Presented by: Daya Upadhyay, MD
Assistant Professor, Pulmonary and Critical Care Medicine
Stanford University Medical Center
November 3, 2011
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease which blocks the airflow and makes it increasingly difficult to breathe. COPD can cause shortness of breath, coughing, wheezing, excess mucus, chest tightness, and other symptoms.
More than 12 million people are currently diagnosed with COPD, and many more may have the disease and not even know it. In 2000 there were 2.74 million deaths from COPD worldwide, and the numbers continue to grow.
COPD is the fourth leading cause of death in the United States, said Daya Upadhyay, MD, an assistant professor of pulmonary and critical care medicine, who spoke at a presentation sponsored by the Stanford Health Library. “Everyone knows about the first three causes —heart disease, cancer, and stroke—but we need to be aware about the impact of COPD and be more aggressive in treating it. Over the past 40 years, cases of COPD have increased 163 percent while numbers of these other diseases are dropping.”
Most cases of COPD occur from long-term exposure to lung irritants that damage the lungs and airways. Smoking is the most common cause, although many cases stem from secondhand smoke, occupational exposure to chemical fumes or dust, or environmental pollution, such as fireplace smoke. In rare cases, a genetic deficiency can affect the lungs and cause COPD. Recurring respiratory infections also damage the lungs, making some people more susceptible to the disease.
COPD develops slowly, and patients usually have no symptoms at first. Symptoms often worsen over time and can limit the ability to do even routine activities. Because it usually develops slowly, many COPD sufferers do not even realize they have the disease. Some people attribute their shortness of breath to simply getting older and slowing down. But age should not make you short of breath and affect your ability to do basic activities like walking, cooking, or taking a shower, said Dr. Upadhyay.
Symptoms include coughing, spitting, wheezing or noisy breathing, and shortness of breath. Many people suffer from morning headaches and fatigue because of lack of oxygen, and they experience shortness of breath, even at rest. “COPD makes you work very hard just to breathe,” said Dr. Upadhyay.
Emphysema and chronic bronchitis are the two main types of COPD. In emphysema, the walls between air sacs of the lungs are damaged and destroyed, causing the air sacs to become larger, which reduces the amount of gas exchange in the lungs. Dr. Upadhyay refers to these patients as “pink puffers” because they have pink lips. Hyperinflation of the chest causes them to purse their lips as they breathe, which also makes them appear ruddy. These individuals are underweight because they lose muscle mass.
In chronic bronchitis, the lining of the airways is constantly irritated and inflamed, which causes the lining to thicken. Mucus forms in the airways, making it hard to breathe. They are known as “blue bloaters” because of the blue-ish cast of their skin caused by the high levels of carbon dioxide in their blood. They tend to be overweight, with swelling in their arms and legs. Their poor blood oxygenation often points to a poor prognosis.
Diagnosis and Treatment
To diagnose the condition, your doctor will try to determine the source of the problem—whether it’s from smoking, pollution, genetics, or another cause. After chest X-rays, you may need to take a series of lung function tests, such as spirometry to measure how much air you can exhale. You may also receive lung volume measurements to check your lung capacity; an oxygen diffusion measurement, and a six-minute walk to assess your resilience in maintaining sufficient oxygenation.
Based on lung function, COPD is ranked on a FEV1 (forced expiratory volume) scale from mild to severe, and tests are administered annually to track disease progression and to monitor how well treatment is working.
Managing COPD involves a relationship between the patient and caregivers, Dr. Upadhyay said. “Since there is no cure yet for COPD, our goal is to assess the extent of the disease, improve breathing and lung function, and prevent further damage,” she added. “It’s important that you stay aware of your condition and know the triggers in your environment that worsen your breathing. Let us know your needs so we can continue to improve care.”
Depending on the FEV1 level, you may be prescribed a short-acting bronchodilator to open the airways (Proventil, Alupent, Ventolin, Atrovent, Combivent) as well as a long-acting medication (Spiriva, Advair, Severent, Foradil) so you can continue your daily activities. Moderate to severe cases may benefit from inhaled glucocorticosteroids. Flu and pneumonia vaccination shots are highly recommended for everyone.
In some rare and severe cases, lung volume reduction surgery or lung transplantation are important treatment options.
All COPD patients should ask their physician to prescribe a spacer chamber, which improves inhaled medication drug delivery by 80 percent. It is also important to do exercises that can improve your breathing reserve.You may receive pulmonary rehabilitation or breathing exercises to train your muscles and improve overall function. Pulmonary rehabilitation is an essential part of the COPD therapy.
Patients with heavy smoking history may need CT monitoring since they are at very high risk for lung cancer. These patients should be scanned annually to identify early signs of lung cancer.
The most important step in preventing and managing the disease, Dr. Upadhyay said, is education. “Understand how COPD occurs, learn how to take the inhalers properly, and take vaccinations to prevent lung infections. Most importantly, “if you don’t smoke, don’t start. If you smoke, stop. The damage from smoking is progressive, so it’s never too late to quit.”
About the Speaker
Daya Upadhyay, MD, is an assistant professor of pulmonary and critical care medicine, specializing in the diagnosis and management of obstructive airway diseases, such as asthma and COPD, and the early diagnosis of lung cancer. She received a medical doctorate in chest medicine from the University of Bombay; an MD in internal medicine from New York University School of Medicine, where she completed her residency; and from Northwestern University, where she did her fellowship in pulmonary medicine and critical care medicine. She joined Stanford in 2002.
For More Information:
About Dr. Upadhyay
Stanford Chest Clinic
Pulmonary and Critical Care Medicine
Stanford Hospital Lung Disease Services
Lung Volume Reduction Surgery for Emphysema (LVRS)
GOLD: Global Initiative for Obstructive Lung Disease