Everything you need to know about COPD

Nearly 16 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), according to the federal Centers for Disease Control and Prevention. There are millions more who have the lung condition but haven’t been diagnosed.

What's COPD and what are the symptoms?

COPD refers to a group of diseases that affect the way air flows in and out of the lungs and make breathing more challenging. With COPD, damage to the air sacs in the lungs (emphysema) and inflammation of the bronchial tubes (chronic bronchitis) can make it difficult for people to get air out of the lungs.

Air becomes trapped inside the lungs, especially during physical activity when breathing frequency increases. This causes “hyperinflation” of the lungs and makes it harder for the diaphragm and other breathing muscles to work correctly, which causes the patient to feel breathless. Because of the damage to the lungs in COPD, oxygen levels can drop during activity, also contributing to the feeling of breathlessness.

Other COPD-related symptoms include excess mucus in the respiratory tract, persistent coughing, frequent respiratory infections and chest tightness. COPD patients are prone to acute exacerbations of the disease. When this occurs, symptoms are more severe and can last for several days, requiring intensive therapy to calm the problem.

People with COPD are also predisposed to other conditions, including heart disease, diabetes and osteoporosis. This may be related to increased inflammation in the lungs, which can contribute to inflammation in other parts of the body. COPD patients may require a portable oxygen tank for daily living and may struggle with anxiety and depression.

There’s no cure for COPD and symptoms often worsen without medical intervention. However, COPD is manageable. At The Ohio State University Wexner Medical Center, we help patients achieve a higher quality of life with advanced treatments, such as prescription medications, pulmonary rehabilitation, lung volume reduction (to decrease hyperinflation) and lung transplantation.

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What are the warnings signs of COPD?

Patients who haven’t yet been diagnosed with COPD may start to feel shortness of breath with exertion or develop a recurring cough that they can’t seem to get over. Patients may also feel more tired than usual and notice more mucus in their respiratory system. If you notice early warning signs like these, make an appointment with your doctor. Like other diseases, early detection can significantly improve health outcomes.

What are the four stages of COPD?

COPD is classified in these four groups:

• Mild
• Moderate
• Severe
• Very severe

To determine where a patient currently is on the scale, we conduct a test called spirometry. The noninvasive evaluation, which takes about 10 minutes, measures how easily oxygen moves in and out of the lungs. More specifically, we measure forced expiratory volume (FEV), meaning how much air the patient can push out of the lungs in 1 second.

We use guidelines set by the Global Initiative for Chronic Obstructive Lung Disease, which are also called the GOLD criteria. Gold 1 is mild, Gold 2 is moderate, Gold 3 is severe and Gold 4 is very severe.

In a mild case, patients can still push out more than 80% of the air in their lungs. In a moderate case, the FEV is between 50% and 80%.

In severe cases, the FEV falls between 30% and 50%. And patients with very severe cases are able to push out less than 30% of the air in their lungs.

What causes COPD?

COPD is a preventable condition predominantly triggered by lifestyle factors. The most common reason a patient develops COPD is a history of smoking tobacco. The American Lung Association estimates that cigarette smoking accounts for as much as 90% of all COPD cases in the United States. The best way to prevent COPD is to not smoke cigarettes. Smoking cessation is also beneficial in slowing the progression of the disease.

Long-term exposure to polluted air, chemical fumes or dust, can also cause COPD. For example, people who work in fields like coal mining and sandblasting are typically exposed to greater amounts of dust compared with other populations. In underdeveloped countries, exposure to indoor wood-burning sources for heating and cooking is also a risk factor.

Genetics and severe early childhood respiratory infections, as well as very premature birth, can contribute to COPD development. The genetic condition alpha-1 antitrypsin deficiency can cause COPD, but as the World Health Organization notes, this condition is rare.

How does COPD differ from asthma?

COPD and asthma patients both struggle to breathe, but they’re very different conditions. Asthma often manifests during childhood, while COPD usually develops in people aged 40 and older.

Both conditions are associated with obstructed airflow. However, the blockage is often fully reversible in asthma patients when treated, but that isn’t the case with COPD. In addition, COPD is often progressive.

Asthma is frequently associated with allergies, while COPD is typically caused by smoking. A patient may also develop asthma because of a genetic predisposition.

In terms of symptoms, COPD patients tend to experience symptoms on a regular basis without an external trigger. Asthma symptoms, on the other hand, are usually produced by something in the environment. An asthma attack could be brought on by exposure to indoor or outdoor allergens, like mold or pollen. Smoking cigarettes doesn’t cause asthma but could aggravate asthma symptoms.

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How is COPD diagnosed?

There are three aspects pulmonologists consider when making a COPD diagnosis.

1. We look for symptoms like shortness of breath with exertion, coughing and excess mucus production.
2. We consider if the patient has a history of smoking as well as other lifestyle risk factors, such as if the patient works in a field that puts them at greater risk for exposure to harmful fumes.
3. We analyze the results of a pulmonary function test that measures the amount of air a person can breathe out for 1 second after taking a deep breath.

How is COPD treated?

At the Ohio State Wexner Medical Center, we often begin COPD treatment with inhaler therapy based on symptoms and frequency of exacerbations. The medication helps to widen the airway and make breathing easier.

Pulmonary rehabilitation is a multidisciplinary program that combines exercise, nutrition and medication to help patients increase strength. The exercise improves the body’s aerobic enzymes and muscle blood flow so that oxygen is used more efficiently. The rehabilitation program increases the body’s exercise tolerance and reduces the sensation of shortness of breath. We’ve found that exercise training is more effective than medication in improving shortness of breath with activity in COPD patients.

During pulmonary rehabilitation, patients learn different breathing techniques to control shortness of breath while exercising, which enables them to become more active. The training empowers patients to become more involved in their own care and helps them develop more confidence. Participating in group sessions also helps build community. Patients learn from each other and benefit from knowing they’re not alone.

Patients with more advanced COPD and low oxygen levels may also benefit from treatment with supplemental oxygen. Supplemental oxygen is most beneficial in patients with low levels of oxygen, even at rest. In certain patients who have elevated carbon dioxide levels, we use a noninvasive ventilation machine, such as BiPAP (bi-level positive airway pressure), during sleep. This can help get air in and out of the lungs and lead to a reduction in carbon dioxide.

There are also advanced options available for patients with severe disease. We perform lung volume reduction surgery to remove the diseased portions of the lungs. Lung reduction can also be performed with the insertion of one-way valves through a bronchoscope. Patients with severe disease who aren’t candidates for lung reduction may benefit from lung transplantation.

Other important health considerations with COPD

The most important thing you can do if you have COPD is to stop smoking. While quitting does not reverse the damage already done to the lungs, it will slow the progression of further deterioration. Many of my patients have had success with smoking cessation programs.

I recommend staying up to date with flu and pneumonia vaccines, as these respiratory illnesses can negatively impact your health. I also advise getting COVID-19 vaccinations and boosters. People with COPD are more at risk for life-threatening complications associated with pneumonia, the flu and COVID-19.