COPD / Emphysema

Chronic obstructive pulmonary disease, or COPD, is the name given to a group of disorders characterized by narrowing of the breathing tubes that limits (obstructs) the movement of air in and out of the lungs. Specific diseases in this group include chronic bronchitis and emphysema. In the older literature and in certain parts of the world, COPD has been called chronic obstructive lung disease (COLD) or chronic obstructive airway disease (COAD), but the term COPD is now preferred.

Chronic Bronchitis is a clinical diagnosis, based on a history of cough and sputum production. Emphysema involves destruction of lung tissue, and can be confirmed by CT scans of the chest. In most cases, COPD is associated with cigarette smoking. The definitive test for COPD is a breathing test, sometimes called a Pulmonary Function Test, a Lung Function Test, or Spirometry.

Although the diagnosis of COPD is not difficult to make, many patients (perhaps the majority) remain undiagnosed. This reflects, in part, the insidious onset of symptoms. The most common symptoms are:

• Shortness of breath
• Cough
• Sputum (phlegm or mucus) production.

Chronic cough and sputum production may occur years before lung function becomes abnormal and are often attributed to smoking – the “smokers cough.” It is important to understand that this is not normal, and any cough that persists more than a few weeks beyond a respiratory illness should probably be investigated.

COPD is often confused with asthma, because some of the symptoms and physical signs are similar. The major difference is that in asthma, most (or in many cases all) of the obstruction to airflow in the bronchial tubes is reversible. In other words, when asthmatic patients are examined or tested in between attacks of their asthma, their lung function is often normal. In contrast, once COPD is established, the lung function is never normal. When patients have flares or “exacerbations” of COPD, they typically get better with administration of medication, but their lung function never normalizes, although it may return to their pre-exacerbation baseline.

Smoking cessation is key, and slows the progressive loss of lung function that is typical of COPD. Medications can improve symptoms and quality of life, improve exercise tolerance, and reduce the frequency and severity of exacerbations. Exercise programs can be very helpful.

UCSF has been designated as a COPD Clinical Research Center by the National Institutes of Health. We are also a site in the NIH's SPIROMICS network. For information about clinical research being conducted by our faculty, click here.