COPD

 

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is an umbrella term used to describe a series of progressive lung diseases characterized by difficulty breathing. The two primary COPD diseases are:

Emphysema

Emphysema results in damage to tiny air sacs in the lungs where oxygen transfers into the bloodstream. Air may also become trapped in the lungs and hard to breathe out.

Chronic bronchitis

Chronic bronchitis causes the bronchial tubes to become irritated or swollen. This causes excess mucus and coughing that can last up to three months. The bronchial tubes may lose their cilia. Cilia are tiny hairs that move mucus so it can be coughed out.

Who develops COPD?

It’s estimated 24 million Americans have COPD, according to the COPD Foundation. Millions more may be undiagnosed or misdiagnosed with asthma, and not getting proper treatment.

Most COPD patients develop the condition after the age of 40 following years of exposure to something that irritates the lung – for most it’s cigarette smoking, but it could also be long-term exposure to air pollution or workplace fumes.

If you smoke, then it’s critical that you stop. This is the single most important thing you can do to slow the rate of lung function decline, regardless of disease severity. Ask your doctor about smoking cessation programs.

Ask the Allergist: Does Chronic Asthma Lead to COPD?

What are the symptoms of COPD?

  • Increased shortness of breath
  • Frequent coughing (with or without mucus)
  • Increased breathlessness
  • Wheezing
  • Chest tightness
  • Frequent colds
  • Nose and throat infections
  • Fatigue
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What is the treatment for COPD?

Several different types of treatments are used for COPD:

Short-acting bronchodilator (SABA)

A SABA is a quick-relief inhaler that relaxes muscles around the airways, providing immediate relief at the first sign of a flare-up.

Inhaled corticosteroids (ICS)

An ICS is a controller medication that reduces airway inflammation and prevents flare-ups before they can start.

Combinations

There are many kinds of combination medications available to treat COPD, including those containing inhaled corticosteroids, long-acting beta-agonists and long-acting muscarinic antagonists.

Nebulizers

Nebulizers are electric or battery-operated devices that turn liquid medicine into a fine mist that can be inhaled via a mouthpiece or face mask.

Oral corticosteroids (OCS)

OCS are prescribed in a short course (or burst) to treat a flare-up and prevent further worsening of symptoms.

Phosphodiesterase-4 (PDE-4) inhibitors

PDE-4 inhibitors are: approved for severe COPD and chronic bronchitis to relax airways and decrease inflammation.

Antibiotics

Antibiotics are used to treat respiratory infections (acute bronchitis or pneumonia) that can worsen COPD symptoms.

Oxygen Therapy

Some patients may need extra oxygen to improve breathing; many different types of devices are available, including portable units.

Pulmonary Rehab

Pulmonary rehab is a whole-body approach that includes COPD education, exercise, nutrition, and more; the program can shorten hospital stays and improve participation in daily activities.

Important: Be sure to talk with your doctor about the potential for side effects with COPD medications, particularly oral corticosteroids and PDE-4 inhibitors.

Does asthma lead to COPD?

Asthma does not necessarily lead to COPD, but a person whose lungs have been damaged by poorly controlled asthma and continued exposure to irritants such as tobacco smoke is at increased risk of developing COPD.
It’s possible for people to have both diseases – this is called Asthma-COPD Overlap, or ACO.

Delayed diagnosis is common with ACO, so if your asthma or COPD symptoms worsen or persist, request further testing from your doctor. ACO treatment involves aggressive medication – usually inhaled corticosteroids and a combination of medications that include a long-acting beta-agonist and a muscarinic antagonist.

Patient Resources

COPD Foundation: copdfoundation.org

Infographic on Pulmonary Rehabilitation. Transcript below in toggle.

Pulmonary Rehabilitation Infographic Transcript

Pulmonary Rehabilitation — Live Better and Live Longer

Pulmonary Rehabilitation and Mortality
  • COPD is the 3rd leading cause of death worldwide
  • More than 16 million people diagnosed with COPD in the US
Pulmonary Rehabilitation Improves Outcomes
  • Increase in exercise capacity
  • Increase in your quality of life
  • Decrease in the number of exacerbations
Pulmonary Rehabilitation Saves Lives
  • But only 3-4% of Medicare beneficiaries with COPD receive Pulmonary Rehabilitation
  • 60% of COPD cases go undiagnosed

There is a 37% decrease in mortality for Medicare beneficiaries who received pulmonary rehabilitation within 3 months of hospital discharge

(Lindenauer et al., Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-year Survival Among Medicare Beneficiaries. JAMA 2020 May 12;323(18):1813-1823.)

There is a 33% decrease in lower risk of death in those with fibrotic interstitial lung disease who participated in 8-% or more of planned pulmonary rehabilitation sessions

(Guler S, et al. Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study. Thorax 2021. Aug 30; throaxjbl-2021-217361.)

Pulmonary rehabilitation helps patients feel better and live longer but is underutilized

For more information about pulmonary rehabilitation, visit www.livebetter.org