Chronic lung diseases cause a great deal of inconvenient and distress for sufferers and their families. According to the National Emphysema Foundation, chronic obstructive pulmonary disease (COPD) is a leading cause of disability and mortality in the U.S. About 30 million Americans are affected across all 50 states.
People suffering from COPD lose an average of $1,800 per year of income due to missed work, amounting to a lifetime loss of about $20,000. One-fifth of 45 to 67-year-olds with COPD are forced to go into early retirement, causing them to miss out on benefits and require more reliance on disability payments.
What is COPD?
COPD refers to multiple progressive lung diseases, including emphysema, chronic bronchitis and refractory asthma. This range of chronic inflammatory lung problems causes obstruction in air flow and disrupts the normal way your lungs function.
In healthy lungs, air flows through a network of increasingly narrow passages called bronchial tubes. Small sacs called alveoli at the end of the tubes inflate to allow oxygen to enter the body and carbon dioxide to be transferred out. COPD reduces the natural elasticity of both the tubes and sacs and narrows airways by causing inflammation and increasing the production of mucus.
Risk Factors and Causes
Cigarette smoking is the most common cause of COPD, accounting for about 90 percent of all cases. Between 20 and 30 percent of chronic smokers wind up with clinical COPD symptoms, but there are also many sufferers who have never smoked.
If you are regularly exposed to secondhand smoke, live in a house where cooking fumes are poorly ventilated or work in an environment in which you inhale chemicals, dust or industrial fumes, you’re at a higher risk of developing COPD. Being over the age of 40 also increases your risk, especially if you smoke or have smoked in the past.
About 1 percent of people with COPD have a genetic condition called alpha-1 antitrypsin deficiency (AATD). A lack of alpha-1 antitrypsin protein in the blood leads to problems with white blood cells and subsequent lung damage in babies, children and adults.
Signs and Symptoms
COPD is divided into four stages, measured by force expiratory volume (FEV), or how much force you can use when exhaling. In the first stage, FEV is around 80 percent of what’s normal. By stage IV, FEV drops to 30 percent.
At first, symptoms may be so mild as to be unnoticeable, and not all COPD patients present with the same collection of symptoms.
Early symptoms include:
- Occasional shortness of breath after exertion
- Persistent mild cough
- Excessive clearing of the throat
- Acute discomfort in the chest
- Need to adjust normal activities, such as taking fewer stairs or exercising less
As the disease progresses, you may experience:
- Increased breathlessness after basic activities
- Chronic cough
- Excessive mucus in the lungs
- Wheezing or rattling breath
- Rapid breathing
- Crackling sounds in the lungs when inhaling
- Chest tightness
- Frequent respiratory infections
- Low energy
Late and severe stages of the disease can present with:
- Weight loss
- Swelling in the legs, feet or ankles
- Difficulty breathing or talking
- Confusion or feeling faint
- Racing heart
- Blue or gray fingernails or lips
If you experience any of these symptoms, visit your doctor. COPD can also increase the risk of respiratory infections, heart disease, lung cancer, pulmonary hypotension and depression, so it’s important to get a diagnosis as soon as possible.
Common Treatment Options
To diagnose COPD, your doctor will take a full health history to determine your smoking habits and level of exposure to environmental pollutants. You’ll also be given a chest X-ray or CT scan and tests for oxygen saturation in your blood. Your doctor may refer you to a lung specialist if symptoms require further investigation.
If you’re diagnosed, there are several treatment options available for various stages of COPD:
- Short and long-acting bronchodilators, such as anticholinergics and beta2-agonists, to open and relax tight airways
- Theophylline to improve breathing and prevent flares
- PDE4 inhibitors to prevent flares
- Corticosteroid pills to treat flares
- Corticosteroid inhalers for preventing flares, especially in asthmatic patients
- Methylxanthines for severe COPD
Surgery is used only as a last resort for COPD sufferers who don’t respond to other methods. Part of one or both lungs may be removed in a lung volume reduction procedure, or a bullectomy may be performed to remove enlarged air sacs called bullae. In extreme cases, a lung transplant may be necessary.
Diet and lifestyle modifications are important in managing COPD. Eating right and taking care of yourself improves quality of life and helps reduce the frequency and severity of your symptoms.
- Focus on fresh, nutrient-dense foods with a high fiber content
- Reduce your intake of gas-producing foods
- Avoid dairy to prevent thickening of mucus
- Minimize or eliminate salty and greasy foods
- Increase your intake of healthy calorie-dense foods if you need to gain weight
- Eat slowly
- Divide daily calories between several small meals
- Choose easy-to-prepare foods
- Stop smoking as soon as possible
- Avoid fumes and smoke in daily life
- Work with your doctor to develop a safe exercise plan
- Learn to conserve energy during normal tasks
- Learn breath training techniques to make breathing easier
- Get vaccinated against potential lung infections
- Get adequate sleep each night
- Stay hydrated
- Engage in stress reduction activities
- Vitamin D supplementation if you’re deficient
- N-acetylcysteine (NAC) to improve lung inflation and loosen mucus
- Ginseng for better lung function
- Bromelain and omega-3 fats to fight inflammation
- XCP, an herbal preparation used in traditional Chinese medicine, to control flares
Pulmonary rehabilitation programs include education, dietary guidance and lifestyle changes to help you understand your disease, get started with an exercise program and make good food choices. By working with a network of specialists, you can learn to adopt new habits and make COPD easier to manage.
COPD worsens over time. All COPD sufferers have some reduction in life expectancy, and smokers in the late stages of the disease are most likely to suffer early mortality. Early detection can improve your ability to manage symptoms as you age.
New treatment options are improving outlooks for COPD sufferers. Doctors and researchers are looking for ways to slow the progression of the disease and preserve quality of life. Research is ongoing into new treatment options, including:
- Antioxidant extracts to reverse oxidative stress
- CXCR2 antagonists to block pro-inflammatory proteins
- Selective glucocorticoid receptor modulators
- Better imaging for earlier and more accurate detection
- Proteases to inhibit inflammatory reactions
- New drugs like 5-lioxygenase inhibitors, endothelin antagonists and mucolytics
Broncoscopic lung volume reduction may also be a possibility for those needing advanced intervention. In this operation, doctors insert metal coils into damaged tissue in an effort to preserve elasticity and improve lung function.
Working with a medical team can help you manage your COPD symptoms for the best possible quality of life. Follow the treatment advice you’re given, and don’t be afraid to ask for help with everyday tasks. When you get the support you need, treat your body well and use the right combination of therapies, it’s possible to minimize the progression of your disease and live life with a positive outlook.