Imagine breathing through a straw.
Gary Skon, 67, and his wife, Katharine, of Pittsville, Wisconsin, are making the most of Skon’s improved health since he began treatment for COPD.
That’s what it’s like to have a severe form of chronic obstructive pulmonary disease, according to John Crump, M.D., a lung disease specialist at Marshfield Clinic Minocqua Center. Known as COPD, this condition can drastically limit life activities, cause long-term disability and death.
While no cure exists, people with COPD can take actions and medications to manage it and improve their quality of life. “We need to dispel the notion that there’s nothing we can do about it,” Dr. Crump said.
COPD symptoms include shortness of breath, wheezing, coughing and chest tightness. “The decline in the lung’s ability is so gradual that many people accommodate it without noticing just how bad the impairment has become,” said Theodore Praxel, M.D., internal medicine physician and medical director of the Clinic’s Institute of Quality and Patient Safety.
COPD is this nation’s third leading killer, according to the National Institutes of Health. By some estimates, one in four people over age 30 will get this condition. More than 4,000 people who get care at Marshfield Clinic have COPD.
COPD is a group of diseases that includes emphysema, chronic bronchitis, asthma or some combination, said Adriane Gianlupi, M.D., Marshfield Clinic Eau Claire Center pulmonologist. It is both common and commonly under-diagnosed, she said.
In the United States, smoking is the leading cause. Other causes include air pollution and workplace exposures.
Symptoms typically begin to appear at about age 50. By then, the lungs may be at about half of normal functioning. “There can be a long period between the onset of symptoms and the end, which can be very difficult – like breathing through a straw,” Dr. Crump said.
Lungs have airways that branch out, ending with small air sacs. Emphysema damages the tiny air sac clusters (alveoli) by destroying their walls. As the walls are destroyed, they stretch out, forming millions of holes in the lungs.
Chronic bronchitis causes inflammation and narrowing of airways, which leads to airway obstruction and recurrent infections.
In COPD, airways are narrowed and collapse during exhalation, trapping air in the lungs. Diaphragms are normally dome-shaped muscles that work like pistons to power breathing, Dr. Crump explained. When the lungs become over-inflated with trapped air, the diaphragms are flattened, making it difficult to breathe.
As with any chronic disease, diagnosing COPD in the early stages gives patients the best chance for a good outcome. Dr. Crump recommends screening smokers who have even mild symptoms of cough, wheezing or shortness of breath.
COPD is diagnosed with a simple breathing test called spirometry, which involves blowing hard and fast into a machine that measures the speed and amount of air exhaled.
“Early diagnosis is so important,” Dr. Gianlupi said.
She promotes prevention, early diagnosis and sticking to a treatment plan. This often includes medications, participating in a pulmonary rehabilitation program and quitting smoking. “Tobacco cessation is the most important step,” Dr. Gianlupi said. “People need to understand, if they don’t quit smoking, the disease will continue to progress.”
“There’s no medication as effective as quitting smoking, and it’s never too late,” Dr. Crump said. “Coughing usually improves quickly. When people quit smoking, quality of life improves and mortality decreases.”
“It’s not easy,” Dr. Crump acknowledged. “The most persuasive approach for a health care provider is to personalize the information. In a supportive way, inform the patient about the severity of their lung disease and other smoking-related conditions. Sometimes we can predict that a patient will need oxygen in the near future or they will need help with daily activities such as bathing or dressing. That can be a powerful incentive to quit.”
Pulmonary rehabilitation is a key component of COPD management. Patients exercise and receive education on how to use medications, make healthful changes to diet.
Most people become less active as COPD progresses. Pulmonary rehab helps break the cycle, Dr. Gianlupi said. “It’s important to maintain that fitness level, not go back to the couch.”
“Many patients tell me that rehab was the most helpful component of their COPD program,” Dr. Crump said. Exercise has benefits that help manage other conditions, including depression and anxiety, too. “Lung function may improve only slightly; but quality of life and outlook often improves tremendously.”
Medications include bronchodilators, which relax the muscles to help open airways; inhaled steroids to reduce airway inflammation; oxygen therapy; antibiotics to fight bacterial infections; and anti-viral medicines to fight influenza.
Once diagnosed with COPD, many people have frequent flare-ups or pneumonia, and they may need hospital care.
“COPD is one of the chronic diseases that results in a number of hospital admissions and readmissions,” Dr. Praxel said. “We are concerned about hospitalization for patients’ personal well-being. Staying out of the hospital keeps their costs down and keeps the overall cost of health care down.”