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COPD

The West Virginia Asthma Education and Prevention Program (WVAEPP) wants all people in West Virginia to breathe easier. The WVAEPP is working with others around the state to give better and more information about lung diseases other than asthma which impacts the some of the same groups of people.

The diagnosis of Chronic Obstructive Pulmonary Disease, commonly called  COPD, poses a particular problem for people with this disease and health care practitioners who treat them. This page helps to define COPD and discusses how to diagnose COPD based on symptom history, physical assessment, and lung spirometry testing.

COPD is the 3rd leading cause of death in the United States, and the 4th leading cause of death in West Virginia as of 2011. COPD also causes long-term disability among those who have the disease. The number of people who have COPD is on the rise --- more than 12 million are currently diagnosed with it. And it is estimated that another 12 million may have COPD but not realize it. 

1 out of every 5 people is affected by COPD.

What is COPD? 

COPD is an obstructive lung disease which means the person has difficulty "breathing air out" of the lungs. By not being able to get air out of the lungs this causes hyperinflation  or air trapping in the lungs, which then causes increasing shortness of breath (dyspnea) and breathlessness. COPD is a general term which includes several types of lung disease which includes: those with emphysema (em-fi-SE-ma), chronic bronchitis, and individuals who have had poorly controlled asthma. A person may have one or more of these lung diseases at the same time. The lungs of COPD diagnosed individuals are always swollen or inflammed. The lungs may also have large areas of destruction, where large cavities (bullae) are in the airways. These cavity areas do not work well, they cannot get the air out, and cause the person to be very short of breath.

The Global Initiative for Chronic Obstructive Lung Disease (also known as "GOLD") defines COPD as follows:

  • COPD is a preventable and treatable disease characterized by chronic airflow limitation that is not fully reversible. Airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs.
  • Chronic Bronchitis is a partially reversible airflow limitation as well as the presence of chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.
  • Emphysema is an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.

People with COPD more commonly get infections in the airways of their lungs. COPD can be a whole body (systemic) disease because the swelling can be in many parts of the body, not just in the lungs. COPD can cause weight loss, overall muscle weakness, heart disease and osteoporosis (brittle bones).

In general, symptoms of COPD don't appear until a lot of lung damage has occurred, and the symptoms usually worsen over a long period of time. People with COPD are also likely to have episodes called exacerbations, or times when their symptoms suddenly get much worse. With this in mind, the signs and symptoms of COPD can vary, depending on which lung disease is most prominent. It's also possible to have many of these symptoms at the same time.  

The Diagnosis 

The diagnosis of COPD is suspected on the basis of person's medical history, physical exam, and confirmed by lung spirometry testing - sometimes called pulmonary function testing (PFT). Spirometry should be used to assess how well you can breathe air in and out of the lungs along with a thorough history and physical exam can help the doctor give a correct diagnosis. Spirometry testing must be done for the proper diagnosis of COPD.

Spirometry can detect COPD long before its symptoms appear. Doctors also may use the results from this test to find out how bad (severe) your COPD or other lung disease is and to help set your treatment goals. 

Your doctor may recommend other tests, such as:

  • A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
  • An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The test can help find out how severe your COPD is and whether you may need oxygen therapy.    
  • Spirometry or Pulmonary Function Testing. A very common lung test. It measures how well you can get air IN and how quickly you can move air OUT of your lungs. For this test, you breathe into a mouthpiece attached to a recording device (spirometer). You should have this test done to make sure which type and how good/bad of lung disease you may have. Your doctor will use this to help treat your illness. 

The Patient

It is uncommon to diagnose COPD under the age of 35. Typically, the person will be a current smoker or former smoker with at least 10 pack years (one pack year is someone who smokes 20 cigarettes a day for one year). The person usually has a cough with mucous or sputum production and shortness of breath.

Note: Alpha-1 Antitrypsin Deficiency (AAT) is a genetic form of lung disease that some people are born with (inherited and passed generation to generation) that causes similar signs, symptoms, and lung destruction. AAT deficient individuals typically do not get relief of symptoms when using inhaled or oral medications used for COPD and progressively become sicker and more short of breath over a short span of time. There are different treatment options for this type of inherited condition. A simple inexpensive blood test by your physician is used to confirm this diagnosis (click on link at the bottom of this page for more details).

How Does COPD Differ from Asthma?

Although COPD and Asthma have similar symptoms such as coughing and wheezing, they are two distinct conditions due to how the disease developed, frequency of symptoms and reversibility of airway obstruction. 

1. The onset of asthma typically occurs during childhood or teenage years where COPD most often develops in current and former smokers who are in their mid-40s. Note: Asthma can develop at any age even in elderly adults - talk to your doctor if you think you have asthma or COPD.

2. Asthma episodes or exacerbations (flare-ups) -- are those individuals with frequently occurring wheezing, shortness of breath, chest tightness and cough -- and who often have specific and sometimes easy to identify triggers of their symptoms especially allergens - such as dust, pollen, pet dander, or exercise induced. However, flare-ups in persons with COPD are commonly caused by respiratory tract infections such as those the common cold or other upper respiratory viruses.

3. With treatment, people with asthma have near-normal lung function and are symptom-free between asthma flare-ups. People with COPD very rarely experience a day without symptoms. Airflow obstruction in COPD sufferers is only partially reversible with smoking cessation and quick-relief bronchodilator (such as Albuterol or Levalbuterol) use.

4. It is not uncommon nor impossible to have both Asthma and COPD. Many adults had asthma or asthma-like symptoms as a child and as they grew up had fewer symptoms or no longer had symptoms. However, due to exposure to smoke either by smoking, environmental (Coal Dust) or work hazards exposure the person has now developed COPD and has Asthma. The myth is that "you out grow asthma", but asthma never goes away - it is a life-long issue even though a person can be symptom-free for many years at a time.

Asthma is often mis-diagnosed and people with Asthma are treated for COPD. The first-line therapy for patients with persistent asthma is taking an inhaled corticosteroid "controller medication" daily (used 2 times daily -usually once in the morning, and once in the evening), and a "quick-relief rescue medication" (bronchodilator) for symptoms such as wheezing and only use when they need it. However, COPD is the opposite. Bronchodilators (such as Albuterol or Levalbuterol) are the first-line daily medication for COPD. Albuterol is commonly prescribed for use for 3 to 4 times a day and as needed. COPD is now being treated more with inhaled corticosteroids (such as Pulmicort, Flovent, or QVAR) and combined drugs - drugs with a corticosteroid and a long-acting bronchodilator (such as Advair, Symbicort, Dulera) because new medications are  being made as more is learned on how to help those with COPD breathe easier.   

The Risk Factors for Developing COPD 

If you have any of these, you may have or get COPD:

  • Exposure to tobacco smoke.This is the number one reason for getting COPD. Using tobacco (cigarettes, cigars, etc.) or being exposured to Secondhand (also called environmental tobacco smoke (ETS)). The biggest risk for getting COPD is smoking cigarettes for a long time. The more years you smoke and the more packs you smoke, the greater your risk. Symptoms of COPD usually appear about 10 years after you start smoking because years of damage has been done to the airways of your lungs. People who don't smoke but are around people that smoke (cigarette, pipe, cigar smokers) also are at a great risk of getting COPD. 
  • Occupational exposure to dusts and chemicals. Being around dust and chemicals (e.g., firefighters, welders) at work. As well as being around chemical fumes, vapors and dusts can cause damage to your lungs.
  • Gastroesophageal Reflux Disease (GERD). This is a very bad form of acid reflux (called REFLUX) — which is commonly known as Heartburn. This is caused by the backflow of acid and other stomach contents into your esophagus. GERD can make COPD and Asthma worse. 
  • Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.
  • Genetics. A rare genetic disorder known as alpha-1-antitrypsin deficiency is the source of a few cases of COPD. Researchers suspect that other genetic factors (passed from down through the family) may also make certain smokers more likely to get the disease.
  • Asthma - a chronic life-long lung disease that has no cure and can develop at any age.
  • Chronic respiratory infections - frequent or yearly occurring illnesses involving the lungs

Symptoms of COPD

You may have COPD if you have any of the following symptoms:

  • Chronic cough (a cough lasting longer than three months) with or without mucous (sputum) being coughed up. 
  • Shortness of breath (also called dyspnea) with or without wheezing.

Common Signs and Symptoms of COPD:

  • Wheezing, with a longer than normal time needed to breath air out from lungs,
  • Rhonchi (the coarse rattling sound somewhat like snoring, caused by mucous in the lungs) and cough
  • Shortness of breath with activity or at rest (dyspnea) 
  • A lot of mucous in the airways (sputum), may or may not be coughed up.
  • Air trapping or Hyperinflation of the chest, is when air gets trapped in the lung and causes it to over-inflate.
  • Use of more muscles to breath (using all chest and neck muscles to breath)
  • Pursed-lip breathing (breathing in through the nose and out through pursed-lips)
  • Signs of cor pulmonale (enlargement of the Left-side of the heart): This includes:
    • Change in heart sounds (only the doctor can say when he/she listens to your heart)
    • Neck vein distention (the vein in the neck is larger than normal and sticks out)
    • Swelling of the feet and/or legs (puffy feet, ankles, and/or lower legs)
    • Enlarged Liver (called Hepatomegaly)

      Note: Finger clubbing is not a common sign of COPD. If you have finger clubbing this should alert the doctor to other illnesses such as idiopathic pulmonary fibrosis (IPF), cystic fibrosis, lung cancer or asbestosis. 

If you or someone you know has symptoms such as coughing, shortness of breath or wheezing, see your doctor for a simple breathing test. By taking steps now, and talking with your doctor about treatment options, you can breathe better and enjoy a more active life. 

Resources  

American Lung Association

Breathing Better with COPD

Drive4COPD

National Heart, Lung, and Blood Institute

National Lung Health Education Program

West Virginia COPD Task Force

What is Alpha-1 Antitrypsin Deficiency?

FDA approves new COPD drug 

Cabell Huntington Hospital Pulmonary Rehabilitation Services

Charleston Area Medical Center Pulmonary Rehabilitation Services

 

 

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