Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States, after cardiovascular disease and cancer. The National Institutes of Health (NIH) report that COPD killed 120,000 Americans in 2004 and deaths are on the rise. Half of the 30 million people with the disease don’t even know they have it. They think that their problems are caused by aging or lack of physical fitness. The disease is costly: $50 billion a year in 2010. But the personal cost is incalculable, especially for those who suffer attacks so serious that they must be hospitalized (1).
When to suspect you have COPD
Although symptoms differ, the most common problem is shortness of breath (dyspnea) during and after exercise. People often react by cutting down activities such as walking and eventually doing house chores or getting dressed. Many people notice a persistent cough that isn’t relieved by medications or antibiotics. Although some people just think they are getting older, these are not age-related issues (2). Smoking is the single most important risk factor for developing the disease: Some studies suggest that as many as half of all smokers develop COPD later in life(3).
Why does smoking lead to COPD?
The lungs have an efficient house-keeping system. Hair-like cells (cilia) in the respiratory tract act as sweepers to get rid of particles like cigarette smoke entering the lungs. When those and other substances come in contact with the cells, they are trapped by secreting mucus, which the cilia move upwards so to be eliminated by coughing or swallowing. But after a time the lungs become inflamed as they strain to rid the lungs of intruders, but in the process, the cilia disappear. The lungs then swell and getting air in and out of the lungs’ air sacs (alveoli) becomes more and more difficult. Some segments collapse (atelectasis) making breathing more difficult and even causing infection(4).
Some diagnostic tools for COPD
It’s time to visit your doctor if any of the common symptoms of COPD occur – especially progressive dyspnea, cough with or without sputum, wheezing or chest tightness. Your doctor may initially test arterial blood gases and take a chest X-ray. These will show if your lungs are not exchanging oxygen and carbon dioxide gases properly. If the results are poor, you may undergo a spirometry test (2), which I explain in the following image:
Like the person in the photo, you take a deep breath and blow as hard as you can into a tube connected to a machine (spirometer) that records the volume of air you breath out during the first second and then the following six seconds.The machine produces a graphic, which the physician can use to diagnose the condition or assess its severity.
Why is it important to diagnose COPD early?
The disease has a high prevalence but it may be underdiagnosed. Left undiagnosed and untreated it can COPD progress quickly and severely impairs quality of life. The more severe the disease, the greater risk of mortality(5). The more breathing becomes labored, the more difficult it becomes to keep up with friends and family and the greater the fear of picking up respiratory infections. An early diagnosis means life-saving treatment and, although COPD is incurable, the more significant symptom improvement can be effected so patients can live as normally as possible.
Because COPD is one of the deadliest diseases, it may be so frightening that you are reluctant get diagnosed. But treatments worldwide have eased symptoms for many and research has taught us a great deal about better treatments. We can better control the symptoms and design effective follow-ups so that patients and physicians can improve outcomes and reduce the economic and emotional burden.
- Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clin Outcomes Res CEOR. June 17, 2013; 5:235-45.
- COPD | National Heart, Lung, and Blood Institute (NHLBI) [Internet]. [cited June 1,2018]. Available at: https://www.nhlbi.nih.gov/health-topics/copd
- Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century [Internet]. [cited June 1, 2018]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672326/
- Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison’s Principles of Internal Medicine 19th Edition and Harrison’s Manual of Medicine 19th Edition (EBook)VAL PAK. McGraw Hill Professional; 2017. P.5228.
- Shavelle RM, Paculdo DR, Kush SJ, Mannino DM, Strauss DJ. Life expectancy and years of life lost in chronic obstructive pulmonary disease: Findings from the NHANES III Follow-up Study. Int J Chron Obstruct Pulmon Dis. 2009;4:137-48.
Author: Julieta Madrid, MD – Linkedin