COPD Prognosis

From the WebMD Archives

If you’re one of the 12 million Americans diagnosed with COPD (chronic obstructive pulmonary disease), you’re at a turning point.

Though you're facing a life-threatening lung disease, knowing that you have it means you can start taking action. That puts you ahead of another 12 million Americans who don't yet know they may have COPD.

"We have no cure, no treatments that will stop progression or reverse the condition," says James Kiley, PhD, director of the lung-disease division of the National Institutes of Health. "But we can do better by getting to people early."

Is It Early COPD?

The first symptoms of COPD are frequent coughing and more mucus or phlegm coughed up from the lungs. Your chest may start to feel tight. The coughing begins to disturb your sleep. You may feel tired, and become short of breath when walking up a hill or a flight of stairs.

It's tempting to think of these symptoms as just a part of normal aging. But they may not be.

"If you've smoked, are over 45, get short of breath doing daily activities, or are backing off your exercise regimen because of a little breathlessness at the end -- all those are reasons not just to talk with your primary care provider but maybe to talk to a lung specialist," Kiley says.

COPD diagnosis depends on a test called spirometry. The test measures how much air you can force from the lungs and how fast it blows out.

Early Disease

There is no such thing as an average case of COPD. One person's experience may differ dramatically from another's.

"Most people don't seek medical attention until they are short of breath and unable to do normal activities,” says pulmonologist Sandhya Khurana, MD, of New York’s University of Rochester Medical Center. “By the time this happens, there's been a critical loss of some lung function."

In general, lung function declines slowly but steadily, until there's a sudden worsening of symptoms. That speeds up lung damage.

To monitor someone with COPD, doctors keep tabs on their current symptoms, lung function tests, and other conditions such as heart disease and diabetes that are often also seen in people with COPD.

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Diagnosed early enough, a person with risk factors for COPD might be able to get off the slippery slope of worsening lung function.

"At that point, the most important thing would be to really quit smoking," Khurana says. "And then their other focus would be being up to date on immunizations -- a flu shot and a pneumonia shot. If someone had no symptoms but just these frequent infections and very early signs of decline, that person would not necessarily progress to worsening COPD."

Later Disease

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.

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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."

WebMD Feature Reviewed by Louise Chang, MD on September 12, 2012

Sources

SOURCES:

James Kiley, PhD, director, division of lung disease, National Heart, Lung, and Blood Institute, NIH.

Sandhya Khurana, MD, associate professor of medicine, pulmonary & critical care division, University of Rochester Medical Center, N.Y.

Global Initiative for Chronic Obstructive Lung Disease web site.

COPD Assessment Test web site.

National Heart, Lung, and Blood Institute web site.

American Thoracic Society web site.

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