Chronic obstructive pulmonary disease (COPD) is a common lung disease that makes it hard to breathe. Though there’s no cure for COPD–lung damage cannot be reversed–there are many excellent treatments that can improve the quality of life for those who are diagnosed with this condition. Keeping on top of COPD can result in fewer visits to the doctor or urgent care, fewer missed days of work, and more opportunities to enjoy all that is good in life.
What is COPD?
COPD is characterized by persistent respiratory symptoms and limits on the flow of air in and out of the lungs, making it harder to breathe. When a healthy person breathes in and out, the tiny air sacs in the lungs get larger and then smaller, like a balloon, as air easily moves in and out of the lungs. COPD occurs when this delicate lung architecture has been damaged and results in limitations to airflow.
What Are the Causes of COPD?
Smoking is the main cause of COPD, accounting for roughly 90 percent of all cases. Even patients who stopped smoking decades ago are at increased risk of developing COPD later in life. Breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs. The number-one way to lower risk of developing COPD is to quit smoking: Anytime is a great time to quit! And if you don’t smoke, don’t start.
With smoking rates declining across the country, so too are rates of COPD. However, COPD is still among the leading causes of death in the United States, and nearly 16 million Americans reported they have been diagnosed with the illness, according to the U.S. Centers for Disease Control and Prevention. Estimates project that millions more go undiagnosed.
In addition to smoking, long-term exposure to other environmental toxins can lead to COPD. Sometimes people are exposed to substances on their jobs that can put them at increased risk, such as coal dust, pesticides, and smoke from fires.
Since lung damage usually doesn’t cause immediate symptoms, COPD is most commonly diagnosed in people ages 60 and older.
Symptoms of COPD
COPD makes breathing extremely difficult. The most common symptoms of this illness are:
• A long-lasting, chronic cough
• Wheezing
• Increased mucous production
• Shortness of breath that worsens when exercising
• Chest tightness
Those who experience these symptoms should ask their physician for a breathing test. This is especially important for those with a history of smoking or a family history of COPD. The earlier COPD is diagnosed, the faster steps can be taken to prevent further lung damage.
Getting Tested
Testing for COPD is non-invasive, painless, and can be done right in the doctor’s office. The doctor will listen to the patient’s lungs and ask the patient to breathe into a spirometer, an instrument that measures how quickly patients inhale and exhale, as well as how much air patients take into the lungs. This is a lung capacity, pulmonary function test. Your doctor may also recommend lung imaging, such as a chest x-ray, to rule out other conditions.
The physician may also choose to conduct a one-time, Alpha-1 antitrypsin (AAT) blood test to determine levels of AAT, a protein that helps protect the lungs. Low levels of AAT indicate a higher potential to develop lung damage from smoking.
Treating and Managing COPD
Though no treatment can repair lung damage, patients can take steps to prevent COPD from worsening. By proactively treating COPD, patients benefit from improved breathing during calm periods, fewer flare-ups, and fewer visits to urgent care and the emergency room.
Ways to manage COPD include:
• Keeping up with COVID-19, flu, and pneumococcal vaccinations. Getting vaccinated is vital: Vaccines are extremely helpful in protecting patients with COPD from severe disease. According to the CDC, patients with COPD are at increased risk of poor outcomes if infected with COVID-19, which often wreaks havoc on the lungs. Anyone with chronic lung issues should receive not only the initial COVID-19 vaccine series, but a booster shot as well.
Patients with COPD also should be sure to get the annual flu vaccine, as patients with COPD are more likely to develop complications if they get the flu. These complications can lead to hospitalization. The pneumococcal vaccine is also highly recommended for patients with COPD.
• Discussing medication options with your doctor. Most patients with COPD take prescription medications, such as bronchodilators, inhaled steroids, and occasionally oral steroids. Inhalers, for example, help air move in and out of the lungs. Some are used every day, and others can be used as needed when symptoms are particularly aggravated. Patients tend to well-tolerate inhalers and do not become dependent.
• Using supplemental oxygen, if needed. Often, patients are concerned that once they start using supplemental oxygen, they will be on it for the rest of their lives. This often is not the case.
• Enrolling in a pulmonary rehabilitation program. These programs help patients learn how to adopt a healthier lifestyle and manage COPD. Patients get counseling on how to breathe easier, eat well, manage stress, and exercise.
• Exercising. Exercise may seem scary to those with COPD, but regular, moderate exercise can help alleviate symptoms. A pulmonary rehabilitation program can offer advice about how to get started. One tip: Go to a large store, grab a shopping cart to lean on, and walk around the store.
• Creating an action plan with your doctor. An action plan details different COPD symptoms and the type of medication the patient should take when experiencing that symptom.
In addition to outlining how to tackle day-to-day symptoms, the action plan should address how to best handle possible flare-ups or COPD exacerbations. Flare-ups, which can be mild or life threatening, are the onset of worsening symptoms and can become more common as COPD progresses. Emergency medications may help alleviate symptoms.
Exacerbations usually don’t occur suddenly but instead develop over the course of hours or days. If after a few hours, symptoms don’t improve, reach out to your primary care physician or pulmonologist. If addressed early, many patients can avoid urgent care or the emergency room.
Patients with COPD should call their primary care physician or pulmonologist if symptoms don’t improve after a few hours. For example, patients should call their doctor for a worsening cough, increased wheezing, shortness of breath, or a fever, which can be a sign of infection. If the exacerbation feels different from previous flare ups, call your physician.
Patients with significant breathing trouble, chest pain, blue fingers or lips, are coughing up blood, or are sweating excessively should call 911 or go to the emergency room.
Though a COPD diagnosis can be scary and life changing, I encourage patients to take some comfort in knowing that COPD is treatable. By working with a physician on the right management plan, getting vaccinated against diseases that hurt the lung, quitting smoking, and joining a pulmonary rehabilitation program, patients with COPD can control their symptoms, feel better, and prevent disease progression.
Andrew Schissler, MD, is a board-certified pulmonologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Gaithersburg and Largo medical centers.
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