Are you at Risk for COPD?

by Alison Brown
July 2009

Maybe you’ve heard of COPD, or maybe you haven’t. But with 12.1 million American adults diagnosed with the disease and further statistics showing many cases go undiagnosed, you probably know someone who is suffering the effects of COPD whether you have heard of it or not.

What is COPD?
Chronic Obstructive Pulmonary Disease, or COPD, refers to chronic lung diseases that obstruct airflow; mainly chronic bronchitis and emphysema. Both conditions cause obstruction of airflow that interferes with normal breathing and frequently exist together, according to the American Lung Association.

Chronic Bronchitis is characterized by limited airflow due to the inflammation and scaring of the bronchial tubes, the tubes that go from the trachea or windpipe to the lungs. Irritation over time due to inflamed or infected bronchial tubes causes the constant production of excessive mucus. This further narrows the passageway for air leading to an irritating cough and scaring of the lungs. This may eventually obstruct airflow and makes the bronchial tubes an ideal place for bacterial and viral infections.

Emphysema is characterized by damage to the tiny air sacs, the alveoli, in the lungs. Alveoli are where oxygen is exchanged for carbon dioxide. When they are destroyed, the lungs transfer less oxygen into the blood stream. The damage is irreversible and leads to permanent holes in the tissue. In addition, lungs lose their elasticity making it difficult to keep the airway open. Both of these effects result in shortness of breath.

What causes COPD?
Smoking is the leading cause of COPD, says Rex Healthcare affiliated pulmonologist Stuart Levin, M.D. Other causes include exposure to second hand smoke and air pollutants, history of childhood respiratory infections, gastroesophageal reflux disorder (GERD), age and genetics, lists the Mayo Clinic. Particulate matter from cigarette smoke and indoor, outdoor and industrial air pollutants causes lung damage when very fine particles produced by pollutants get caught in the lungs. The result is inflammation and impaired immune response. In only five percent or less of COPD cases, a deficiency in the protein alpha-1 antitrypsin (AAT) or alpha-1 protease inhibitor, causes the disease, according to the American Lung Association. Some people lacking AAT never develop COPD, however, in those who smoke, the onset of COPD is earlier in life; between ages 32 and 41 on average.

Who is at risk?
While not the only risk factor, 80-90% of deaths caused by COPD are related to smoking. It is the greatest risk factor for developing and dying from COPD. Any current or former smoker over the age of 40, anyone with a family history of lung disease, anyone exposed to occupational or environmental hazards and anyone who has a chronic cough, sputum production or breathlessness is at risk for COPD. COPD is a progressive disease, so you may notice these symptoms in older friends, relatives or a parent in your care.

How do I know if I have COPD?
COPD is often mistaken for something less serious. Smokers may think they just have a "smoker’s cough" that will go away if they quit. Or, people may think breathlessness is a natural part of aging. Neither of these symptoms is normal nor are they temporary. These are signs of a life threatening illness that may be irreversibly damaging the lungs. Dr. Levin says it is important to be aware of changes. See your physician if you are experiencing chronic cough, increased mucus, frequent clearing of the throat, shortness of breath or limited tolerance for exercise.

COPD is easily diagnosed with a simple pulmonary function test called a spirometry. The test measures how well the lungs exhale by having the patient breath into a mouthpiece. The America Lung Association says your physician may also recommend other tests including a chest x-ray, bronchodilator reversibility testing (shows maximum lung function), arterial blood gas measurement (shows amount of oxygen and carbon dioxide in the blood) and alpha-1 antitrypsin deficiency screening (shows presence of genetic protein deficiency).

What can I do if I suspect I have COPD?
Talk with your physician if you experience any signs of COPD. While lung damage is irreversible, it can be managed and the progression can be slowed. If you smoke, quitting is the most beneficial and least expensive way to improve your quality of life. Medications, surgery, oxygen therapy and pulmonary rehabilitation programs can also minimize complications. In addition, early detection is important, because close follow-up is necessary to maintain health for a COPD patient, says Dr. Levin.

The ability to exercise is critical as physical activity keeps muscles working and may slow the decline of lung function. Pulmonary rehabilitation programs are medically supervised physical activity and education programs that increase a patient’s ability to perform daily tasks and provide the activity needed to slow the decline of lung function. Programs aim to improve quality of life by decreasing respiratory symptoms and complications. Participation leads to less frequent hospitalization and better self management among other benefits. You may need a referral for Pulmonary Rehabilitation programs, so talk with your physician about an accredited program near you.

How do I prevent COPD?
Unlike some diseases, COPD has a clear cause and a clear path of prevention. The vast majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to quit smoking says the Mayo Clinic.

"Don’t smoke. Don’t smoke. Don’t smoke," said Dr. Levin. If you are smoker, this may be easier said than done, but it is the number one way to prevent COPD. Find a smoking cessation program that works for you. Talk with your physician about programs in you area. In North Carolina, we have resources like Quit Now NC!, and right here in the Triangle, we have a great healthcare network that can provide a wealth of smoking cessation resources. You can also visit the American Heart Association and the American Lung Association online for more information and resource guides to help you quit.

Second hand smoke, exposure to indoor, outdoor and industrial air pollutants is another risk factor. If you work with these types of lung irritants, talk to your supervisor about the best ways to protect yourself, such as wearing a mask, suggests the Mayo Clinic. Talk with you physician about what you can do to avoid indoor and outdoor irritants at home.

If you are younger than 60 or do not have any of these risk factors but are experiencing the signs of COPD, talk with your physician about the possibility of an AAT deficiency, suggests Dr. Levin.

COPD was responsible for over 127,000 deaths in 2005 making it the fourth leading cause of death in the United States causing, says the American Lung Association. There is, however, good news about COPD. Unlike many other diseases, we can prevent it. Awareness is the first step to prevention and management of COPD. As Dr. Levin says, awareness is generally limited, because COPD has not received the same kind of attention as other diseases although it is a major cause of mortality. Talk with your physician about your risk, and visit rexhealth.com to take the LungAware online risk assessment and for more information about COPD.

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Resources
American Heart Association - americanheart.org
American Lung Association - lungusa.org
LungAware - rexhealth.com
Mayo Clinic - mayoclinic.com
Quit Now NC! - quitnownc.org
Rex Pulmonary Rehabilitation - rexhealth.com

Alison Brown is the Marketing Coordinator for Rex Healthcare, alison.brown@rexhealth.com.