CONDITIONS

What Is COPD

Chronic obstructive pulmonary disease (COPD) is a generic name for three long-term lung diseases that affect the ability to breathe. The two most common forms of COPD are chronic bronchitis and emphysema, which can occur either as a single disease or together. Chronic asthmatic bronchitis is the third condition under the COPD umbrella. COPD may produce mild symptoms at first, which can become progressively worse. COPD is the third leading cause of death in the U.S., according to the American Lung Association (ALA). In 2010, the latest year for which figures are available, it claimed 134,676 lives. Women are twice as likely as men to be diagnosed with chronic bronchitis. And although men have historically been diagnosed with emphysema at a greater rate than women, the rate of diagnosis for women surpassed that of men in 2011 (2.6 million for men vs. 2.1 million for women).

What Causes COPD

COPD is caused primarily by exposure to substances that obstruct and irritate the lungs. These irritants damage the cilia – the hair-like structures that help move mucus out of the lungs – and cause airways to become narrow or blocked. Over time, the lungs may also lose their elasticity, making it more difficult to take in enough air or exhale completely when you breathe.

The most common cause of COPD is smoking. According to the COPD Foundation, about 90% of COPD sufferers are current or past smokers. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked, the American Lung Association says. Male smokers are nearly 12 times as likely to die from COPD as men who have never smoked. Other causes of COPD include exposure to air pollution, secondhand smoke and chemical or fuel fumes.

Risk Factors For COPD

The risk factors for COPD include:

  • Smoking. Your risk increases depending on the number of years you smoke and the amount of tobacco you use. Pipe and cigar smokers have a lower risk than cigarette smokers. Smoking both cigarettes and marijuana increases your risk more than smoking only cigarettes or only marijuana.
  • Asthma. Although the two diseases are not related, asthma patients may be at higher risk for COPD than people without asthma.
  • Family history. Some research suggests that there is a genetic component to COPD. People with a rare inheritable disorder called alpha-1 antitrypsin deficiency are also at risk. Alpha-1 antitrypsin, in normal amounts, helps maintain the elasticity of the lungs. Patients with alpha-1 antitrypsin deficiency suffer from diminished lung elasticity and are likely to develop COPD.
  • Preterm birth. Babies born prematurely (at 26 weeks or younger) often have underdeveloped lungs and need oxygen therapy to aid their breathing. Researchers have found that this can cause lung damage, which increases the chance of developing COPD as an adult.
  • Environmental factors. People who are regularly exposed to lung irritants such as air pollution and secondhand smoke are at greater risk for COPD. Working in a job involving exposure to chemicals or dust can increase your risk, as can using stoves or fireplaces in poorly ventilated homes.

Diagnosing COPD

If you have symptoms of COPD – particularly if you also smoke – your doctor will likely perform one or more of these tests:

  • A full medical history, which will give your doctor a picture of your general health and help pinpoint any risk factors.
  • Lung function tests to determine how well your lungs are working. The most common of these is spirometry, a simple test in which you will be asked to exhale as hard as possible into a tube attached to a measuring device. This shows how much air your lungs can hold and how quickly it goes out. Patients with COPD have limited air capacity and can’t blow out, or exhale, as much air as people with healthy lungs.
  • A chest X-ray. This can help a doctor diagnose emphysema, one of the two most common forms of COPD. A chest X-ray can also help rule out other conditions, such as lung cancer or heart failure.
  • A CT scan. Like a chest X-ray, a scan of your lungs can help your doctor diagnose emphysema and rule out other causes behind your symptoms.
  • Electrocardiogram An EKG uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart, and can rule out potential heart conditions that may be the cause of the COPD symptoms.
  • Echocardiogram, or echo. These tests, in which sound waves are used to produce a video image of your heart, can detect heart conditions that may cause symptoms similar to those of COPD.
  • Blood arterial gas test. This blood test measures the amount of oxygen and carbon dioxide (blood gases) in your blood, which indicates how well your lungs are functioning.
  • Oximetry test. This also measures the oxygen level in your blood. A probe (a device similar to a clothespin) is placed on a finger to obtain a reading. Low oxygen levels could mean decreased lung function and may necessitate oxygen therapy. Oximetry tests are much less invasive; however, they are not as informative as the blood arterial gas test.
  • Other blood and mucus tests as needed to rule out other conditions.

Symptoms of COPD

People with COPD may feel only mild symptoms at first or none at all, so the disease may be ignored or misdiagnosed. Over time, as lung damage worsens, the symptoms become more severe and begin to interfere with daily life. Typically, patients are diagnosed in their 60s.


The most common symptoms of COPD are:

  • Chronic cough (defined by the Mayo Clinic as a cough that occurs at least three months out of the year, for two consecutive years)
  • Productive cough (a cough that produces large amounts of mucus)
  • Shortness of breath that worsens during physical activity
  • A sensation of tightness in the chest
  • Shortness of breath (breathlessness). In the later stages, shortness of breath can make it difficult to perform simple daily activities.
  • Increased fatigue
  • Weight loss (usually in the later stages)

COPD patients may also experience periods of exacerbation (“flare-ups”), when symptoms suddenly become worse. These exacerbations may increase in frequency over time.

Prognosis

There is no cure for COPD, and lung damage cannot be reversed once it occurs. The disease can be fatal, particularly if complications such as heart disease occur. However, treatment and lifestyle changes can help you control your symptoms, prevent exacerbations and live longer.

Living With COPD

Here are some important tips for living with COPD:

  • Stop smoking. This is the first and most important step. Even if you’ve been a heavy smoker for years, quitting will help slow the damage to your lungs and keep your symptoms from getting worse. According to the Cleveland Clinic, after just eight hours after stopping smoking, the oxygen level in your blood increases; within one to eight months, your lungs become more efficient at clearing mucus and fighting infection. If you’re having trouble quitting, talk to your doctor.
  • Reduce your exposure to pollutants. For example, stay indoors on days when the air quality index (AQI) is high. If your job involves exposure to chemicals, fumes, dust or other irritants, wear a mask. Avoid secondhand smoke whenever possible.
  • Get your shots. If you have COPD, it’s important to get a flu shot every year. Also, talk to your doctor about getting the pneumococcal vaccine, which prevents pneumonia. If you had one before age 65, you may need a second booster shot.
  • Exercise. Regular exercise – even just a daily walk – can help reduce the strain on your lungs by keeping your muscles strong. Physical therapy for your arms and shoulders may also help make it easier to breathe.
  • Lose weight. If you are overweight or obese, your lung function, already damaged by COPD, may be impaired still further. Talk to your doctor if losing weight is a problem for you.
  • Maintain an active social life. Staying home because of your condition can make you feel isolated and depressed. Keeping in touch with your family, friends and other loved ones will help you feel less alone. There are also COPD support groups where you can talk to others who understand what you’re going through. The American Lung Association has a national support-group network known as Better Breathers Clubs. Visit the association’s website to find out more. Additionally, the association offers an online support community.

Screening

Early detection is important; the earlier you’re diagnosed, the sooner you can begin treatment and help improve your quality of life. The COPD Foundation recommends spirometry screening for anyone who has a family history of COPD, or who:

  • Has a history of smoking
  • Has had long-term exposure to air pollutants such as secondhand smoke
  • Has a chronic cough, with or without sputum
  • Experiences wheezing
  • Experiences increasingly worsening shortness of breath
  • Has trouble maintaining the normal activity level of persons their age

Prevention

The best way to prevent COPD is to stop smoking – or never to take up smoking in the first place. When you quit, your lungs gradually regain their function, although existing lung damage can’t be reversed.

If you have been diagnosed as having low levels of the protein alpha-1 antitrypsin, getting regular shots of the protein may lower your risk of severe COPD.

Exercising regularly is important as well; a study from the World Health Organization found that people who were physically active five or more times per week had a 29 percent reduced risk for COPD. In addition, a new study suggests that obesity – especially excess belly fat – may be a risk factor for COPD. Women with waist sizes of 43 inches or more, as well as men with waist sizes of 46 inches or more, were 72 percent more likely to develop the disease as those who had smaller midsections.

There are a number of things you can do to avoid an exacerbation (flare-up). Getting an annual flu shot is important; you may also need booster shots for pneumonia and pertussis (whooping cough). Take steps to stay healthy, particularly during cold and flu season: Wash your hands frequently; avoid touching your eyes, nose and mouth; get plenty of rest and drink water frequently to thin the mucus in your lungs.

Medication And Treatment

Although there is no cure for COPD, a variety of medications are available to help control symptoms and help you feel more comfortable. Some COPD medications are taken daily, while others are taken on an as-needed basis.

The following are some of the medications approved by the Food and Drug Administration (FDA) for control of COPD symptoms:

  • Long-acting bronchodilators (Spiriva, Serevent, Foradil, Perforomist and others). These daily, inhaled medications help relax the muscles around the airway and make breathing easier. Common side effects include anxiety, tremors, headache, and increased heart rate.
  • Short-acting bronchodilators (ProAir HFA, Xopenex, Atrovent and others). Also known as rescue inhalers, these medications, which are known as beta 2 agonists, are taken before physical activity or whenever breathing abruptly becomes difficult. Common side effects include dizziness, headache, muscle cramps, nausea, vomiting, nervousness, tremor, heart palpitations, and increased heart rate/blood pressure.
  • Corticosteroids can help slow the progress of COPD in patients who experience frequent exacerbations. They can either be inhaled (Flovent, Pulmicort) or taken in pill form (Medrol, Prelone). Some corticosteroid medications are combined with beta-2 agonists (Symbicort, Advair). All these medicines reduce inflammation. Inhaled corticosteroids are favored for long-term treatment of COPD because they are associated with fewer and less severe side effects than those taken orally. Common side effects for oral corticosteroids include weight gain, loss of muscle mass, mood changes, and high blood pressure. Common side effects for inhaled corticosteroids include sore throat, changes in the voice (hoarseness), and oral thrush.
  • Phosphodiesterase-4 inhibitors (Daliresp) are a new type of medication for people with severe COPD. Like the other medications, phosphodiesterase-4 inhibitors reduce inflammation and relax the muscles around the airways. Common side effects include nausea, loss of appetite, slight weight loss, flu-like symptoms, and dizziness. More serious side effects include rapid/unintended weight loss, tremors, and pain/burning during urination.
  • Theophylline (Accurbron, Elixicon, T-Phyll) is another oral medication used to treat and prevent wheezing and shortness of breath by relaxing the air passages. Side effects include confusion, dizziness, mood changes, weakness, rapid breathing, fainting, vomiting, and seizures.
  • Antibiotics (azithromycin and others) work to kill the bacteria that can cause lung infections and exacerbations. Side effects include nausea, vomiting, hearing changes, vision problems, and liver conditions.
  • Oxygen therapy is used to help deliver oxygen to the lungs, which extends patients’ lives and improves its quality. Depending on need, it can be used as an overnight treatment or delivered continuously through a mask or nose tube. If you use oxygen therapy, be aware that safety measures are essential. There can’t be any open flame – a candle, tobacco, matches – in your environment, and you should avoid using petroleum-based products such as Vaseline. The American Lung Association also recommends that there be at least five feet between the oxygen and sources of heat such as electric or gas stoves and heaters because of combustion hazards. Complications include mucus blockage of windpipe or oxygen tube, infection, and injury to the lining of the windpipe.

Complementary and Alternative Treatment

Although alternative medicine cannot cure COPD, many patients use it as a supplement to their traditional medications. Some complementary therapies include:

  • N-acetylcysteine (NAC). This medicine, derived from the amino acid L-cysteine, is said to help thin mucus and reduce coughing. However, a recent long-term study found that NAC does not reduce flare-ups or reduce decline in lung function.
  • Vitamin D. People with COPD may be deficient in this vitamin for a number of reasons, including age, diet and an indoor lifestyle. Because higher levels of vitamin D have been linked to improved lung function test results, your doctor may recommend vitamin D supplements if your level is low.
  • Ginseng. This herb may help reduce symptoms of COPD. However, ginseng can interact with other medications, so consult your doctor before taking this or any other supplement.
  • Pulmonary rehabilitation. These programs combine gentle exercise with education to help you increase your activity level while learning more about your condition.

When To Contact A Doctor

See a doctor if you:

  • Smoke
  • Have a family history of COPD
  • Experience symptoms such as a chronic long-lasting cough, wheezing or shortness of breath

If you have already been diagnosed with COPD, contact your doctor if:

  • Your medicine doesn’t seem to be working as well as usual
  • Your symptoms are gradually worsening
  • You have a cold with a fever that lasts longer than a day or two, a worsening or lingering cough (longer than 7-10 days) or increased breathlessness

Call your doctor immediately or go to the emergency room if:

  • You cough up blood
  • You experience shortness of breath that quickly gets worse
  • You experience sudden chest pain
  • You have a cough that gets worse, produces large amounts of mucus or if there is a change in the color of the mucus
  • You have a high fever (over 101° F)
  • You notice swelling in your legs or stomach

Questions For A Doctor

Being diagnosed with a serious condition like COPD is frightening, and it can be difficult to know what to ask during your doctor’s appointment.

Here is a list of questions that you might want to ask when discussing your treatment plan:

  • How severe is my condition?
  • What is the prognosis for people in this stage of COPD?
  • What will make my condition worse? How can I avoid these triggers?
  • How often and at what time of day should I take my medication(s)? What side effects might I expect?
  • Can you show me how to use my inhaler? How do I know when it’s getting empty?
  • How will I know if my symptoms are getting worse? When should I go to the ER?
  • What exercises might help keep my muscles strong?
  • Do I need any vaccinations?
  • (For smokers) How can I get help quitting? What can I expect once I stop smoking?