Winding Up Breathless

If you are young and you smoke, here’s another reason to put the butts down. Smoking is the most common cause of COPD, a respiratory disease that could leave you breathless later in life.

COPD (chronic obstructive pulmonary disease) includes emphysema and chronic bronchitis. Both conditions reduce the airflow in and out of the lungs. The disease affects an estimated 16 million Americans – twice the number as diabetics – and is the nation’s fourth leading cause of death, according to federal health statistics.

You can have COPD and not know it for years because the disease has a long “silent period,” according to Stephen Rennard, Larson Professor of Medicine at the University of Nebraska Medical Center and one of the nation’s top experts on COPD.

“Typically, a patient has been a smoker since youth. However, they develop shortness of breath when they are 40 years old, and by then, 15 percent of lung function or more has been destroyed,” Rennard says. The disease, he says, is “relentlessly progressive.”

A chronic cough, chest tightness, increased mucus production and frequent clearing of the throat also are symptoms.

Smoking accounts for 80 percent to 90 percent of all COPD cases, although heredity, second-hand smoke, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections also are factors.

COPD interferes with basic activities

A national survey “Confronting COPD in America” found that millions of American suffer from shortness of breath so severe it interferes with basic daily activities. Of the nearly 600 people with COPD interviewed:

    • Nearly half have difficulty breathing while bathing and dressing or doing light housework.
    • One in three loses his or her breath while talking.
    • More than one-quarter have difficulty breathing even when sitting or lying still.
    • Almost one-quarter say the condition has made them an invalid.
    • Some are too breathless to leave home.

The survey also showed that COPD symptoms are a cause of great distress for patients: 58 percent say they panic when they cannot get their breath; 52 percent feel that they are not in control; 39 percent worry about having serious breathing problems when they are away from home.

Therapies that help

  • Bronchodilators help open narrowed airways. There are three main categories: sympathomimetics (for example albuterol) that can be inhaled, injected or taken by mouth; anticholinergics (for example, ipratopium) and methylxanthines that can be given intravenously, orally or rectally.
  • Corticosteroids or steroids can be given orally or intravenously during acute exacerbations of COPD to help resolve inflammation and bronchospasm. The use of inhaled corticosteroids remains one of the most controversial issues in COPD pharmacology. Data from pooled studies shows a modest reduction in the frequency of COPD exacerbated with inhaled coricosteroids.
  • Antibiotics fight infection. They are frequently given at the first sign of a respiratory infection.
  • Expectorants help loosen and expel mucus secretions from the airways.

Other drugs sometimes taken by patients with COPD are tranquilizers, painkillers, cough suppressants and sleeping pills. All these drugs depress breathing to some extent; they should be avoided whenever possible and used only with great caution.

While aerobic exercise cannot reverse the damage, exercise can help deconditioned COPD sufferers dramatically improve their well-being and daily activities, Rennard says.

Also, COPD sufferers often have heart disease as well, and exercise as part of cardiopulmonary rehabilitation can also help if done properly.

Getting tested

If you smoke or if you have recently quit, you should consider having your lungs tested. COPD can be diagnosed by spirometry testing, which measures lung volumes (and is commonly used to determine the severity of asthmatics’ conditions).

“The neat thing about spirometry is that it is one of those few things done in medicine that isn’t invasive. It doesn’t require a needle stuck in you. And you don’t have to take your clothes off for it,” says Sam Giordano, executive director of the American Association of Respiratory Care (AARC).

The average age of diagnosis for COPD is 53, Giordano says. “We think that’s way too old. We want to get that average age of diagnosis way below that figure. The earlier a person is diagnosed, the better opportunity to get him or her to stop smoking if they are, or to improve the quality of life or to avoid the deconditioning that accompanies the disease.”

Ask your doctor about spirometry testing or check with the AARC, which coordinates free public screenings around the country.