People who have COPD can expect increasing breathlessness over time.
At first, this just means being short of breath after strenuous exercise. Later, it means getting out of breath from walking in a hurry, or from going up a flight of stairs. Eventually, someone with COPD has to stop for breath after walking slowly for just a few minutes. In the end, dressing and undressing becomes difficult.
Fortunately, there's a lot that can be done to make it easier to breathe. For smokers, quitting smoking is always the most important step at any stage of COPD. Preventing infections is important, so make sure to be vaccinated for flu and pneumococcal disease. So are drug treatments that make it easier to breathe.
"For those with very advanced COPD, we offer pulmonary rehabilitation," Khurana says. "We focus on improving quality of life, reducing shortness of breath, and increasing exercise tolerance. Pulmonary rehab improves outcomes in COPD."
Exercise always helps. "Even if patients are still independent in daily activities and fully employed, any degree of activity would help," Khurana says. "Making sure breathing muscles are in good condition lets people use their lungs to their fullest capacity to improve shortness of breath."
In the later stages of COPD, when the lungs can't get enough oxygen, proper use of home oxygen makes a big difference.
"We make every effort to educate patients about using home oxygen on a regular basis," Khurana says. "It is one of the interventions that improve survival and longevity."
The Future of COPD
Early diagnosis of COPD has been the exception rather than the rule. As that changes, Kiley says, more and more people with COPD will enter clinical trials.
Kiley says that what's needed right now are small, relatively fast clinical trials to find treatments that work for at least some people with COPD, and to learn why some treatments work for some people and not for others.
"To manage the COPD patient, we are going to have a variety of agents that will hit different disease pathways," he says. "We must then figure out how to combine them to improve lung structure and function."
And in the not-too-distant future, Kiley expects regenerative medicine to provide tools to repair lungs damaged by COPD, which is the No. 3 cause of death in the U.S.
"We are on a pathway that in 10 years will make things very different for the COPD patient," he says. "We hope for novel therapies at a minimum. And at a maximum, would like to say we can regrow lung tissue, repair lung injury, or actually cure COPD. That is a reach, but not totally out of our game plans."