Are You Experiencing Early Warning Signs of COPD?

Chronic obstructive pulmonary disease, also known as COPD, is a chronic lung disease that causes obstructed airflow (less air moves in and out of the lungs). This is a result of airways—branching tubes that carry air in the lungs—becoming inflamed and narrowed, the air sacs (alveoli) getting destroyed, loss of elasticity in the lungs, and increased mucous production which can block the ease of airflow. These changes cause breathing-related symptoms.

COPD is an umbrella term that includes multiple conditions, the two most common being chronic bronchitis and emphysema. Chronic bronchitis is characterized by a chronic (long-term), daily cough with mucous (sputum) production as a result of airway inflammation. Emphysema is the result of damage to the air sacs (alveoli).

You likely know someone with COPD as it affects nearly 16 million American adults. 

An early diagnosis and treatment are key to living well with COPD. Symptoms can range from being asymptomatic to respiratory failure depending on the severity of illness. These symptoms can include:

• Shortness of breath, usually at first with physical activity 
• Chronic cough 
• Coughing up mucous (sputum)
• Wheezing (whistling sound as you breathe)
• Fatigue or tiredness
• Frequent respiratory infections

At first, COPD may cause no symptoms or very mild symptoms but as the disease progresses, symptoms can worsen. Unfortunately, there is no cure for COPD but with early detection, the right treatment, and lifestyle changes, many people with COPD live active, fulfilling lives. Left untreated, COPD can make it difficult to engage in daily living and activities. Therefore, the sooner you begin treating your COPD and controlling your symptoms, the less damage you will cause to your lungs, which can improve outcomes. 

Those with COPD are also likely to experience exacerbations (“flare-ups”) or events where their symptoms are worse than the usual day-to-day symptoms and may require additional treatment. 

Because the nature and severity of COPD symptoms can vary from day-to-day, people with COPD often have to take each day as it comes, adjusting their plans based on how they feel and their breathing ability. This can lead to feelings of anxiety, frustration, and increased isolation as the disease begins to take increasing control of one’s life.

But, again, if diagnosed early, there are treatment options that can slow the progression of the disease

COPD is caused by long term exposure to lung irritants that cause damage to the lungs and airways. Cigarette smoking is the most common cause but the inhalation of other irritating gases or particulate matter can cause the same effect. This includes secondhand smoke and environmental and occupational exposures. While rare, there is a genetic condition called alpha-1 antitrypsin deficiency that can cause emphysema. 

Given the leading cause of COPD is exposure to harmful particles, gases, air pollution, or chemicals—including cigarette smoke— an important first step in diagnosing the disease is a comprehensive review of your life and health history. Your healthcare provider will look to explore your:

• Clinical history
• Family history of lung disease
• Environmental and occupational exposure history
• Diagnostic testing, including a lung exam and pulmonary function test
• Review of symptoms you are currently experiencing

Your healthcare provider may recommend a range of tests and imaging to get a clear picture of any issues within your lungs and how they are performing. Tests may include:

Breathing tests (pulmonary function tests or PFTs): This includes spirometry, which measures how fast, and how much air you can blow out of your lungs. Due to the inflammation and narrowing of the airways of those with COPD they blow out air more slowly. This testing is imperative for the diagnosis, staging, and monitoring of COPD. This test can also include the measurement of lung volumes or how much air your lungs can hold and diffusion capacity, which is the lungs’ ability to exchange gases like oxygen and carbon dioxide. 

Other tests might include:

Chest x-ray: This is not needed for diagnosis but might show changes consistent with COPD or be used to rule out other causes of symptoms

Computed tomography (CT) scan: This can detect the presence of emphysema, malignancy (cancer), or other lung diseases. Many people with COPD qualify for annual CT screenings for lung cancer; this is usually done with a low-dose computerized tomography (LDCT) scan.

Arterial blood gas: A blood draw from an artery to determine if you have trouble clearing carbon dioxide from the blood.

Testing for alpha-1 antitrypsin deficiency: a blood test to determine your level of alpha-1 antitrypsin, a protein produced by the liver that protects the lungs. Everyone with COPD should be screened for this. 

With a clearer picture of the specifics of your condition, your healthcare provider can prescribe the best treatment option to slow the progression of the disease, help control symptoms, reduce flare-ups, and keep you engaged in the things that mean the most to you.

Treatment options include:

Smoking cessation is the most important part of any treatment plan, if you smoke. This can help slow the progression of COPD.

Medications such as:

• Inhaled medications to decrease inflammation and clear the airways
• Mucolytics to thin and loosen mucus
• Antibiotics to treat infection
• Steroids to reduce inflammation
• Oral medication to reduce flare-ups

Oxygen therapy if your oxygen level is 88% or lower. Supplemental oxygen must never be used when smoking. 

Airway clearance techniques, which work to move mucus out of the lungs and allow air to move in and out of your lungs more easily.

A pulmonary rehabilitation program. Spanning eight weeks, the program is a combination of education and exercises conducted under the guidance of a team of physical and respiratory therapists. The goal is to reduce any shortness of breath, improve oxygen levels, increase energy and endurance, manage your weight, and help you maintain long-term independence along with better mental and physical health. 

Preventing infections is also an important part of management. One effective way of doing this is by getting all recommended vaccines. 

If you or a loved one is regularly experiencing any symptoms of COPD, it’s important to speak to a healthcare provider sooner than later. Early diagnosis means you can start treatment sooner, which can help slow the progression of the disease and work to improve your lung health before your condition becomes severe.

Caitlin Mathers, DNP, is a member of the pulmonary medicine team at Southwestern Vermont Medical Center.