Expert Video Series: Understanding COPD
In this video, Columbus Regional Health interventional pulmonologist Dr. Deepankar Sharma of the Lung Institute shares insights about chronic obstructive pulmonary disease (COPD) — what it is, how COPD is diagnosed and treated, as well as how to live with and manage the disease.
What Is COPD?
COPD is a chronic obstructive pulmonary disease. It is a very treatable and preventable disease that prevents the patients to empty the air out of their lungs, giving them a sensation of shortness of breath. It also presents with cough, extra mucus production with the cough, fatigue and sensation of breathing harder while active or sometimes at rest.
COPD has a few subtypes. Chronic bronchitis and emphysema both come under COPD. Both have different characteristics, features, based on their imaging and presentation, but overall the fundamental disease remains the same, which includes difficulty breathing out and feeling of shortness of breath and increase cough and mucus production. Chronic bronchitis is a form of COPD where there is inflammation in the airways and the bronchial walls, or the breathing tubes are swollen and cause them in producing extra mucus, whereas emphysema, there is damage to the walls of the alveoli, which are the small, subunits of our lungs that help in exchange of air and basically the empty spaces in the lungs, which are not participating in gas exchange, giving us a feeling of shortness of breath.
Most of the patients who have chronic bronchitis will have some form of emphysema. All of patients who have emphysema will have some overlap of chronic bronchitis. So, COPD is not the same as asthma. Some people who have asthma will eventually develop pulmonary bronchial constriction and will have some degree of COPD, but asthma is a reversible disease, whereas COPD is mostly lung damage from chronic smoke and allergen exposure, which is not the same as asthma.
The major cause of COPD is smoking. Constant exposure to smoke causes damage to the breathing tubes and the alveoli, which are the breathing units in the lungs, causing chronic damage and presenting as COPD. Other factors include pollution, indoor and outdoor, environmental factors, constant allergen exposure, also genetics play a very significant role and that's why not all smokers have COPD and not everyone who develops COPD develops it because of smoking.
A small proportion of patients with COPD develop it because of what's known as Alpha 1 antitrypsin deficiency, and basically it's a deficiency of a protein in the body and the lungs which has a protective nature against all the environmental factors. Other than that, the rest of the causes that lead to COPD are related to some kind of smoke, allergen, pollution, chemicals or dust exposure to the lungs.
There are a lot of myths involved with smoking and COPD. As I said before, everyone's lungs behave differently, so that's why not every smoker develops COPD and not everyone who has COPD is because of the smoking exposure, so it is hard to predict how one will respond to it, but the more you smoke, the risk of developing COPD goes higher. The other biggest myth is about other forms of smoking, like e-cigarettes, which are considered relatively safe, but it is not and it still has the chemicals and the harmful exposure to fumes, which will still cause your lungs to develop COPD.
How is COPD diagnosed and treated?
If you have chronic shortness of breath, cough or excessive mucus production with the cough, then all that points towards COPD. Some patients, early on, will just present with fatigue and that also is one of the common presentation that we see, especially in the milder form of the disease. Once you have any of these symptoms, you talk to your doctor and your doctor will mostly likely recommend what we call PFT, or the pulmonary function test, where you will breath out and in into a box or into some machines, which will determine how your breathing pattern is and will be able to help your doctor determine if you have COPD or not.
Then most likely after that, your doctor will either order a chest x-ray or a CT scan of your chest to look at your lungs and determine if there are any imaging patterns that will suggest COPD or if the shortness of breath is from other causes not related to COPD. So, your CT scan will give your doctor a very high resolution image of your lungs at multiple levels and that will tell us how your lung parenchyma looks like, what does the tissue look like, if there are any swollen airways, increased blood vessel or fluid in the lungs or if there are any alveolar damage suggesting of emphysema.
COPD treatment involves understanding your disease and your medication and details. First of all, it starts with whatever factor you had that is contributing to COPD or worsening of your COPD. Most of the time it is smoking. So, smoking cessation is absolutely essential and as soon as possible after diagnosis of COPD. Once you have quit smoking, other forms of treatment would involve inhalers and medications which we call bronchodilators or inhaled steroids. That will improve the lung function and also prevent flare-ups of the COPD. Your doctor may have you on oral medications to prevent flare-ups, including steroids and some non-steroidal agents and then may put you on oxygen as well to maintain your oxygen level, which also has shown significant improvement in your shortness of breath and functional capacity.
One other major factor is pulmonary rehab, which allows the patient to regain their lung function, develop strength of the respiratory muscles and breath better and be able to do more activity and function during their daily living. One other major factor involved in treatment is managing other diseases that contribute to worsening of the COPD, including obesity, congestive heart failure, high blood pressure and sleep apnea, so it is very important to discuss management of those comorbidities with your provider and manage those diseases as well as closely as possible.
Living with and managing COPD
Once you're diagnosed with COPD, you will have that diagnosis, since it is a very stable disease. What will change is the lung function and, what we call as the FEV1, on your lung function. And depending on the degree of severity, it can go up and down, but you will always have the obstructive component of the disease and that's why it is very important to manage COPD very closely on daily basis.
So, once you're diagnosed with COPD, the diagnosis will stay and may never go away, but it is very easily managed to the point that the symptoms can be controlled and that you never notice the symptoms and all that will depend on the severity of the disease and the treatment options and also being compliant with the treatment options. So, once you're diagnosed with COPD, depending on the severity of disease, you may have a spectrum of symptoms ranging from mild shortness of breath with strenuous exercise, versus a more significant shortness of breath with even minimal exercise.
Other factors that patients deal with are chronic cough and excessive mucus production. To manage COPD, the first thing you have to do is make sure that you stay away from all the possible factors that can cause a flare-up. That will include constant exposure to smoke, allergens, dust at home or work, and also passive and second-hand smoke exposure. Staying compliant with your inhalers as prescribed by your doctor is very important as it reduces the exacerbations and also prevents your lung function from going down. If you have been told to use oxygen, then it is also extremely important to use your oxygen to maintain the oxygen level so that you're able to perform the activities and the physical function that you need to.
Other factors include managing your sleep apnea, so if you have a CPAP machine or BiPAP machine, at night, make sure to stay compliant and use it regularly. If you have congestive heart failure or high blood pressure, manage that very closely with your cardiologist as an imbalance of your heart failure or fluid level in the body can provoke a COPD flare-up as well. COPD flare-up, or COPD exacerbation, is a condition where you may notice worsening shortness of breath, worsening cough and more mucus production. Also your mucus may look more dark greenish in color and that will be different from the usual cough and expectoration that you notice on a daily basis. The most common factors that can cause COPD exacerbation is exposure to smoke, hot and cold weather, increased exposure to allergens or pollution. It is also very commonly noticed during the flu season due to flu and other viral infection. The best way to prevent a flare-up is to avoid any kind of smoke exposure and also make sure that you stay away from any sick contacts and during the flu season, make sure you wash your hands to prevent any infection or catching flu.
Once you have any of the symptoms, including shortness of breath, worsening cough or expectoration, talk to your doctor as those may all suggest COPD exacerbation. Also if you are noticing more wheezing with activity, let your doctor know. Most likely, your doctor will increase your inhalers and will also give you a short course of antibiotics and prednisone to help resolve the inflammation in your airways and get rid of the superimposed infection in your lungs. If you're not doing well at home and your oxygen drops below 88%, or what is usual for you, then your doctor may decide to keep you in the hospital under close observation while you're being treated for COPD exacerbation.
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