In this article:
What is COPD?
COPD is the abbreviated term for chronic obstructive pulmonary disease. It affects 5% of the population (approximately 12 million people) and is the fourth most common cause of death in the United States. (1)
COPD consists of two disease processes: emphysema and chronic bronchitis.
By definition, chronic bronchitis is a productive cough that lasts for 3 months in each of 2 successive years.
Emphysema refers to structural changes and airway dilation that lead to airflow limitation.
Overall, COPD causes significant airflow limitation leading to symptoms of shortness of breath, breathlessness, and fatigue.
COPD is one of the leading causes of hospital and ED visits in the United States.
What are the different stages of COPD?
There are many different ways to stage COPD.
The most common method is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) system. This system uses your forced expiratory volume (FEV1) result from your pulmonary function test. FEV1 is the amount of air you can exhale during a forced breath.
Based on the FEV1, the COPD stages are:
- GOLD 1, mild: FEV1 > 80%
- GOLD 2, moderate: FEV1: 50% – 79%
- GOLD 3, severe: 30% – 49%
- GOLD 4, very severe: < 30%
A newer method for classifying COPD is the GOLD ABCD Grading. This grading system is based on the symptoms rather than FEV1.
The COPD grade is calculated based on your number of exacerbations per year and your modified Medical Research Council dyspnea scale (mMRC) score:
- Grade A: 0 – 1 exacerbation per year, mMRC 0 – 1
- Grade B: 0 – 1 exacerbation per year, mMRC > 2
- Grade C: over 2 exacerbations per year, mMRC 0 – 1
- Grade D: over 2 exacerbations per year, mMRC > 2
The mMRC scores are:
- 0: No difficulty breathing except with strenuous exercise
- 1: Dyspnea with walking fast or hurrying
- 2: Walks at a slower pace than people of the same age group or has to stop multiple times to catch a breath
- 3: Stops after 100 yards or after a few minutes because of dyspnea
- 4: Cannot leave the house because of dyspnea
A combination of these methods is used for COPD staging.
What are the leading causes of COPD?
The primary culprit for COPD is tobacco abuse. Other causes of COPD include exposure to secondhand smoke, air pollution, and dust and fumes from one’s occupation.
Some genetic factors, such as alpha-1 antitrypsin deficiency, may increase the risk of COPD. Undiagnosed and untreated asthma is also another risk factor that can lead to COPD.
Patients who are young or have a family history of COPD or those without exposure to tobacco should be screened for genetic causes of COPD and alpha-1 antitrypsin deficiency.
What are the symptoms of COPD?
The most characteristic symptoms of COPD are running out of breath or labored breathing, cough, and sputum production. Shortness of breath becomes progressively worse with the advancement of the disease and can get aggravated by both activity and rest.
The patient may also experience wheezing and chest tightness. The patient usually complains of a productive cough with chest tightness and shortness of breath that has been going on for some time.
Most of the time, patients with COPD go to their primary care doctor or emergency physician complaining of a productive cough with yellow or green phlegm. Often, they are diagnosed with an infection or asthma, and therefore diagnosis is typically delayed.
According to statistics, how many people suffering from COPD can recover?
Everyone’s lung function declines after the age of 25.
However, a smoker will have a much more rapid decline in lung function. From the moment one stops smoking or the offending agent is removed, the decline in lung function is reduced. After about 5 years, the rate of decline is similar to that of a nonsmoker.
The lung function that is lost usually will not be regained. Therefore, the goal with most COPD treatment modalities is to reduce the rate of lung function decline and control the symptoms.
In most patients, once exposure (i.e., tobacco smoke) is avoided, the rate of decline will stabilize to that of a nonsmoker. You can reach this state more readily if you accompany the avoidance of smoke with the necessary treatment, after which your symptoms would stabilize as well.
Therefore, patients do not recover from COPD, like recovering from a cold or the flu. However, with treatment and trigger avoidance, they may become stable and their rate of lung function decline will be reduced.
From an acute exacerbation, about 75% of patients recover to their baseline lung function at about 4-5 weeks.
How to prevent COPD?
The most important thing with COPD is to quit smoking or to prevent secondhand smoke exposure. Most people develop COPD as a result of cigarette smoking.
Thus, giving up this nasty habit and avoiding exposure to secondhand smoke are the first steps toward reducing the risk of developing COPD.
Avoidance of environmental fumes can also significantly reduce the risk of developing COPD.
Those with friends and family who smoke at home should also try to avoid the smoke or request the smoking individual to smoke outside.
What dietary changes should be made while dealing with COPD?
Before getting to the answer to this question, it is important for you to understand that different types of food are broken down differently in the body, in a process called metabolism. The breakdown of these products produces CO2, which is then expired through the lungs.
Carbohydrate breakdown produces the most amount of CO2, fat creates the least amount of CO2, and proteins are in the middle. Limiting the amount of carbohydrate consumed reduces the amount of CO2 produced.
Eating a high-protein diet not only helps with the amount of CO2 produced but also helps with building strong muscles of breathing. A high-fiber diet is also recommended for patients with COPD.
For those who are obese, foods that may help reduce fat and weight can help lessen the load of the muscles of respiration. Those who are very thin can consume foods to help gain weight to strengthen the muscles of breathing.
For those with diabetes, glycemic control can help reduce muscle weakness and muscle breakdown.
Drinking plenty of fluids to keep the body properly hydrated is one of the cardinal rules of good health, but it is especially important for people suffering from COPD. The fluids you consume help water down the mucus, making it easier to expel.
Patients on chronic oral steroids may have more muscle breakdown. Therefore, it is important for them to take calcium and vitamin D supplements continuously to help prevent bone breakdown.
What lifestyle changes should be adopted by people suffering from COPD?
Here are some steps that patients with COPD can do to help manage their condition:
- Stop smoking or prevent exposure to smoke and other environmental/ occupational triggers as much as possible to prevent the disease from getting worse.
- Use your long-acting inhalers and medications regularly as doing so prevents acute exacerbations and worsening of lung function.
- Make exercise a regular part of your everyday activities. Daily walking, biking, and swimming can help strengthen the muscles of breathing.
- Decrease stress and anxiety.
- Eat low-carbohydrate, high-fiber, and high-protein meals. They not only help strengthen the muscles of breathing but also reduce the amount of CO2 produced by the body.
- Seek care to determine if you need oxygen with activity or exercise.
- If you plan to travel to a place with a high altitude, seek medical attention to determine if flying and going to such a location are safe and whether you need extra oxygen or not.
- Participate in support groups and pulmonary rehabilitation programs to increase your understanding of the disease and promote compliance with therapy.
What exercises are recommended for people suffering from COPD?
In general, exercise is very good for people suffering from COPD.
Aerobic exercises are great for those suffering from COPD. Exercising works by keeping the muscles of breathing and of the chest active in order to be able to compensate for the poor lung function.
Walking is one form of exercise that is recommended for someone suffering from COPD. Biking and water aerobics are other forms of exercise that are recommended to improve the breathing of patients with COPD.
Pulmonary rehabilitation is a 6-8-week program that most patients with COPD should undergo. The goal of the program is to promote exercise techniques and tools that may help improve the muscles of breathing and reduce the symptoms of COPD.
Breathing exercises may also help with the symptoms. One such exercise is pursed-lip breathing, which allows one to inhale better and exhale more air. It also helps with the anxiety associated with the disease.
Exercises to help strengthen the diaphragm (the main muscle of breathing) is also important. This can be done by placing one hand on the chest and the other on the abdomen and trying to breathe with only the abdomen moving and minimal chest movement.
Lack of exercise can lead to muscle deconditioning and may worsen COPD symptoms. Therefore, exercising to keep the muscles active and engaged is very important in COPD.
What lab tests are required for COPD diagnosis?
In general, COPD diagnosis is based on the patient’s history, symptoms, and pulmonary function test results.
Certain lab tests can be done to look for genetic mutations that can cause COPD or exclude other causes of shortness of breath. Otherwise, no lab tests can help pin down COPD.
COPD is mainly diagnosed using pulmonary function tests. These tests involve sitting in a room and performing breathing tests that can last between 1 and 1.5 hours. If the test results show obstruction and the symptoms are consistent, then a diagnosis of COPD is made.
Typically, a chest x-ray is also done to exclude other causes.
Without these tests, a definite diagnosis of COPD cannot be made.
Sometimes, an arterial blood gas is done. However, this is not to diagnose COPD, but to determine the level of breathlessness the patient is having and whether they require oxygen at home or not.
Why does COPD worsen during the night?
Many patients with COPD also suffer from sleep-disordered breathing, which may make the symptoms of COPD worse at night. That is why patients with COPD should also be screened for sleep-disordered breathing and related problems to effectively manage COPD.
Also, at night when one tries to relax and sleep, one is more cognizant of one’s breathing and, therefore, may notice the irregular breathing more.
Is COPD a contagious disease?
COPD is not a contagious disease. Therefore, being in close proximity to someone who has COPD does not put you at risk of developing the disease.
In patients with genetic mutations such as alpha-1 antitrypsin deficiency, the disease may be passed on from one family member to the next – not because the disease is contagious.
What are endobronchial valves that everyone is talking about? How can they make COPD symptoms better?
The endobronchial valve for lung volume reduction surgery is a novel technique that has recently received FDA approval in the United States to help with COPD symptoms.
The idea is that the valves are placed in a lobe of the lung that is more diseased in order to cause a complete collapse of that lobe and to allow for the other better lobes to take over and function more efficiently.
Results from studies have so far shown great improvement in patients’ symptoms, distance walked, and oxygen needs.
These valves will not cure COPD. However, they may help with COPD symptoms.
The procedure is minimally invasive. The valves are placed in the lung using a small camera that is inserted through the mouth. There is no pain associated with the procedure, and the patient can tolerate the procedure very well.
You should seek advice from your pulmonologist regarding endobronchial valve placement if you suffer from COPD.
Is COPD a fatal disease?
Yes. COPD causes significant airflow obstruction and can be fatal in severe cases.
COPD accounts for nearly 140,000 deaths in the United States annually, with 1 American dying of this disease every 4 minutes. (1)