Obstructive Airways Disorder

Obstructive airways disorder affects millions of people worldwide, making it difficult to breathe and limiting daily activities. Understanding this condition and its management can help improve quality of life and reduce serious complications.

Table of contents

• What is obstructive airways disorder?
• Types of conditions included
• Symptoms
• Causes and risk factors
• Diagnosis
• Treatment approaches
• Living with the condition
• Complications

What is obstructive airways disorder?

Obstructive airways disorder, also called obstructive lung disease, is a group of respiratory conditions where the airways become blocked or narrowed, making it hard to breathe. The problem mainly occurs when air cannot move out of the lungs properly^[3][5].

In these conditions, the airways and air sacs in the lungs suffer damage or become inflamed and swollen. This inflammation prevents good airflow into and out of the lungs. Because of damage to the lungs or narrowing of the airways inside the lungs, the exhaled air comes out more slowly than it should. At the end of a full breath out, too much air may remain trapped in the lungs^[5].

Many obstructive diseases result from narrowing of the smaller airways, often because of excessive contraction of the smooth muscle itself. These conditions are generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems breathing out, and frequent medical visits and hospitalizations^[3].

Types of conditions included

Several different lung conditions fall under the category of obstructive airways disorder. The most common include asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and chronic bronchitis^[3][6].

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition caused by damage to the lungs. The damage results in swelling and irritation inside the airways that limit airflow. Emphysema and chronic bronchitis are the two most common types of COPD. These two conditions usually occur together and can vary in severity among people with COPD^[1].

In emphysema, the small air sacs of the lungs, called alveoli, are damaged and enlarged. The damaged alveoli cannot pass enough oxygen into the bloodstream. The most common symptom is shortness of breath^[1][2].

Chronic bronchitis is inflammation of the lining of the tubes that bring air into the lungs. These tubes are called bronchi. The inflammation prevents good airflow and makes extra mucus. Cough is the most common symptom^[1][2].

Asthma is a condition where the airways are extra sensitive and become inflamed. The airways produce excess mucus and the muscles around them tighten, making the airways narrower. Unlike COPD, the airway obstruction in asthma is reversible^[3][6].

Bronchiectasis refers to the abnormal, permanent widening of the airways caused by destructive and inflammatory changes in the airway walls^[3].

Symptoms

The main symptom of obstructive airways disorder is shortness of breath when you exert yourself^[5]. COPD symptoms often do not appear until significant lung damage has occurred. Symptoms usually worsen over time, especially if smoking or other irritating exposure continues^[1].

Common symptoms include trouble catching your breath, especially during physical activities or with mild exertion. Many people experience a cough with mucus that lasts for a long time. Some describe having had a cough for three months or longer at a time for at least two years^[1][2].

Other symptoms include difficulty taking a deep breath, a tight, whistling sound in the lungs called wheezing, and feeling tired. Some people may develop a barrel-shaped chest or bluish skin, a condition called cyanosis, which indicates low oxygen levels^[2][7].

As the condition progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness. COPD symptoms can get worse quickly during periods called flare-ups or exacerbations. These usually last for a few days and often require additional medicine^[7][2].

Causes and risk factors

Obstructive airways disorder is caused by prolonged exposure to harmful particles or gases. Cigarette smoking is the most common cause worldwide and accounts for over 70% of cases in high-income countries^[4][7].

The condition develops when an irritant, such as smoking, causes an inflammatory response in the lungs. This leads to the release of inflammatory substances that can destroy the air sacs and cause a loss of elastic recoil, resulting in airway collapse during exhalation^[4].

Other causes include second-hand smoke, environmental and occupational exposures to chemicals, dust, or fumes, and household air pollution. A rare genetic disorder called alpha-1 antitrypsin deficiency can also lead to lung damage^[4][2][7].

Several factors increase the risk of developing obstructive airways disorder. While smoking is the biggest risk factor, not everyone who smokes will develop it. Women appear to be at higher risk, as are people over the age of 65. Those who have been exposed to toxins in the air, worked with chemicals, dust or fumes, or had many respiratory infections during childhood are also at increased risk^[2].

The condition primarily affects smokers and those greater than age 40. It is currently the third most common cause of death worldwide. In 2021, COPD caused approximately 3.5 million deaths, representing about 5% of all global deaths^[4][7].

Diagnosis

To diagnose obstructive airways disorder, a healthcare provider will perform an exam and ask about your health history. They will ask questions about whether you smoke or have ever smoked, your work environment, and your symptoms^[2].

The provider will do a physical exam that includes listening to your lungs. You may also have several tests to diagnose your condition and measure how well your lungs are working^[1][2].

The most important test is called spirometry. In this test, you breathe out quickly and forcefully through a tube connected to a machine. The machine measures how much air the lungs can hold and how quickly air moves in and out of the lungs. Spirometry can diagnose the condition and show how much airflow is limited^[9].

Other tests may include a lung volume test, which measures the amount of air the lungs hold at different times when breathing. A lung diffusion test shows how well the body moves oxygen and carbon dioxide between the lungs and the blood^[9].

Pulse oximetry is a simple test that uses a small device placed on one of your fingers to measure how much oxygen is in your blood. You may also have a six-minute walking test with a check of your oxygen saturation, or an exercise stress test^[9].

Imaging tests are almost always part of the diagnosis process. These may include chest X-rays or computed tomography scans to look at the structure of your lungs^[5].

Treatment approaches

The damage to the lungs caused by obstructive airways disorder is permanent, but treatment can help slow down the progression of the condition. Although there is currently no cure, treatment can help keep it under control so it does not severely limit daily activities^[8][10].

If you smoke, stopping is the most important thing you can do. It is the most effective way to prevent the condition from getting worse. Although any damage already done to your lungs and airways cannot be reversed, giving up smoking can help prevent further damage. This may be all the treatment needed in the early stages^[8][10].

Bronchodilators are medicines used to open or relax your airways and help you breathe easier. Short-acting bronchodilators ease symptoms and are considered a good first choice for treating stable disease when symptoms come and go. These include medicines called beta-2 agonists and anticholinergics^[10][14].

Long-acting bronchodilators help prevent breathing problems and are used for people whose symptoms do not go away. They need to be used only once or twice a day^[10].

If you are still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups, your doctor may suggest including a steroid inhaler as part of your treatment. Steroid inhalers contain medicines that can help reduce inflammation in your airways. They are normally prescribed as part of a combination inhaler^[10].

Other medicines include tablets or capsules such as theophylline, which is a type of bronchodilator. Mucolytic medicines like carbocisteine can help if you have a persistent cough with lots of thick mucus. These medicines make the mucus in your throat thinner and easier to cough up^[10].

Oxygen therapy boosts the amount of oxygen in your blood and helps you breathe easier. It can help people with very severe disease and low oxygen levels live longer^[14].

Pulmonary rehabilitation is a specialized program of exercise and education. A team of health professionals can provide counseling and teach you how to breathe easier, exercise, and eat well. This program can help you learn to manage your disease and improve your quality of life^[1][10].

Getting vaccinated against influenza every fall and receiving the pneumococcal pneumonia vaccine series as recommended are important preventive measures. Vaccination against COVID-19 should also be kept up to date^[10][21].

Living with the condition

Obstructive airways disorder can affect many aspects of your life, but there are ways to help reduce its impact. Taking good care of yourself is important^[17].

It is essential to take any prescribed medicine, including inhalers, as this can help prevent serious flare-ups. Also read the information leaflet that comes with your medicine about possible interactions with other medicines or supplements^[17].

Exercising regularly can help improve your symptoms and quality of life. The amount of exercise you can do will depend on your individual circumstances. Exercising until you are a little breathless is not dangerous, but do not push yourself too far. It is a good idea to speak to your doctor for advice before starting a new exercise program if your symptoms are severe or you have not exercised in a while^[17][21].

Maintaining a healthy weight is important. Carrying extra weight can make breathlessness worse, so losing weight through a combination of regular exercise and a healthy diet is beneficial if you are overweight. Some people unintentionally lose weight, and for them, eating foods that are high in protein and taking in enough calories is important^[17].

Various breathing techniques can be helpful for breathlessness. These include breathing control, which involves breathing gently using the least effort with the shoulders supported. Other techniques include relaxed, slow, deep breathing, breathing through pursed lips as if whistling, and paced breathing in time with activities like climbing stairs^[17][21].

There are certain things that should be avoided to reduce symptoms and the chances of a flare-up. These include dusty places, fumes such as car exhausts, smoke, air freshener sprays, strong-smelling cleaning products without plenty of ventilation, hairspray, and perfume^[17].

Cold spells and periods of hot weather and humidity can cause breathing problems, so it is a good idea to keep an eye on the weather forecast and make sure you have enough medicine on hand in case your symptoms get temporarily worse^[17].

Complications

Obstructive airways disorder can trap bacteria in your lungs, leading to infections. It can also prevent oxygen from getting into your body and carbon dioxide from getting out. This can lead to serious complications^[2].

People with the condition have a higher risk for other health problems. These include lung infections like the flu or pneumonia, lung cancer, heart problems, weak muscles and brittle bones, and depression and anxiety^[7][2].

Other potential complications include high levels of carbon dioxide in your blood, called hypercapnia, and low levels of oxygen in your blood, called hypoxemia. Respiratory failure can occur in severe cases. Some people may develop pulmonary hypertension, which is high blood pressure in the lungs, or right-sided heart failure, also called cor pulmonale. A collapsed lung, called pneumothorax, and making too many red blood cells, called polycythemia, are also possible complications^[2].

The condition can get progressively worse over time. Flare-ups get more severe and happen more often, though this usually takes years or decades. The outlook varies from person to person, but with proper management, most people can control symptoms and improve their quality of life^[2][8].