Comprehensive Guide to COPD14 minute read

14 minute read

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Updated for December, 2018

COPD afflicts 16 million Americans, making it the fourth leading cause of death in the United States today, according to the National Heart, Lung, and Blood Institute (NHLBI). To put this in perspective, this is more than the entire population of Alabama, Connecticut, and Indiana combined, per the U.S. Census Bureau 2017 estimates.

Though this number is already a concern, the NHLBI goes on to say that it is actually probably much higher, because it’s suspected that millions of people are walking around daily with this particular health condition without even realizing they have it. That’s why COPD has been elevated to the status of being a major health issue that, consequently, has doubled since 1969.

In 2017, the NHLBI released its COPD National Action Plan, which they call a “blueprint” for patients, caregivers, health professionals, and policymakers. This plan was created so the country as a whole has something to follow to gain a greater hold on this far-too-common medical condition.

The NHLBI’s goal with this plan is to better educate the public and improve the prevention, diagnosis, treatment, and management of this disease. It also hopes that the information provided enables the nation to take steps toward increasing research in this field, developing more comprehensive COPD care, and ultimately reducing the burden of this medical condition on the individuals and families it affects.

But what exactly is COPD and why is it such a major concern?

COPD stands for chronic obstructive pulmonary disease, which the COPD Foundation says is actually an “umbrella term” used to identify three primary progressive lung diseases: emphysema, chronic bronchitis, and refractory (non-reversible) asthma.

Emphysema

The National Emphysema Foundation reports that roughly 3.1 million Americans have been diagnosed with emphysema, a condition that occurs when the walls between the lungs’ air sacs become damaged. This causes them to lose their shape, increase in size, and decrease in numbers, ultimately making it more difficult for the lungs to exchange gases effectively.

Chronic Bronchitis

Approximately 8.9 million people, or 3.7 percent of the population, have been diagnosed with chronic bronchitis in the last year alone, according to the Centers for Disease Control and Prevention (CDC). Healthline adds that, while this is a serious condition in and of itself because it is an inflammation of bronchial tube lining, many people with chronic bronchitis eventually end up developing emphysema.

Refractory Asthma

Research published in the journal Allergy describes refractory asthma as asthma that’s “poorly controlled … despite optimal therapy.” Approximately 17.4 percent of individuals have this type of asthma, according to the American Academy of Allergy, Asthma & Immunology, with an estimated 3.6 percent of adults reportedly having refractory asthma that is categorized as severe.

The main effect of this category of conditions is difficulty breathing, which typically increases over time and leaves those with COPD in constant search of relief. But how do you know if you have this disease?

It’s important to watch for and recognize telltale signs like fast and shallow breathing patterns, shortness of breath, being overly tired or confused, increased mucus production, and experiencing more wheezing than normal.

Individuals with COPD may also have periods of time where their symptoms seem to grow increasingly worse. Healthline explains that this is called COPD exacerbation, sometimes referred to simply as a flare-up. In addition to damaging the lungs, these flare-ups can be deadly. When it’s harder to breathe, the body isn’t able to adequately expel carbon dioxide, and a build-up of this particular gas can ultimately take your life.

That’s why it’s so important to watch for things that can limit your carbon dioxide exhalation. This includes recognizing fast and shallow breathing patterns, shortness of breath, being overly tired or confused, increased mucus production, and experiencing more wheezing than normal. These are all potential signs of an exacerbation and are reason to seek immediate medical care.

While COPD is a physical disease affecting the lungs, research has discovered that this particular condition can affect a person psychologically as well. One study found that individuals with this disease have higher rates of depression and anxiety than those who don’t have this lung-based disease. It even suggests that these rates are higher for those with COPD than for individuals with some other type of chronic disease.

This research also found that female COPD patients tend to be affected the most psychologically. Additionally, if the disease has a higher severity, than the risk of anxiety and depression is higher, too.

Other potential risk factors identified in this study include living alone, being hospitalized with a flare-up, and impaired physical function. All of these can increase the likelihood that someone with COPD can become more depressed or anxious.

In its Pocket Guide to COPD Diagnosis, Management, and Prevention, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) states that COPD is largely preventable because the number-one risk factor leading to the development of this health condition is smoking. Tobacco is the worst for damaging the lungs to this extent, according to GOLD, but smoking marijuana can contribute to COPD formation, too.

That’s not to say that non-smokers can’t get this disease, because they can and do. That’s because there are many other factors that can potentially contribute to the development of this set of lung-based diseases. GOLD calls this a “complex interplay” of a variety of issues, some of which include being exposed to higher levels of:

Indoor Air Pollution

Such as when using biomass fuels for cooking and heating a poorly ventilated home

Outdoor Air Pollution

While this appears to have little effect on the disease directly, exposure to outdoor pollutants can increase the overall burden on the lungs

Occupational Pollutants

This includes being exposed to various dusts, chemical agents, and fumes while on the job

There are more factors that can increase your risk of COPD, some of which you cannot change and/or have little to no control over. Among them are genetics, gender, age, and stunted lung growth (both pre- and post-birth).

Genetics

Sometimes, our genes can increase our susceptibility to this disease. According to a study published in EMBO Molecular Medicine, genetic variants in the alpha-1 antitrypsin (AAT) gene serpin peptidase inhibitor, clade A, member 1 (SERPINA1) can lead to this health condition. Authors also add that many family-based studies (those involving parents, siblings, and children) have found a genetic link to COPD, further proving that genetics can play an important role in whether this disease develops.

Gender

Research has also found that women get COPD at a higher rate than men. One study published in the American Journal of Respiratory and Critical Care Medicine suggests that this may be because men and women’s bodies respond differently to smoke and other pathogens, or that they have different levels of function in regard to the immune system and lungs. Interestingly, this study also points out that despite the fact that women are known to have a higher risk of this disease than men, on average males are correctly diagnosed with this condition by their doctors more often than females.

Age

Research in the Journal of Behavioral Medicine reports that “COPD is commonly diagnosed after the age of 45, and is usually considered a disease of the elderly.” However, for smokers with AAT deficiency specifically, COPD development can occur much earlier, like in the person’s 20s. On the flip side, if few risk factors are present, the condition may not develop until much later, like in their 60s or 70s.

Stunted Lung Growth During Gestation and Early Childhood

In addition to gender, genetics, and age, “insults to the developing lung” during both gestation and in the first few years of life can also contribute to the development of COPD, according to research published in Therapeutic Advances in Respiratory Disease. This includes being exposed to cigarette smoke or other pollutants while in utero (which generally shows up in the form of low birth weight) and/or while very young (often increasing respiratory infection incidents), both of which can diminish a child’s lung function as he or she ages and open the door for COPD later in life.

As of right now, there is no known cure for COPD. However, there is a variety of treatment options that can help patients better manage their symptoms. These include medication-based therapies, pulmonary rehabilitation, oxygen therapy, and, in extreme cases, surgery.

Medication Based Therapies

Different medications can help with managing the disease, according to the American Lung Association, and each serves a different purpose.

The first is a bronchodilator, which is usually administered in the form of an inhaler. A beta2-agonist bronchodilator makes it easier to breathe by relaxing the muscles around the airway so they stay open, whereas an anticholinergic bronchodilator keeps airway-related muscles from getting too tight. Some of these bronchodilators work immediately (short-acting) and others take longer to kick in, but their effects last longer (long-acting).

Another common type of COPD medication is corticosteroids or steroids. These anti-inflammatories help by reducing swelling and decreasing mucus production, and can be taken in either pill or inhaler form. However, they have the potential for creating negative side effects, so they’re usually monitored fairly closely.

Some medications prescribed for this condition are combination meds, which means that they contain both bronchodilators and corticosteroids. These typically come in inhaler or nebulizer form to provide the benefits of both types of medicine.

It’s possible that your doctor will prescribe an antibiotic if you have COPD and develop a bacterial or viral infection,. This helps ease the flare-up that infections like these can create, but it’s also important to take this type of medication as prescribed so that the infection doesn’t come back or develop a resistance and no longer work.

Pulmonary Rehabilitation

COPD can also be treated with pulmonary rehabilitation. The COPD Foundation notes that this program offers “exercise, education, and support to help you learn to breathe and function at the highest level possible.”

Pulmonary rehabilitation teaches effective breathing techniques, how what you eat can impact your COPD, and ways to limit flare-ups or exacerbations. It also covers the mental aspects of this condition, such as how to deal with related depression and anxiety.

Oxygen Therapy

As one of the oldest types of treatment, oxygen therapy “was the first treatment shown to prolong life in people with COPD,” according to research published in the CHEST Journal. And it is still used quite often today to help patients with this disease—more than one million Medicare recipients utilize this therapy.

However, there are some questions as to how much it helps those with more moderate hypoxemia, or lower blood-oxygen levels. So, the CHEST Journal researchers say that more studies need to be conducted in this area to know for sure when and how oxygen therapy helps most.

Surgery

In some cases, surgical intervention may be necessary to help with managing this disease. Medscape says that this option does come with risks, but also that it may be the best course of action if the patient is in end-stage COPD and not responding to other types of medical treatment.

The three types of related surgery are:

Bullectomy

This procedure involves removing the bullae, which are the dilated air spaces in the lungs. As a result, it helps reduce airway resistance and increase the lung’s elastic recoil pressure, and move the diaphragm to a “more efficient position.”

Lung Volume Reduction Surgery

By surgically removing diseased parts of the lung, airflow can be improved (especially when breathing out), blood-oxygen can increase, and the diaphragm can often function more effectively.

Lung Transplant

Emphysema is the number-one diagnosis behind lung transplants worldwide, accounting for 39 percent of these types of surgeries. Medscape shares that this is an option in severe cases. Additionally, patients under the age of 65 are preferred, primarily because those over this age tend to have significant cardiac disease due to their prior smoking habits.

Modern medicine isn’t the only option when it comes to treating COPD. In fact, some patients have found alternative ways to find relief from this particular disease.

Sources:

https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan
https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx
http://www.emphysemafoundation.org/index.php/the-lung/copd-emphysema
https://www.cdc.gov/nchs/fastats/copd.htm
https://onlinelibrary.wiley.com/doi/full/10.1111/all.12412
https://onlinelibrary.wiley.com/doi/full/10.1111/all.12412
https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/symptoms-causes-risk-factors/symptoms.html
https://www.medicinenet.com/copd_chronic_obstructive_pulmonary_disease/article.htm#what_are_the_signs_and_symptoms_of_copd
https://www.healthline.com/health/copd/exacerbation-symptoms-and-warning-signs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255157/
https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf
https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/managing-your-copd-medications.html
https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Pulmonary-Rehabilitation.aspx