Chronic obstructive pulmonary disease is a diagnosis no one wants to get. But according to the American Lung Association, COPD is the third leading cause of death in the U.S., and more than 11 million Americans have been diagnosed with the disease. Millions more may be living with it without a diagnosis. Worldwide, the World Health Organization estimates 65 million people have moderate to severe COPD.
COPD is chronic, progressive lung inflammation that causes obstructed airflow that the COPD Foundation reports “most often occurs in people 40 years of age and older who have a history of smoking.” COPD includes emphysema and chronic bronchitis — you may have one or both of these conditions as part of your COPD diagnosis. The American Lung Association reports that “studies show a direct correlation between severity of asthma as a child and the incidence of COPD.”
[See: 7 Lifestyle Tips to Manage Your Asthma.]
In short, COPD makes it hard to breathe, which makes it hard to do a lot of other things. Symptoms may also include a persistent cough, excess mucus production and wheezing. Dr. Barry Make, a pulmonologist and professor of medicine at National Jewish Health in Denver, says that “COPD is not just one thing,” and it can be tricky to diagnose.
COPD is diagnosed by your doctor by taking a medical history and conducting tests and a physical exam. Your doctor will ask whether you smoke or have a history of smoking, because that’s the leading cause of COPD. The COPD Foundation reports that about 90 percent of COPD patients smoke or were smokers at some point in their lives. The other 10 percent of COPD patients likely developed the condition because of exposure to other environmental factors — such as air pollution or exposure to certain chemicals in the workplace — or a history of asthma or another lung disease.
Because not all smokers develop COPD, genetics are also a likely factor in developing the condition, Make says. “A lot of COPD is genetic related, but it’s not from a single gene. There’s one gene that we’ve known about for a long time that increases your risk,” he says. This gene is related to Alpha-1 antitrypsin deficiency, which means your body does not make enough of a certain protein that protects the lungs and liver. This can lead to the development of emphysema and liver disease, and possibly COPD. Secondhand smoke has also been cited as a risk factor for developing COPD later in life, but Make says this type of exposure “is not nearly as big a risk factor as if you’re smoking yourself.”
When trying to establish a COPD diagnosis, your doctor will conduct a spirometry test by asking you to blow into a tube attached to a small machine that measures the force with which you can blow out. These tests can detect COPD before the usual symptoms develop, and by catching it early, the severity of your case may be reduced. Your doctor may also order chest X-rays or a blood-gas test, which measures the level of oxygen in your blood. This will indicate how well your body removes carbon dioxide from the blood.
Available Treatments
Because COPD is a chronic condition, once you’ve been diagnosed with COPD, you’ll have it for the rest of your life — there is no cure, but there are treatments that can help you manage the symptoms and live a more normal life. Make says some patients believe that, because it’s not curable, there’s no reason to seek treatment for COPD. But he disagrees: “The goals of treatment are to make people feel better, improve general quality of life, reduce symptoms, help you increase your activity level, reduce exacerbations and prevent progression of the disease.” In other words, the disease is treatable, and that treatment begins with reducing exposure to environmental factors.
Quitting Smoking
“One of the big things that we tell people first is to stop smoking. That will prevent progression of the disease and reduce exacerbations,” Make says. These exacerbations can include bouts of pneumonia, influenza and whooping cough, and vaccinations against these diseases can help reduce the chances of contracting them. These simple, relief-providing steps can help straight away before medications are started, he says.
Medications
Inhalers are the primary medications that are currently available to treat COPD, and Make says they can be divided into two classes: long-acting inhalers to help with shortness of breath and short-acting, “rescue” inhalers used on an as-needed basis to decrease shortness of breath.
Short-acting inhalers, as the name implies, typically work within 15 to 20 minutes to help decrease shortness of breath. These are similar to the types of inhalers asthma patients use, and may include the inhaled steroid albuterol. These drugs are helpful to take when you’re exercising or if you’re having a particularly difficult time breathing and need some immediate relief. “Their main role is to reduce exacerbations,” Make says.
Long-acting bronchodilators are used daily to open the airways and keep them open. These medications relax the muscles around your airways, which can reduce shortness of breath and coughing fits, making breathing easier.
[See: 7 Things You Didn’t Know About Lung Cancer.]
Your doctor may also prescribe a combination long-acting bronchodilator and anti-inflammatory medication. The anti-inflammatory medication helps reduce inflammation in the lungs, which can also reduce exacerbations of COPD while the bronchodilator opens up the airways.
Some COPD medications also come in pill form, such as oral steroids that may be taken for a few days to prevent worsening of COPD. According to the Mayo Clinic, taking steroids long-term, however, may bring about serious side effects including weight gain, diabetes, osteoporosis, cataracts and an increased risk of infections.
Additionally, some antibiotics can be helpful in preventing or treating exacerbations, such as pneumonia, acute bronchitis and influenza. The Mayo Clinic reports that antibiotics can treat these exacerbations, “but they aren’t generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn’t clear whether this is due to its antibiotic effect or its anti-inflammatory properties.”
Lung Therapies
The American Lung Association reports that some patients benefit from pulmonary rehabilitation — a combination of exercise training, nutritional advice, education and counseling that can help rebuild lung strength and can lead to regaining a more active lifestyle. Supplemental oxygen is also useful for patients with very severe COPD. It’s considered a lung therapy by the Mayo Clinic, which reports that “oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life.”
Surgery
Some patients with very severe COPD may benefit from surgery. The Mayo Clinic reports that these surgeries could include lung volume reduction surgery, in which the surgeon removes damaged lung tissue from the upper lungs. “This creates extra space in your chest cavity so that the remaining, healthier lung tissue can expand and the diaphragm can work more efficiently.” This surgery has been shown to reduce exacerbations and prolong survival in some patients.
Some other patients may receive a bullectomy, in which large air sacs, called bullae, are removed. In COPD patients, these bullae can enlarge and block airflow, so removing them can ease the flow of air.
A lung transplant may also be beneficial for patients who meet certain criteria, the Mayo Clinic reports. But, because it’s a major surgery with risks and potential complications of its own, it’s not the right choice for every patient.
[See: 16 Ways Your Body Adjusts to a New Climate.]
Bottom line: There are many different treatments available for COPD patients and varying approaches to managing this chronic condition. As with so many other medical concerns, many factors are figured into determining which treatment protocols will be the right ones for your COPD. Be sure to talk with your doctor about the right approach for you.
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