Ask Dr. Lo
COPD: Making Breathing Difficult for Millions of Americans
by Dr. Thomas K. Lo
Chronic obstructive pulmonary disease, or COPD, is a progressive disease that refers to a group of diseases that cause airflow blockage and breathing-related problems, to include emphysema and chronic bronchitis. COPD not only affects the 16 million Americans who have this disease, but also the millions more who are undiagnosed.
To understand COPD, it helps to get familiar with how the lungs work. The air you breathe goes down your windpipe into the bronchial tubes or airways in your lungs. The bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli.
Small blood vessels called capillaries run along the walls of the air sacs. When air reaches them, oxygen passes through the air sac walls into the blood in the capillaries. At the same time carbon dioxide (CO2) moves from the capillaries into the air sacs where the lungs expel the CO2.
In COPD, less air flows in and out of the airways. This can be due to the airways and air sacs losing their elastic quality. The walls between many of the air sacs become damaged or thick and inflamed if the airways make more mucus than usual, becoming clogged. As a result, the air sacs lose their shape and become floppy. This damage can lead to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.
Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.
What causes COPD?
Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. This includes secondhand smoke. Up to 75 percent of people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dusts—also may contribute to COPD. People who have a family history of COPD are more likely to develop the disease if they smoke.
A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT), a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants.
Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.
At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include an ongoing cough or a cough that produces a lot of mucus, this is often called smoker’s cough, shortness of breath, especially with physical activity, wheezing, whistling, or squeaky sounds when you breathe and chest tightness.
If you have COPD, you often may have colds or other respiratory infections such as the flu, or influenza.
Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms
If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.
Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion.
When you do visit your doctor, let your doctor know about these symptoms and if you have an ongoing cough; let your doctor know how long you have had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.
The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking.
Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs, weight loss, and low muscle endurance.
Some severe symptoms may require treatment in a hospital. Seek emergency care if you are experiencing a hard time catching your breath or talking, your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood, people around you notice that you are not mentally alert or your heartbeat is very fast.
COPD is a major cause of disability, and it is the fourth leading cause of death in the United States.
COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.
Most of the time, COPD is diagnosed in middle-aged or older adults. COPD has no cure at this time. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
If you do have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above.
Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms.
Prevent COPD Before It Starts
The best way to prevent COPD is to never start smoking or to quit smoking. If you do smoke, talk with your doctor about programs and products that can help you quit.