Breathe Easier

Sunday, November 1, 2009

Illustration by Stephen Sauer

More Information

New Hampshire Lung Association
(800) 835-8647
www.breathenh.org

Elliot Hospital
www.elliothospital.org

Southern New Hampshire Medical Center
www.snhmc.org

The best way to do that? Don't smoke.

Information about Chronic Obstructive Pulmonary Disease (COPD) doesn't appear in the press much; surely it's not in the public consciousness the way that breast cancer and heart disease are. But it is the fourth leading cause of death in the United States. More than 12 million people are currently diagnosed with COPD, and an additional 12 million likely have the disease but don't know it, according to the National Institutes of Health.

COPD is an umbrella term for a group of lung-related diseases -- mainly emphysema and chronic bronchitis -- that interfere with a person's ability to breathe. Symptoms include chronic coughing, wheezing, shortness of breath while performing activities that used to be easy, chest tightness and mucus production. COPD is a progressive disease, with symptoms typically worsening over time. In severe cases of COPD, patients find it difficult to breathe while performing even basic tasks like cooking or getting dressed.

"It's sort of an orphan disease," says Albee Budnitz, MD, FACP, FCCP, Pulmonary and Internal Medicine specialist with Downtown Medical Associates in Nashua and Southern New Hampshire Medical Center. Some patients and their families might be reluctant to openly discuss COPD, Budnitz says, because of a sense of embarrassment or shame: most COPD patients are smokers and have, in effect, brought the disease upon themselves by choosing to smoke.

COPD patients are typically over the age of 40. "All of us lose lung function from age 25 or 30 on," Budnitz says, "but people who are smokers and people who get COPD lose the lung function much more quickly."

Women are more susceptible to developing COPD than men are, Budnitz says. (In 2005, nearly 66,000 women died of COPD compared to 61,000 men, according to the American Lung Association.) On the plus side, female COPD patients who quit smoking tend to have a better recovery than their male counterparts, at least in the first six to twelve months, Budnitz says.

The way and rate at which symptoms reveal themselves can vary, says Peggy Simon, MD, Pulmonary Disease specialist at Elliot Hospital in Manchester. Sometimes symptoms come on slowly, gradually increasing until even tasks requiring very little exertion are difficult. In other cases, symptoms show up very acutely. Patients come to the doctor with a chest illness and suddenly have a lot of coughing, phlegm production, wheezing and shortness of breath.

With current or former smokers accounting for more than 85 percent of COPD patients, "COPD is probably almost a totally preventable disease," says Budnitz. Second-hand smoke can also cause COPD, along with exposure at home or work to certain fumes, dust or pollution. A genetic disorder and family history can also increase a person's risk.

Early intervention

Early detection and treatment of COPD can delay the progression of the disease and greatly affect the quality and the length of a patient's life, Budnitz says. The sooner the diagnosis is made, the more lung function the patient has left, giving the doctor and the patient more to work with.

Some instances of COPD go unnoticed and untreated because patients assume that breathing difficulties are simply a part of aging. They notice a shortness of breath and start to decrease activity and avoid exertion. "They shift their expectations about their activity level," says Simon. This can lead to a delayed diagnosis because as patients cut back on activity, they are less symptomatic. But, over time, those patients are able to do less and less, and they miss out on the benefits of early treatment.

It's important, Simon and Budnitz say, for patients to know their level of risk, including their family history, and to recognize COPD symptoms so that they see their doctor for testing and, if necessary, begin treatment. Spirometry, a noninvasive method of measuring lung function, is commonly used to test for COPD. Ideally, smokers in their 30s or 40s should be tested with spirometry even if they're not showing COPD symptoms, says Simon.

Treatment

There is no cure for COPD, but patients do have various treatment options. The first step for a COPD patient who smokes should be to take advantage of smoking cessation programs and kick the habit. "It's never too late to quit, and the sooner you quit, the better," Budnitz says, so that further lung damage can be prevented.

Another non-pharmacological COPD treatment is pulmonary rehabilitation, which typically includes endurance and breathing exercises, education about the disease and learning how to do things in a more efficient way, from a breathing standpoint, so that COPD patients with reduced lung capacity can still do activities that they enjoy. Pulmonary rehab can make a marked difference for some COPD patients, Budnitz says, allowing them to enjoy things that their COPD had overtaken.

Other treatment methods include bronchodilator medications, which are used to widen the airways; inhaled steroids, used to reduce airway inflammation; antibiotics, to treat infection if any is present; and oxygen therapy to help with shortness of breath. For a select group of COPD patients, surgery might also be a treatment option.

And as a preventative step, COPD patients should be sure to get a flu shot each year, notes Simon. "Patients with underlying lung disease should be getting vaccinated," she says, to avoid the potential exacerbation of COPD symptoms that the flu could trigger. NH

Spillover Effect

COPD can affect body organs in addition to the lungs, causing inflammation through a sort of spillover effect, says Peggy Simon, M.D., Pulmonary Disease specialist at Elliot Hospital in Manchester. "Enzymes that cause the lung inflammation [in COPD] can affect other organ systems," says Simon. For example, if you compare patients who smoke with patients who smoke and have COPD, she says, the COPD patients have a higher incidence of coronary artery disease. Osteoperosis, depression and lung cancer also tend to be more common in smoking COPD patients than in smokers who do not have COPD.

Never Too Late

If you smoke, "it's never too late to quit, and the sooner you quit, the better," says Albee Budnitz, MD, FACP, FCCP, Pulmonary and Internal Medicine specialist with Downtown Medical Associates in Nashua and Southern New Hampshire Medical Center. Smoking-related disease tends to shorten a smoker's lifespan by 15 years, he says, but one health study showed that if you quit smoking at age 40, you can gain about three-quarters of those years back. You can gain about half of them back if you quit at age 50, and still gain about a third back if you quit at age 60.