Controlling COPD

You have shortness of breath where each one feels like your last. You wheeze in between breaths where it sounds almost like a whistle. You might have a nasty phlegmy cough to top it all off. You could be wrestling with COPD.

Chronic obstructive pulmonary disease (COPD) is characterized by two lung diseases at the same time: emphysema and chronic bronchitis both of which obstruct airflow and interfere with breathing.

Some symptoms of COPD are persistent shortness of breath (over months or years), wheezing, chronic cough, increased mucus, frequent clearing of the throat, and a decreased tolerance for exercising due to breathing difficulty.

As a result of the chronic bronchitis element of COPD, the lining of the bronchial tubes (through which we breathe) becomes thickened, which produces too much mucus and the tubes and lungs become scarred. The emphysema element of COPD develops more gradually and is the result of years of exposure to cigarette smoke or other air pollutants.

Emphysema destroys the alveoli, or air sacs, in the lungs, which exchange carbon dioxide for oxygen in our blood. Damage to the alveoli is permanent and over time results in less and less oxygen getting into the blood.

Some cases of emphysema are caused by a genetic deficiency (lack of) a certain protein, alpha-1 antitrypsin (AAT), which protects the lungs from neutrophil elastase, which is an enzyme that eats damaged lung cells to promote healing. Without AAT, the enzyme eats healthy lung cells as well, including the alveoli, and causes emphysema.

COPD affects more than 15 million Americans. It is the fourth leading cause of death in the United States. Cigarette smoking is the number one cause of the condition but one in four sufferers of COPD have never smoked. Early detection may be the key to treating COPD effectively.

Risk factors for COPD include being female, over the age of 65; having been exposed to air pollution; having worked with chemicals, dust, or fumes; having AAT deficiency; and having had many respiratory infections during childhood.

The single most important thing you can do to prevent or improve COPD symptoms is to stop smoking. Tobacco smoke irritates the airways, triggering inflammation (irritation and swelling) that narrows the airways. Smoke also damages cilia (the small hair-like structures on the inside of the bronchial tubes) so they can’t do their job of removing mucus and trapped particles from the airways.   

COPD can cause complications such as respiratory infections, heart problems, lung cancer, high blood pressure in the lung arteries, and depression.

To diagnose COPD, your doctor may run certain tests on you including a lung (pulmonary) function tests which measures the amount of air you can exhale and inhale. The most common type of test, a spirometry, you blow into a large tube connected to a small machine to measure how much air your lungs can hold and how fast you can blow air out of your lungs. Other tests include measurement of lung volumes and diffusing capacity, six-minute walk test, and pulse oximetry.

Your doctor may also run a chest X-ray which may show emphysema or to rule out other lung problems or heart failure. A CT scan can help detect emphysema or tell if you may need surgery for COPD or to detect lung cancer. An arterial blood gas analysis measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. And laboratory tests to determine the cause of your symptoms and to rule out other conditions or check if you have conditions such as the genetic disorder alpha-1-antitrypsin deficiency, which may be the cause of COPD in some people.

Treatment for COPD begins with smoking cessation but also includes medication such as bronchodilators, medication that usually comes in inhalers which relax the muscles around the airways. There are short-acting and long-acting bronchodilators. There are other types of medication such as inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors, theophylline, and antibiotics.

Your doctor may use other types of therapies depending on if you have moderate to severe COPD like oxygen therapy, pulmonary rehabilitation program, and in home noninvasive ventilation therapy similar to bilevel positive airway pressure. You may also need to figure out with your doctor how best to manage exacerbations.

Surgery is a choice for those where medication isn’t meeting your needs sufficiently. For example, lung volume reduction surgery is an option where your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in the chest cavity so the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. Endoscopic lung volume reduction is a minimally invasive procedure approved by the U.S. Food and Drug Administration to treat people with COPD.

Lung transplantation is another option for people who meet specific criteria. Transplantation may improve your ability to breathe and to be active. But there are risks with organ rejection and you will need to take lifelong immune-suppressing medications. There is also bullectomy where doctors remove bullae which are large air spaces that form in the lungs when the walls of the air sac (alveoli) are destroyed. Removing bullae from the lungs improves air flow.

Other remedies you can use to improve your condition may be to control your breathing, clear your airways, exercise regularly, eat a healthy diet, avoid smoke and air pollution, and see your doctor regularly. It might be a good idea to get the flu shot and the pneumonia vaccine if you haven’t already.  

It is important that patients with COPD be as healthy as possible to avoid exacerbations. The most common culprit that may trigger a flare-up in symptoms is a respiratory infection, which can be avoided with properly managed COPD. As always, practice self-care habits like getting enough sleep and rest and learning to manage stress in order to avoid symptom flare-ups.