Understanding and Treating COPD

The more you know, the easier it is to control COPD.

From the WebMD Archives

Anyone can have trouble breathing once in a while. But for those who have COPD, debilitating symptoms such as shortness of breath, cough, and poor lung function can seem relentless.

If you have COPD (chronic obstructive pulmonary disease), you need to know that while it can’t be cured, it can be managed. Its symptoms can be controlled. And COPD doesn’t have to keep someone from having a fulfilling and satisfying life.

COPD is a term that describes a group of lung diseases, mainly emphysema and chronic bronchitis, that cause air-flow obstructions.

Everyone experiences a slow decline in lung function after their 20s or 30s, says Neil Schachter, MD, medical director of the Respiratory Care Department at Mount Sinai Center in New York City. “As we age, lung function slowly declines each year.”

But some people, such as those who smoke cigarettes, experience a rapid decline in lung function associated with COPD. Indeed, smoking is a major risk factor for COPD, but it is not the only one. Environmental risk factors include exposure to fumes and irritants, living with air pollution, or living in a dusty environment. And some people can inherit a genetic predisposition for developing COPD.

Recognizing COPD Symptoms

Early detection and medical treatment makes it easier to manage COPD. While early COPD may not cause noticeable symptoms, a doctor’s exam can reveal abnormal breathing and wheezing when a person exhales. Other COPD symptoms may include:

  • an increase or decrease in the amount of mucus or sputum, also called phlegm, that is produced in the lungs and coughed up
  • the presence of blood in the sputum
  • shortness of breath that is persistent -- often described as ‘heaviness’ or ‘air hunger
  • a chronic cough present throughout the day
  • wheezing
  • a general feeling of ill health
  • swelling of the ankles
  • difficulty sleeping
  • using more pillows or sleeping in a chair instead of a bed to avoid shortness of breath
  • unexplained increase or decrease in weight
  • increasing morning headaches, dizzy spells, or restlessness
  • increased fatigue and lack of energy

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Chronic Coughs and COPD

In the beginning, a chronic dry cough may be the only symptom of COPD, and people often don’t even notice it. Or they may ignore a symptom such as feeling breathless or mistakenly attribute it to aging or being out of shape. It’s important to remember that difficulty breathing is not a normal sign of aging. Any unusual shortness of breath should be checked by a doctor.

“Patients will tell me they’re coughing all the time,” says Schachter. “Or they complain that they can’t keep up with their friends or climb stairs.”

As a result of ignoring symptoms, many people with COPD aren’t diagnosed until the disease is advanced. At that point, it’s harder to control the symptoms. But the disease can still be managed, and following an effective treatment plan can help keep the symptoms under control.

Stages of COPD and Lung Function

The stages of COPD are based on the severity of lung function, measured as airway obstruction.

To determine the severity of lung function, doctors use a test called spirometry. You blow into a mouthpiece and tubing that’s attached to a recording device. The test measures your ability to move air in and out of the lungs quickly.

One specific measurement, FEV1, or forced expiratory volume, shows how much air a person can blow out in one second. FEV1 is used to determine how far COPD has progressed. There are four stages of COPD:

Stage 1: Mild. FEV1 is greater than 80%. At this stage, the person with COPD may not even be aware that there is any abnormal lung function.

Stage 2: Moderate. FEV1 is between 79% and 50%. At this stage, the person may have shortness of breath and other respiratory symptoms.

• Stage 3: Severe. FEV1 is between 49% and 30%. At this stage, the person may have a reduced ability to exercise. The person may also have more shortness of breath and frequent exacerbations.

Stage 4: Very Severe. FEV1 is below 30%. At this stage, the person may have life-threatening exacerbations. Some patients have chronic respiratory failure.

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COPD Treatments Can Vary

No matter your stage, the goal of COPD treatment is to:

• relieve symptoms

• improve health and exercise tolerance

• prevent complications and worsening of illness

But people with COPD may need very different treatments based on the severity of their condition, says Richard ZuWallack, MD. ZuWallack is the associate chief of pulmonary and critical care medicine at Saint Francis Hospital and Medical Center in Hartford, Conn.

“One person with COPD may be asymptomatic and might just need a smoking cessation program,” ZuWallack says. “Then another person with COPD could have more moderate symptoms and need rehabilitation and psychopharmacology.”

Guidelines for treating COPD are set out in the Global Initiative for Chronic Obstructive Lung Disorder (GOLD).

COPD treatment includes:

  • Smoking cessation. Stopping smoking can help slow the decline in lung function as measured by FEV1.
  • Oxygen therapy. When the lungs cannot function well, inhaled oxygen helps get enough oxygen into the blood to meet the body’s needs.
  • Nutrition. People with COPD often lose weight, which can lead to loss of muscle mass. Underweight people with COPD often have greater difficulty breathing.
  • Bronchodilators. These medications relieve symptoms, improve exercise capacity, and improve airway obstruction. They work by opening up the air passages and making it easier to breathe. There are many different kinds of bronchodilators. Atrovent, for example, is short acting, so it’s used for the immediate relief of symptoms. Spriva, by contrast, is long acting, so it’s used to help keep airways open day to day.
  • Corticosteroids. These drugs, such as prednisone or budesonide, are used to reduce inflammation and to treat symptoms, especially symptoms of an exacerbation. These medications may help slow the progression of the lung symptoms.
  • Vaccines. COPD can flare up and worsen when you get sick, so it’s important to get the flu shot and the pneumonia shot.
  • Surgery. Several surgeries, including lung transplantation, can reduce symptoms and improve a person’s quality of life when medications are not effective.
  • Antibiotics. Antibiotics treat bacterial infections and are used primarily during an exacerbation.

Oxygen therapy has clearly been shown to prolong life, says Schachter. Patients with COPD should not rely solely on a test at the doctor’s office to see if they need oxygen therapy. Be sure to monitor levels at home, especially at night.

“Doctors can check oxygen levels at the office. But because oxygen levels drop during sleep at night, there are home monitors that can record oxygen saturation. This helps doctors see if patients may qualify for oxygen therapies,” Schachter says.

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Rehabilitation Is Beneficial

Rehabilitation therapy also helps people with COPD. Schachter says rehabilitation therapy should include physical activity and exercise training. It also includes education about COPD and diet counseling.

“The physical conditioning is geared to people who have lung disease, and it can improve the patient’s endurance. Even though lung function may not improve, the person with COPD is able to be more physically active,” says Schachter.

Depression and Denial Are Common

As with any chronic illness, depression is a common response to COPD. “Some patients are embarrassed about having COPD, which leads to depression and denial,” says Schachter.”Many feel duped by cigarette companies and feel that they brought the problem [COPD] on themselves.”

Schachter urges patients with COPD who smoked to stop worrying. “Smokers are not self-destructive, lazy, or unmotivated.” People smoke because they are addicted to nicotine, he says. And nicotine in cigarettes is as addictive as heroin or cocaine.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 27, 2010

Sources

SOURCES:

Neil Schachter, MD, professor of pulmonary medicine, medical director of respiratory care department, Mount Sinai Center, New York City.

Richard ZuWallack, MD, associate chief of pulmonary and critical care medicine, Saint Francis Hospital and Medical Center; senior attending physician, Saint Francis; professor of clinical medicine, University of Connecticut School of Medicine.

Smolley, L. and Bruce, D. Breathe Right Now, Norton, 1998.

GOLD: Global Initiative for Chronic Obstructive Lung Disorder.

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