tag:theconversation.com,2011:/fr/topics/bronchitis-4495/articlesBronchitis – The Conversation2022-09-29T20:05:08Ztag:theconversation.com,2011:article/1904292022-09-29T20:05:08Z2022-09-29T20:05:08ZWhy has my cold dragged on so long? And how do I know when it’s morphed into something more serious?<figure><img src="https://images.theconversation.com/files/483890/original/file-20220912-7256-6grcdr.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6120%2C4076&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-lying-on-bed-while-blowing-her-nose-3807629/">Photo by Andrea Piacquadio/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Common colds are caused by viruses. There are no effective cures, and antibiotics do not work on viruses, so treatment is targeted at managing the symptoms until your immune system has cleared the cold.</p>
<p>So why might someone go to a doctor at all for a cold?</p>
<p>Well, occasionally a cold might turn into something more serious requiring assessment and specific treatment, and a GP visit could be warranted. Or you may just want reassurance and advice.</p>
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<strong>
Read more:
<a href="https://theconversation.com/sore-throats-suck-do-throat-lozenges-help-at-all-184454">Sore throats suck. Do throat lozenges help at all?</a>
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</em>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&rect=0%2C50%2C6709%2C4416&q=45&auto=format&w=1000&fit=clip"><img alt="A woman blows her nose." src="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&rect=0%2C50%2C6709%2C4416&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Occasionally a cold might turn into something more serious requiring assessment and specific treatment.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-blowing-nose-7195040/">Photo by Karolina Grabowska/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Don’t rush to the GP for something totally normal</h2>
<p>Problems arise when there too many unwarranted visits to GPs for cold symptoms.</p>
<p>Studies have shown <a href="https://www.annfammed.org/content/11/1/5">antibiotics</a> are <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja16.01042">still prescribed widely</a> for viral colds, even though they don’t help, and this contributes to antibiotic resistance. It hastens the arrival of an era when many antibiotics simply don’t work at all.</p>
<p>On average, children have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/">four to six colds</a> per year, while in adults the average is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/">two to three</a>.</p>
<p>Some people are more <a href="https://www.sciencedirect.com/science/article/abs/pii/S1530156705601189?via%3Dihub">prone</a> to colds, but we don’t know exactly why.</p>
<p>The usual cold persists about one week, although 25% last two weeks. In one <a href="https://journals.asm.org/doi/10.1128/jcm.35.11.2864-2868.1997">study</a> with 346 adults, the infection lasted 9.5 to 11 days. </p>
<p>Cold symptoms may last longer in younger children. One <a href="https://publications.aap.org/pediatrics/article-abstract/87/2/129/56810/Upper-Respiratory-Tract-Infections-in-Young?redirectedFrom=fulltext">study</a> showed an average duration of colds ranged from 6.6 to 9 days. But symptoms lasted more than 15 days in 6.5% of 1-3 year old children in home care, and 13.1% of 2-3 year old children in day care.</p>
<p>A cough tends to last longer than other symptoms, and often beyond the actual viral infection. The average <a href="https://www.annfammed.org/content/11/1/5">duration</a> of a cough is about 17.8 days.</p>
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<a href="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man coughs into his elbow." src="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A cough tends to last longer than other symptoms.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-sick-man-covering-his-mouth-4031634/">Photo by Edward Jenner/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Discoloured sputum, cough or snot</h2>
<p>Discoloured mucus in snot or cough is a common trigger for requesting antibiotics from a GP. But as we know, antibiotics are useless against a virus. They only work against bacterial infection. </p>
<p>In fact, thick or coloured nasal mucus secretion is common following colds. Only a tiny proportion <a href="https://europepmc.org/article/pmc/pmc7151789">involve</a> bacterial infection.</p>
<p>When it happens, this is termed <a href="https://www.nps.org.au/australian-prescriber/articles/treating-acute-sinusitis-3">acute rhinosinusitis</a>. But antibiotics are not recommended unless it lasts more than ten to 14 days and there are <a href="https://europepmc.org/article/pmc/pmc7151789">signs</a> of bacterial sinusitis infection, such as:</p>
<ul>
<li>symptoms worsening after improvement in the original cold</li>
<li>return of fever and</li>
<li>strong facial pain.</li>
</ul>
<p>A prolonged cough after colds is usually caused by an irritated throat or the clearing of sticky mucus coming down from the nose. The cough may sound moist (so wrongly called “chesty”) due to the phlegm, but only small amounts of phlegm are coughed up. </p>
<p>Yellow or green coloured mucus is often interpreted as a <a href="http://theconversation.com/health-check-what-you-need-to-know-about-mucus-and-phlegm-33192">sign</a> of bacterial infection.</p>
<p>But yellow or green sputum alone <a href="https://www.tandfonline.com/doi/full/10.1080/02813430902759663">does not</a> mean you have a serious bacterial infection. One study found being prescribed antibiotics under these circumstances <a href="https://erj.ersjournals.com/content/38/1/119">failed</a> to shorten recovery time. </p>
<p>Nasal saline sprays and washes can be used to rinse out the nose and sinuses and possibly <a href="https://dtb.bmj.com/content/57/4/56">shorten</a> rhinosinusitis and cough after colds.</p>
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<a href="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A cold can make you feel rubbish for quite a while.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/apartment-bed-carpet-chair-269141/">Photo by Pixabay, via Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Could it just be hayfever, or another underlying issue?</h2>
<p>Hayfever or allergic rhinitis is a common cause for prolonged symptoms after a cold, especially cough and nasal congestion and maybe also sneezing. </p>
<p>The damage in the upper airways following a viral infection may allow airborne allergens to trigger hayfever. Self-medicating with antihistamines, nasal saline spray or intranasal steroids is worthwhile if <a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172">allergic rhinitis</a> is suspected. </p>
<p>There may be other reasons for persistence of cough, such as exacerbation of underlying asthma or chronic lung disease. If so, this may require a visit to your GP.</p>
<h2>What about bronchitis or pneumonia?</h2>
<p>Many people worry about developing a chest infection after a cold. </p>
<p>Acute bronchitis is a self-limiting infectious disease characterised by acute cough with or without sputum but without <a href="https://www.nhs.uk/conditions/pneumonia/">signs of pneumonia</a> (such as high temperatures and feeling breathless). Most acute bronchitis cases are caused by viruses. Antibiotics are often prescribed, but produce <a href="https://www.tandfonline.com/doi/full/10.1080/14787210.2016.1193435">no significant clinical improvement</a> compared with placebo, so are not recommended.</p>
<p>Pneumonia is a potentially serious secondary disease that <a href="https://pubmed.ncbi.nlm.nih.gov/28159155/">may follow</a> an episode of flu in a small number of cases, but is <a href="https://www.ncbi.nlm.nih.gov/books/NBK532961/">relatively rare</a> following a cold. Symptoms and signs of pneumonia feature heavily in the list of warning signs that signal the need for a medical assessment. </p>
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<a href="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man looks at his phone." src="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sometimes, contacting your GP is a good idea.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>When should I seek medical help for a cough or a cold?</h2>
<p>Contact a GP if you experience:</p>
<ul>
<li>shortness of breath or trouble breathing</li>
<li>feeling faint or dizzy</li>
<li>chest pain</li>
<li>dehydration </li>
<li>fever or cough symptoms that improve but then return or worsen</li>
<li>worsening of chronic medical conditions such as asthma.</li>
</ul>
<p>This is not a complete list, but may guide you on what to expect and what to watch out for. </p>
<p>You might also contact your GP (perhaps for a telehealth consult) if you are finding your symptoms very unpleasant, or are concerned your condition is more serious or prolonged than expected. You might just need reassurance and education about self care options.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-nose-spray-good-sex-clears-a-stuffy-nose-just-as-effectively-and-is-a-lot-more-fun-167901">Forget nose spray, good sex clears a stuffy nose just as effectively — and is a lot more fun</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/190429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Problems arise when there are too many unwarranted visits to GPs for cold symptoms. Occasionally, though, a cold might turn into something that needs specific diagnosis and treatment.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/342002014-11-25T10:11:01Z2014-11-25T10:11:01ZHave a cold? Don’t ask your doctor for antibiotics<figure><img src="https://images.theconversation.com/files/64879/original/8k39fftq-1416327409.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People know that antibiotics won't help viruses. So why ask doctors for antibiotics? </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-118647259/stock-photo-sick-woman-flu-woman-caught-cold-sneezing-into-tissue-headache-virus-medicines.html?src=uiU2TSE3nAINC3G6TRpuUA-1-0">Subbotina Anna/Shuttstock</a></span></figcaption></figure><p>Antibiotic resistance is a major threat to public health. Resistance makes it harder for physicians to treat infections and can increase the chance patients will die from an infection. What is more, the treatment of antibiotic-resistant infections poses a huge cost to health-care systems. Patients have to stay in the hospital for longer and doctors have to prescribe newer, more expensive antibiotics. </p>
<p>However, despite campaigns to curb misuse of antibiotics, it continues to be a problem.</p>
<p>For instance, antibiotics are often prescribed to treat bronchitis, sinusitis and pneumonia – all of which can be caused viruses that antibiotics cannot cure. This is because antibiotics work against bacterial infections. </p>
<p>So why are antibiotics being misused in this way? </p>
<p>Patient expectations can drive inappropriate prescribing. <a href="http://www.bmj.com/content/317/7159/637">Studies</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/11833832">show</a> that physicians often write prescriptions based on <a href="http://www.ncbi.nlm.nih.gov/pubmed/17467120">their beliefs</a> about what patients expect, even when the patient does not ask for a prescription directly. A doctor is more likely to write a prescription for an antibiotic if he or she thinks the patient expects one. </p>
<h2>What do patients know about antibiotics?</h2>
<p>Our team <a href="http://mdm.sagepub.com/content/early/2014/10/16/0272989X14553472">surveyed</a> 113 patients in an inner-city emergency department in downtown Baltimore in order to determine their expectations and beliefs regarding antibiotics. </p>
<p>Although attempts have been made to educate patients about the differences between viruses and bacteria, we found that 48% of patients surveyed believe that antibiotics will cure a viral illness. About three-quarters of patients surveyed agreed that they would take antibiotics “just in case” or because “it can’t hurt.” </p>
<p>Current efforts to educate patients about the risks of antibiotic resistance focus on communicating the differences between viruses and bacteria. For example, the US Centers for Disease Control and Prevention (CDC) run a program called “<a href="http://www.cdc.gov/getsmart/antibiotic-use/know-and-do.html">Get Smart</a>,” which advises patients about the symptoms that are typically associated with viral illnesses, and thus do not require antibiotics.</p>
<p>The underlying assumption in many education programs is that when patients ask for antibiotics, it is because they believe that “germs are germs.” They make no distinction, or have little understanding, of the different causes of infection. They view viruses and bacteria as just “germs”. Therefore, because antibiotics work against germs, antibiotics will make them feel better. </p>
<p>However, in our study we found that less than half of the patients we surveyed agreed with the idea that germs are germs, meaning that most patients understand that there is a difference between viruses and bacteria. This means that to efforts to educate patients about the difference between bacteria and viruses do not address the misconceptions that cause many patients to expect antibiotics.</p>
<h2>The gist of germs</h2>
<p>According to <a href="http://mdm.sagepub.com/content/28/6/850.abstract">Fuzzy Trace Theory</a> (FTT), a theory of medical decision-making, patients interpret the decision of whether or not to take antibiotics is based on how they perceive risk. </p>
<p>These perceptions, called “gists,” can be quite independent of the actual risk they face. For example, patients will tend to compare risks with the status quo. For example, if they do not feel well, they can take an antibiotic and possibly get better, or they can do nothing and definitely stay sick. So why not take a risk? </p>
<p>These misconceptions can be two-sided. Patients might believe that antibiotics have some chance of making them better. At the same time they might believe that there is basically no chance of harmful side effects from antibiotics. </p>
<p>We found that more than three-quarters of patients surveyed agreed with the “why not take a risk” gist. Furthermore, patients who knew that antibiotics would not work against viruses (and therefore disagreed with “germs are germs”) still agreed with “why not take a risk” gist. </p>
<h2>Reframing the issue: antibiotics can hurt</h2>
<p>Antibiotics are critical for treating infections, but like any medication, they are most effective when used correctly. When they are overused or misused, antibiotics can be harmful.</p>
<p>Many common antibiotics can have harmful side effects. These can include allergic reactions, and secondary infections, like <em>Clostridium difficile</em>. Secondary infections have been estimated to result in approximately 140,000 emergency department <a href="http://cid.oxfordjournals.org/content/47/6/735.full">visits annually</a>, or approximately one out of every 2,000 antibiotic prescriptions. </p>
<p>Serious side effects have also been documented for some antibiotics. One common antibiotic carries an increased risk of <a href="http://jama.jamanetwork.com/article.aspx?articleid=1148331">retinal detachment</a> and another carries a risk of serious <a href="http://www.cnn.com/2013/03/13/health/fda-antibiotic-heart-warning/">arrhythmia</a>. Antibiotics can also have uncomfortable and costly side effects, such as diarrhea, colitis, reflux, nausea or headache. </p>
<p>Repeated antibiotic use can pose personal resistance-related risks, including hard-to-treat infections, increased time in the hospital and larger medical bills. Antibiotic resistance is also a significant threat to the population. </p>
<h2>Communicating risk</h2>
<p>So what is the right way to communicate the risks of misusing antibiotics? </p>
<p>Our results suggest that physicians and public health officials need to understand how patients understand risk when it comes to using antibiotics. It is important to educate patients about the differences between viruses and bacteria. But, this is not enough. Talking about antibiotic resistance is also not likely to influence individual behavior. Patients must know that antibiotics can hurt, and that when taken in the wrong circumstances, they just won’t do any good.</p><img src="https://counter.theconversation.com/content/34200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eili Klein receives funding from The National Institutes of Health, The National Center for the Study of Preparedness and Catastrophic Event Response (PACER) at the Johns Hopkins University, and The Robert Wood Johnson Founcation. He is also a fellow at the Center for Disease Dynamics, Economics & Policy.</span></em></p><p class="fine-print"><em><span>Valerie Reyna receives funding from the National Institutes of Health and has previously received funding from the National Science Foundation.
</span></em></p><p class="fine-print"><em><span>David Broniatowski does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Antibiotic resistance is a major threat to public health. Resistance makes it harder for physicians to treat infections and can increase the chance patients will die from an infection. What is more, the…David Broniatowski, Assistant professor, School of Engineering and Applied Science, George Washington UniversityEili Klein, Assistant Professor, Johns Hopkins UniversityValerie Reyna, Professor, College of Human Ecology , Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/255392014-06-17T20:45:34Z2014-06-17T20:45:34ZExplainer: what is chronic obstructive pulmonary disease?<figure><img src="https://images.theconversation.com/files/51306/original/93vqmn2b-1402982109.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The toxic effects of cigarette smoke reach far into the lungs.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/27620885@N02/2652259432">Flickr/SOCIALisBETTER</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Almost everyone will know someone with chronic obstructive pulmonary disease (COPD): an incurable disease of the lungs that makes breathing difficult. </p>
<p>Never heard of it? Well, chances are you’ve heard of “smoker’s lung”, emphysema or chronic bronchitis – all of which fall under the umbrella term COPD. </p>
<h2>Causes and prevalence</h2>
<p>According to the World Health Organization, <a href="http://www.who.int/mediacentre/factsheets/fs315/en/">64 million people worldwide have COPD</a>. And while the prevalence varies from country to country, around one in every 13 Australians over the age of 40 have the illness. </p>
<p>COPD essentially develops as a result of long-term exposure to airborne toxins. Across the western world, the main risk factor is exposure to cigarette smoke. However it’s a slightly different story in developing countries, where years of exposure to biomass fuel smoke (wood smoke, for example, from cooking or indoor heating) is an important cause in people who do not smoke cigarettes. </p>
<p>Even so, COPD related to cigarette smoking is projected to increase in the developing world, as smoking rates continue to increase to alarmingly high levels. By the <a href="http://gamapserver.who.int/gho/interactive_charts/tobacco/use/atlas.html">latest estimates</a>, more than 30% of 11- to 15-year-old children smoke in some parts of Africa. </p>
<p>The WHO estimates that, without intervention to cut risks, the total number of COPD deaths will increase by 30% over the next ten years.</p>
<h2>Harmful effects</h2>
<p>The toxic effects of cigarette smoke reach far into the lungs, affecting almost every part of them to varying degrees. </p>
<p>A person with COPD may have inflammation and narrowing of their airways (bronchitis). They may have destruction of the lung’s tiny air sacs, with holes scattered throughout their lungs like Swiss cheese (emphysema). Most likely, they have a combination of both. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=625&fit=crop&dpr=1 754w, https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=625&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/51298/original/5vq77fd6-1402980783.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=625&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-90181153/stock-photo-chronic-obstructive-pulmonary-disease.html?src=7OvYS81TRuY03EdcliSBvw-1-35">Shutterstock</a></span>
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<p>It probably matters little to a person with COPD precisely what pathological processes are brewing inside their chest, since they all contribute to the same debilitating symptom: breathlessness.</p>
<p>The lungs are not the only part of the body affected in this disease. COPD is also associated with disorders of the cardiovascular system, weight loss, muscle wasting and chronic inflammation. </p>
<p>Even in Australia, COPD can occur in people who have never smoked a cigarette in their lives. In these people, the cause may not be quite as apparent. It may be the result of occupational exposures (to dusts or fumes, for instance), or the presence of other lung diseases such as long-standing asthma or tuberculosis (although COPD develops only in a minority of people with these conditions). </p>
<p>Even more elusive is the cause of COPD in people who have no identifiable risk factors at all. <a href="http://www.copdgene.org/copd-genetics">Genes</a> probably play an <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0088051">important role</a> in these cases. </p>
<h2>Therapies</h2>
<p>Despite this dire portrait of COPD, treatments are available. Generally speaking, treatment starts with inhaled medications that open up the airways, known as <a href="http://www.nhs.uk/Conditions/Bronchodilator-drugs/Pages/Introduction.aspx">bronchodilators</a>. Some people require the addition of anti-inflammatory medications such as steroids.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=277&fit=crop&dpr=1 600w, https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=277&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=277&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=348&fit=crop&dpr=1 754w, https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=348&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/51293/original/rwwyrgm5-1402980266.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=348&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Inhaled medications can open the airways.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pewari/5378147442">Pewari</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Clinicians often prescribe non-medical therapies such as pulmonary rehabilitation – a tailored, supervised exercise program for people with lung disease. At the extreme end, some people may be offered a lung transplant, although in Australia this is quite rare. </p>
<p>Obviously, advice and support on smoking cessation is an important part of any treatment plan, and is essential at all stages of the disease.</p>
<p>But most of these therapies have been around for many years. So where are we headed?</p>
<h2>Future treatment</h2>
<p>The future of COPD treatment really is as varied as scientists’ imagination. Most proposed new therapies <a href="http://linkinghub.elsevier.com/retrieve/pii/S1094-5539(14)00066-2">target inflammation</a>. Other research focuses on developing better bronchodilator medications, decreasing the size of each drug molecule to deliver it deeper into the lungs. </p>
<p>A <a href="http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6780584">more novel approach</a> to treating COPD is to design therapies that essentially rebuild the lungs. </p>
<p>The biggest problem in treating COPD is that current treatments cannot replace the missing lung tissue, and this has lead <a href="http://www.ipscell.com/2013/06/stem-cells-for-copd/">some researchers</a> to propose that <a href="http://www.lung.org/finding-cures/research-news/stem-cells-cell-therapies.html">stem cell therapy</a> may be a viable treatment option. As exciting as this may sound, it is likely to be many more years before such therapy makes it into clinical practice. </p>
<p>Despite research into new therapies, when it comes to COPD, prevention is still better than cure. Australia has long been a world leader in tobacco control, an accolade we can be proud of. The hard part will be maintaining momentum and avoiding complacency as smoking rates decline. </p>
<p>Research needs to continue into effective education and control measures, so that COPD might one day be relegated to the history books rather than top of the list of preventable lifestyle diseases.</p><img src="https://counter.theconversation.com/content/25539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Milne receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Brian Oliver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Almost everyone will know someone with chronic obstructive pulmonary disease (COPD): an incurable disease of the lungs that makes breathing difficult. Never heard of it? Well, chances are you’ve heard…Brian Oliver, Doctor of Pharmacology and Research Leader in Respiratory cellular and molecular biology at the Woolcock Institute of Medical Research, University of Technology SydneyStephen Milne, Specialist Respiratory and Sleep Medicine Physician, Woolcock Institute of Medical Research; PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.