Recognition for chronic obstructive pulmonary disease (COPD) is long overdue. The disease, which encompasses emphysema and chronic bronchitis, is now the third leading cause of death in developed countries such as the United States. Its incidence is steadily increasing in developing countries like the Philippines. In an era when heart disease and cancer are declining, COPD is on the rise. But patients and physicians alike appear unaware of the gravity of COPD and its consequences. As a result, it is often ignored or under-treated — with disastrous results.
If you needed another reason to stop smoking, this is it. This progressive disease occurs when lung damage — typically caused by smoking — leads to obstruction of your lung’s airways, which may shorten your life. Fortunately, when COPD is detected at a mild to moderate stage — as the majority of cases are — stopping smoking and adopting a healthier lifestyle likely means your symptoms will remain mild and may improve. For more severe COPD, drugs and therapies can be added to greatly improve your ability to breathe and your quality of life.
People who develop COPD may have emphysema, chronic bronchitis, or both. Emphysema destroys the air sacs (alveoli) in the lungs where the exchange of oxygen and carbon dioxide takes place while chronic bronchitis causes congestion and inflammation in the airways or bronchus (see diagram). COPD patients have increasing difficulty expelling air. Many COPD patients also have asthma, which inflames the airways and makes it hard to inhale. Shortness of breath when you exert yourself often is the first symptom of emphysema.
COPD usually begins around age 40 in people who have smoked a pack a day for 10 years. At this age, lung function starts to decline naturally. This misleads some patients into thinking that breathlessness following exertion is a normal sign of aging. Those problems though develop gradually over the years and produce few signs and symptoms in the early stages. If you’re a smoker, a breathing test called spirometry and a chest x-ray can determine if you’re on your way. And don’t dismiss a chronic cough or a change in your breathing as a case of smoker’s cough or as being out of shape. They may be early signs of COPD.
The other symptoms of COPD are regular cough that produces sputum (“smoker’s cough”), wheezing, and tightness in the chest. People’s breaths become very shallow as they try to force a little oxygen into their already full lungs. They move slower to keep from getting out of breath. So much energy is used in attempting to breathe that simple tasks like eating become a chore. Sleeping becomes difficult, and patients begin to sleep sitting up to prevent feeling suffocated.
Slowly worsening lung function can be accelerated by viral and bacterial lung infections. Patients with COPD lose lung function rapidly during exacerbations and may never fully recover.
In the US, 85 percent of the 12 million patients diagnosed with COPD are or have been cigarette smokers. The remaining 15 percent acquire the disease from dust, chemicals, or fumes in the workplace, or the burning of natural fuels, such as coal or wood. A study from China suggests secondhand smoke may trigger COPD in nonsmokers.
Easing Your Breathing
Slowing COPD progression requires eliminating exposure to the cause. For most, this means stopping smoking. If you have mild to moderate COPD, one study found that 11 years after smoking, the risk of developing severe COPD dropped from 18 to three percent.
Strategies that can help mild to moderate COPD include:
• Avoiding respiratory infections. This involves getting the pneumonia vaccine and annual flu vaccinations, and taking basic sanitary precautions such as washing your hands frequently.
• Getting daily exercise. This increases the efficiency of your muscles and circulatory system.
• Using short-acting bronchodilators. These help relax muscles around your airways that can go into spasm, helping to relieve coughing, and making breathing easier.
• Avoiding irritants. In addition to stopping smoking, you’ll need to avoid lung irritants such as secondhand smoke, air pollution, wood smoke, strong odors or dust.
• Maintaining a healthy weight is best. Being too thin may make you frail, while being overweight increases shortness of breath.
Additional therapies for moderate to more severe COPD include:
• Long-acting bronchodilators. Long-acting beta-agonist bronchodilators, including salmeterol (Seretide) and formoterol (Foradil), can improve life span, lung function, and quality of life, and can reduce the risk of life-threatening infections (exacerbations) and hospitalizations. Another class of bronchodilators called long-acting anti-muscarinics, including tiotropium (Spiriva), have a similar effect on symptoms but haven’t been proved to improve longevity. Recently, concern was raised about stroke risk among those taking tiotropium. The US Food and Drug Administration announced a caution for the drug, but it’s not known whether its benefits outweigh this small risk. A major study due to be published soon should answer questions about tiotropium.
• Corticosteroids. For more severe and uncontrolled COPD, a corticosteroid inhaler may be added.
• Supplemental oxygen. If normal breathing doesn’t get enough oxygen into your blood, you may need to use a device that delivers oxygen to your lungs.
Because these therapies are a lot to manage, many people benefit from a comprehensive pulmonary rehabilitation program. If you have advanced emphysema, a procedure in which diseased portions of the lung are surgically removed to allow the remaining lung tissue to work more effectively may be considered.
More Than Just A Lung Disease
The effect of COPD outside the lungs is widely misunderstood. Its systemic nature is so significant that some experts want COPD renamed chronic systemic inflammatory syndrome. Most patients with COPD suffer from other diseases, such as cardiovascular disease, chronic infections, cancer, depression, and muscle wasting. Twenty percent have heart failure, and 70 percent develop osteoporosis due to lack of physical exercise and use of steroid medications.
People with moderate to severe COPD die earlier than their healthy peers, often of an associated disease such as heart disease. Even when patients are not in immediate danger of dying of COPD, quality of life can be affected for many years by repeated hospitalizations and increasing disability.
Now For The Good News
COPD is treatable, even though damage caused by the disease cannot be reversed. The earlier treatment begins, the more effective it is in preserving existing lung function. Effective inhaled anti-inflammatory medications are available, with the choice of the appropriate medication based on a simple, noninvasive test of lung function. Recently, statins have been found to quell inflammatory diseases associated with COPD. Supervised exercise through pulmonary rehabilitation programs and the use of supplemental oxygen can help patients feel better and maintain quality of life.
The most important step is to stop smoking. Quitting halts the progression of the disease and can help keep lung function from worsening. Only 50 percent of smokers develop COPD, which suggests a genetic role in the disease. However, it is impossible to know whether or not you are at risk. If you smoke, have ever smoked, have a morning cough, or are finding it increasingly difficult to accomplish daily activities without getting short of breath, tell your doctor. Appropriate medications and other treatments can help ensure that you live a longer and healthier life.–TYRONE M. REYES, Philippine Star