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General Information About COPD

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What causes COPD?

By far the most important cause of COPD in the United States and the developed world is personal cigarette smoking.  So, if you smoke cigarettes, quit!  Pipe and cigar smoking can also cause COPD.  Other long-term exposures such as inhaling second-hand smoke (from other smokers), air pollution, and chemical fumes or dust may contribute to the development of COPD.  World-wide, the most common cause of COPD is cooking over wood fires.  An uncommon, inherited, genetic disorder called alpha-1 antitrypsin deficiency can also lead to COPD; this process is sped-up in those who also smoke cigarettes.  One surprising fact is that only a minority of smokers go on and develop COPD, which tells us that there must be other genes in our makeup that predispose to COPD.  However, even if a smoker does not develop COPD, he/she is still highly susceptible to several other lethal diseases resulting from exposure, including lung cancer and heart disease.

What is a COPD exacerbation?

A flare-up of COPD is called an exacerbation.  Some people with COPD rarely have exacerbations while others have several each year.  Most hospitalizations for COPD are for exacerbations.  Most, but not all, COPD exacerbations are triggered by upper respiratory infections such as the common cold or influenza.  A “head cold” settles into a “chest cold.”  The person with COPD develops chest congestion, increased shortness of breath, wheezing and increased cough.  Often the sputum turns darker.  Fatigue often sets in and the person feels miserable.  The COPD exacerbation can last days to weeks, and is a serious event that requires prompt contact with the health care physician for therapy.  This therapy often includes increased bronchodilator therapy, antibiotics, and oral steroid medication such as prednisone. 

How is COPD diagnosed?

The diagnosis of COPD can be tentatively made by a health care professional in an individual at risk for the disease (such as an adult cigarette smoker) who has typical symptoms (cough, sputum production, shortness of breath) and certain findings on physical examination.   However, this diagnosis must be confirmed by breathing tests called spirometry.  Neither you nor your doctor would settle for a diagnosis of hypertension without a direct measurement of your blood pressure.  Similarly, COPD is diagnosed through getting “your numbers” via testing.  Spirometry takes just a few minutes, does not involve blood tests, and is usually covered by insurance.  It provides information on whether or not you have this disease and, if so, how advanced it is.  Remember, just the presence of cough in a cigarette smoker does not necessarily mean that person has COPD.  On the other hand, about 10% of individuals with diagnosed COPD have never been smokers.  So spirometry is essential for the diagnosis. 

How do I prevent COPD?

If you are a smoker, quit.  If you have never been a smoker, do not take up this lethal habit.  If possible, avoid chronic exposures to environmental factors that contribute to the development of COPD, including second hand smoke, fumes, etc.

How do we treat COPD?

The following outlines a general approach to the treatment of COPD:

  1. Smoking cessation.  Smoking cessation reduces the rate of decline of lung function in individuals with COPD, and thereby favorably modifies the course of the disease.  Successfully quitting smoking over time also helps reduce the risk of other diseases such a heart disease and cancer.
  2. Maintain a healthy lifestyle.  Exercise regularly (after having your doctor’s clearance), keep physically active, and eat well.  Avoid other smokers, if possible.
  3. Get your shots.  Influenza vaccination is very important in reducing the rate of flare-ups of COPD.  Influenza in a COPD patient is potentially fatal, and its incidence can be substantially reduced with a vaccination.  The pneumonia vaccination may also provide some benefit.
  4. Get yourself checked out for other problems.  COPD does not like to travel alone. It often is accompanied by other diseases (called co-morbidity), such as heart disease, hypertension, diabetes, vascular disease, thinning of the bones, and depression. 
  5. Bronchodilator medications.  Bronchodilator medications help reduce the narrowing of the bronchial tubes in COPD.  Most bronchodilators are now given as inhaled medications.  Bronchodilators can be classified as: 1) quick-onset, short-acting bronchodilators, usually used for quick relief of increased symptoms, and 2) longer-acting bronchodilators, used as maintenance therapy.  These can be taken twice daily or once-daily, depending on the medication.  There are quite a few types of bronchodilator medications approved for use in COPD.  While this is a good thing, their delivery devices often are considerably different, and sometimes it is difficult to learn to use them correctly.  Therefore, if you are prescribed an inhaled medication, check with the pharmacist, doctor, or other health care provider to make sure you are using it correctly.
    • Pulmonary rehabilitation.   Pulmonary rehabilitation, which is provided by a team of health care professionals, focuses on your specific health problems. Most programs in the US take place 2-3 times per week and last about 6-12 weeks.  Pulmonary rehabilitation consists of exercise training and education.  The education is sometimes called self-management education.  It helps you become a more informed consumer and to work more closely with you health care providers to achieve and maintain your best health status.  The latter includes reduced symptoms such as shortness of breath and fatigue, increased exercise capacity, and an overall improved quality of life.  Ask your health care provider whether you might be a candidate for pulmonary rehabilitation and whether there is a program in your area.
      • Manage COPD exacerbations (flare-ups).  As stated earlier, COPD exacerbations are serious events.  Two ways of reducing their impact are to prevent them as best possible and to treat them early and competently if they do occur.  Prevention strategies include vaccinations, regular exercise, physical activity, and certain medications.  Several medications are now approved to help reduce the frequency of exacerbations.  Ask your healthcare provider about taking them, especially if you are particularly prone to frequent exacerbations.   If you have moderate or severe COPD, you should ask your healthcare provider about a COPD Action Plan.  This provides information of the exacerbation, but specific instructions on what to do if you are developing one.  Some patients have filled prescriptions for antibiotics and steroids (such as prednisone) to start when the exacerbation begins.  This approach to therapy by necessity requires close collaboration with your healthcare provider.
        • Oxygen therapy.  Humans are aerobic organisms that require oxygen for life. In some patients with COPD their oxygen levels have decreased to the level that requires them to take supplemental oxygen.  This generally requires documentation of the low oxygen level before insurance will cover it.  It is a common misconception among COPD patients that low oxygen and the sensation of breathlessness always track together.  However, some individuals can have seriously low oxygen levels and not necessarily have increases in breathlessness.  Also, low oxygen level is only one of several causes of breathlessness in COPD patients.  Breathing through narrowed bronchial tubes, being hyper-inflated with your breathing muscles at a mechanical disadvantage, and being very out of shape are also very common causes of breathlessness, even in individuals with near-normal oxygen levels.

Where can I get more information?
Contact the COPD Foundation at www.copdfoundation.org for more information.

Source:  Richard ZuWallack, MD,  Chair, ATS Assembly on Pulmonary Rehabilitation

Four Facts About COPD

  1. COPD is the third leading cause of death in the U.S.—twelve years earlier than predicted.
    • Every four minutes an individual dies of COPD.
      • COPD kills more women than men each year. In 2006, COPD killed more American women than breast cancer, Alzheimer’s and diabetes.
        • The National Heart, Lung and Blood Institute estimates that 12 million adults have COPD and another 12 million are undiagnosed or developing COPD. COPD cost the U.S. government approximately $42.6 billion in both direct and indirect expenses in 2007. A majority of those expenses are due to hospitalizations, which can be prevented with better diagnosis and management practices.

 (Source:  www.copdfoundation.org )