you get a diagnosis, the sooner you and your doctor can start treatment to reduce future lung damage.
When you see your doctor, they will:
- Ask about your symptoms.
- Perform a physical exam.
- Review your medical history.
If your doctor suspects you might have COPD, they may order one or more pulmonary function tests.
Treating COPD
There is no cure for COPD. Your treatment focuses on preventing additional lung damage, reducing your symptoms and improving your quality of life.
Disability from COPD can limit your ability to take part in daily activities you enjoy. Comprehensive care from Lahey helps you prevent complications, slow disease progression and live fully.
You and your care team design a treatment plan to optimize your quality of life with COPD.
Smoking Cessation
If you’re a smoker, the first and most important thing you should do is stop smoking. When you no longer smoke, you slow the progress of COPD and you’ll breathe easier. At Lahey, you can get free tobacco cessation counseling. Call us at 781-744-7848 (781-744-QUIT) to schedule an appointment.
Symptom Reduction
Try making these lifestyle changes:
- Avoid or limit exposure to irritants: Do your best to limit exposure to substances that can aggravate your lungs. These irritants can make COPD symptoms worse. Avoid second-hand smoke, dust, fumes and smoke from burning wood, charcoal or crop residue.
- Get daily physical activity: Exercise or be active every day. You can reduce lung function decline and stay strong.
- Get your vaccinations: If you have COPD, get your recommended vaccines. You can reduce your risk of getting infections like the flu, pneumonia and COVID-19.
- Lose weight: Extra weight makes you breathe more to accomplish the same amount of physical activity. Try to maintain a healthy weight.
- Seek treatment early: If you get a chest infection, see your doctor right away. COPD impairs your lungs’ defense mechanisms. This causes infections to last longer.
COPD Medicines, Oxygen and Breathing Devices
When you have COPD, medicines can help reduce breathing difficulties. Your doctor may prescribe certain medicines for a short time to see how well they work for you. This trial period may last from six weeks to three months.
Your doctor will evaluate your breathing at each appointment. Your doctor talks with you about your symptoms and adjusts your medicines as needed.
Medicines for COPD include:
- Short-acting bronchodilators or short-acting muscarinic antagonist agents: These medicines are also called rescue inhalers. They open your airways, relax the muscles that surround your airways and prevent them from constricting. Your doctor may prescribe short-acting medicines alone or with other treatments to provide symptom relief. Examples include albuterol and ipratropium.
- Long-acting bronchodilators or long-acting muscarinic antagonist agents: These long-lasting medicines relax the muscles around your airways. They prevent constriction and keep your airways open. You can take these medicines every day to control your COPD symptoms. Their effects last for at least 12 hours. Examples include salmeterol and tiotropium.
- Inhaled corticosteroids: Inhaled steroids help reduce airway inflammation. Your doctor may prescribe this medicine if you have moderate or severe COPD. Typically, inhaled steroids are used together with a long-acting bronchodilator or a long-acting muscarinic antagonist agent. Examples include fluticasone/salmeterol and budesonide/formoterol.
Your doctor may also recommend other treatments, such as:
- Oxygen therapy: Oxygen therapy can help if you have severe COPD and struggle with shortness of breath. This therapy helps maintain appropriate oxygen levels in the blood. Proper oxygen levels:
- Improve your nighttime sleep.
- Improve your daytime mental alertness.
- Improve your ability to complete activities of daily living.
- Prolong your life.
- Protect your heart and other organs.
- Respiratory therapy devices: Inhalers, nebulizers and oxygen devices can help you breathe better. Follow your doctor’s instructions on how to use your device. If you have questions, ask your care team to show you the right way to use the device.
Pulmonary Rehabilitation
If you take part in pulmonary rehabilitation you get care and support from a full team of experts. Doctors, nurses, respiratory therapists, physical therapists, exercise physiologists and dietitians work together to give you the best care so you learn how to live well with COPD.
Meet the Team
Our COPD specialists provide expert care to optimize your quality of life.
Additional Services
Your lung and respiratory care team coordinates your care with other specialty providers throughout our medical center. This ensures you receive comprehensive, streamlined care.
