COPD affects millions of adults, but many people don’t know much about the disease until they or a loved one is diagnosed. Here are answers to common questions about what COPD is, who is at risk, and what can actually help.
What is COPD, and what symptoms of COPD appear first?
COPD (chronic obstructive pulmonary disease) is a common lung disease that narrows the airways and makes breathing more difficult over time. These include chronic bronchitis and emphysema, both of which change the structure of the lungs.
Common symptoms include coughing up mucus (often worse in the morning), shortness of breath when climbing stairs and wheezing, says Dr Suman Paul, a COPD specialist and consultant in respiratory medicine. Symptoms tend to get worse over time, and relapses, called exacerbations, may occur when symptoms suddenly get much worse.
It’s easy to miss the early signs. “Many of the early symptoms of COPD can be so subtle that patients may not notice them,” said Dr. Blen Tesfu, a physician and women’s health advocate. People may notice a mild cough, notice more phlegm in the morning, or feel windy during daily activities.
What are the 4 stages of COPD?
Clinicians grade COPD based on a breathing test that measures how much air you can expel in one second (forced expiratory volume in one second, or FEV1). According to COPD Global Lung Initiative (GOLD) guidelines:
- Stage 1 (mild): FEV1 is greater than 80% of what is expected for your age and size.
- Stage 2 (Moderate): FEV1 is 50% to 79%.
- Stage 3 (severe): FEV1 is 30% to 49%.
- Stage 4 (very severe): FEV1 is less than 30% or less than 50% if there is chronic respiratory failure.
What are the risk factors for COPD?
Smoking is the biggest risk factor for COPD, affecting about 8 out of 10 people. Long-term exposure to secondhand smoke increases your risk, according to Tesfu. Nonetheless, biological and hormonal factors play a role in whether non-smoking women are diagnosed with COPD. In fact, more than 8 out of 10 non-smokers with COPD are women.
Other known risk factors for COPD include:
- Workplace exposure to dust, fumes, and chemicals, including silica and concrete dust
- Outdoor air pollution and poor indoor air quality
- Burning wood or biomass fuel for cooking
- History of uncontrolled asthma or tuberculosis with lung damage
Some risks start in childhood. According to Paul, lungs begin developing in the womb and continue to develop until the mid-20s. Damage to the lungs from recurrent viral infections, childhood asthma, maternal smoking during pregnancy, low birth weight, or premature birth can cause the lungs to stop working properly and increase the risk of developing COPD as an adult. A systematic review found that these exposures early in life significantly increased the odds of developing COPD later in life. Serious infections, including bronchitis and pneumonia, double the risk, and asthma increases the risk three to 10 times.
What role do genetics play in COPD risk?
Genes can shape COPD risk in several ways. The best-known example is a rare genetic disorder called alpha-1 antitrypsin deficiency. “People with alpha-1 antitrypsin deficiency are at higher risk of developing early-onset chronic obstructive pulmonary disease, regardless of whether they smoke or not,” said Dr. Tespu.
In addition to that one gene, research has identified more than 80 common gene types associated with COPD. Many of these affect lung growth in childhood, which helps explain why some smokers develop COPD while others do not.
What is the risk of losing lung function?
As COPD worsens, breathing becomes more difficult and your body has to work harder to keep up. “As lung function, particularly FEV1, declines, it becomes difficult for patients to inhale and exhale air through narrow airways,” Paul said. “This increases respiratory activity.”
A large international study found that low lung function was associated with more hospitalizations, heart problems and premature death, even when the loss was mild.
Pneumonia poses a greater threat because damaged airways become trapped with mucus, swell, and lose some of their natural defenses. And certain bacteria can begin to colonize the lungs, causing infections that are difficult to treat, Paul said.
How can I improve my COPD symptoms?
Pulmonary rehabilitation, which typically lasts 8 to 12 weeks, is one of the most effective treatments for COPD. “Pulmonary rehabilitation is a supervised, personalized medical program that combines tailored exercise training, education and behavioral support for people with chronic lung diseases, such as COPD or pulmonary fibrosis,” said Noah Greenspan, DPT, founder of the Pulmonary Wellness Foundation. “The goal is to reduce symptoms, increase stamina, improve quality of life and reduce hospital visits.”
Studies have shown that pulmonary rehabilitation improves walking distance, shortness of breath, and overall health compared to usual care. It may also reduce the likelihood of having to return to the hospital after a recurrence.
Greenspan said many people with COPD avoid physical activity due to shortness of breath and fall into a “dyspnea cycle,” in which their muscles become weaker and breathing becomes more difficult. Rehab can help change these patterns. “Patients often feel less breathless and can do more things, such as walking longer distances without stopping (and not feeling anxious), more control over their daily lives, and an increased sense of overall well-being,” he said.
His message for everyone living with COPD is, “It’s not over until it’s over and there is always hope.”
This training material was created with support from Chiesi.
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