Let's Talk About COPD
We’ve got the doctor-approved scoop on the causes, symptoms, treatments, and a jillion other facts and tips that can make life with this lung condition easier.by Marjorie Korn Health Writer
This is not your run of the mill congestion or wheezing caused by allergies. It’s a situation so challenging, at its worst you may feel forced to take a seat after taking several steps—just to catch your breath. COPD is serious. But it’s also treatable, especially in its earliest stages. We spoke with experts who have decades of experience helping patients learn how to live a full life while managing the symptoms of this lung disease. Here’s what you need to know.
Our Pro Panel
We went to some of the nation’s top experts in COPD to bring you the most up-to-date information possible.
Nereida A. Parada, M.D.
Associate Professor of Medicine, Clinical Lead for Asthma and COPD
Tulane School of Medicine, Tulane Asthma Center
New Orleans, LA
Paul Andrew Reyfman, M.D.
Assistant Professor of Medicine, Pulmonary and Critical Care
Northwestern University Feinberg School of Medicine
Byron Thomashow, M.D.
Professor of Medicine, Co-Founder and Senior Medical Advisor
Columbia University, COPD Foundation
New York, NY
There’s no one reason. In the 1960s, the tobacco industry went after women, which converted a generation of smokers. Estrogen may also make the lungs more susceptible to damage. It may also be that women are more likely to see a doctor when symptoms arise, so it’s possible that more men are out there living with undiagnosed COPD than women.
Milk may cause phlegm to thicken, potentially problematic because COPD can damage your cilia—little “arms” that line the bronchus and move mucus out of the lungs. Plus, COPD patients tend to produce more mucus already, and can have difficulty coughing it up. However, dairy does contain important nutrients like vitamin D and protein. Ask your doctor about dairy in your diet.
Unfortunately, no. These have not been around long enough to get a full picture of potential side effects and what they do to the body, but studies already show evidence that these activities are harmful. If you're trying to quit cigarettes, the new smoking cessation aids that are on the market are much better than they were 10 years ago.
Maybe. About 1% of people diagnosed with COPD have a gene variation that causes low levels of alpha-1-antitrypsin (AAt), a protein that helps protect the lungs. Environmental causes are also possible. Do people in your family smoke? Are they in the same industry, exposing them to the same chemicals? Familial patterns can matter just as much as genetics.
What Is COPD?
The very name of the condition starts to tell you what it's like to have it: Chronic obstructive pulmonary disease (COPD) makes it feel like there’s something continually blocking the pathway to your lungs, making it hard to breathe. Although it’s considered a disease in itself, COPD is also an umbrella term that incorporates several other breathing-related conditions, including emphysema and chronic bronchitis.
To understand COPD, let’s begin with a quick lesson about the makeup of your lungs.
This organ is made up of bronchial tubes, which themselves branch into smaller bronchioles—like a network of roots that split off into smaller roots.
At the ends of the bronchioles, there are alveoli, minuscule air sacs that cluster together. (Picture the pocketed surface of a raspberry, where each pocket represents an air sac of the alveoli.)
When you breathe in, the alveoli fill up with air and separate out the oxygen, feeding it into the bloodstream via your capillaries.
In turn, the capillaries expel carbon dioxide back into the alveoli, and that carbon dioxide is released when you exhale. It’s called gas exchange.
When you’re healthy, your body has a whopping 480 million alveoli that function like new balloons—pliable and strong. But when you have COPD, these alveoli can be damaged in different ways.
Types of COPD
Beneath the umbrella of COPD, two major breathing conditions stand out. Let’s take a closer look at how your breathing is compromised with the two most common forms of COPD:
When the walls of the alveoli break down, instead of having a bunch of little air sacs, one sac leaches into the next, and you end up with fewer, larger, air sacs. The problem with these larger sacs is that there is less overall surface capacity for oxygen to reach your bloodstream. Plus, the airways throughout the lungs can lose their stretchiness, trapping air inside, which is why emphysema causes shortness of breath.
When the bronchial tubes become inflamed or irritated, it can lead to coughing and feeling short of breath. The duration of the bronchitis is important. If you’re coughing and producing mucus at least three months at a time for two years in a row, it’s considered chronic bronchitis, a type of COPD that is treatable, but not fully reversible.
How serious are these breathing problems? Well, COPD is the fourth leading cause of death in the U.S. More than 16.4 million people have been diagnosed with COPD, although experts believe the true number is much higher (many people don’t seek help until the disease has advanced). Let’s take a closer look at what’s behind this chronic lung condition.
What Causes COPD?
For the majority of Americans, COPD is the result of cigarette smoking. The remaining 25 percent of people can attribute it to air pollution—mainly secondhand smoke and chemical fumes, particularly in places where people cook over open flames and are exposed to cooking oil fumes (so-called biomass fuel exposure). Some asthma sufferers are also diagnosed with COPD, and in this case, treatment can usually reverse the inflammation that causes narrowing in the lung’s airways.
Do I Have COPD Symptoms?
Because COPD symptoms could apply to any number of respiratory illnesses, it can be hard for doctors to isolate the cause. The wheezing and coughing can sound like allergies, and the shortness of breath could just be a result of simply getting older or being out of shape. But a cough that lasts six to eight weeks is considered chronic—a sign that COPD might play a role.
With so many broad symptoms, perhaps it’s not surprising that COPD is often misdiagnosed. That’s particularly true for women, who account for the majority of people with this condition, even though it’s commonly thought of as a “man’s disease.”
Along with a lingering cough, if any of the symptoms below describes your situation, make a beeline to your doc who may then refer you to a pulmonologist. The most common signs of COPD include:
Chronic coughing—sometimes producing mucus, sometimes not
Frequent respiratory infections
Increased shortness of breath
You can also take the COPD Assessment Test, available for free at catestonline.org. A CAT score of 10 or more suggests significant symptoms.
If you do have one or more of the symptoms above, it’s good to see your doctor sooner than later. Some people may avoid getting help because they’re afraid of the stigma surrounding smoking or feel like the disease is their fault. But being a smoker doesn’t mean you don’t deserve health care, and the longer you wait to have your COPD treated, the more it can advance.
If you are experiencing COPD symptoms, you should not be afraid or ashamed. You’re one of millions of Americans in the same boat. There are many treatment options and combinations of drugs. Once you receive the proper diagnosis, you and your doctor can figure out a plan to improve your health and quality of life.
How Is COPD Diagnosed?
Your doctor will start by taking your health history, including finding out about your smoking status (past and present) and exposure to pollutants like secondhand smoke and chemicals. You’ll likely also be asked about your symptoms and whether other family members have been diagnosed with COPD.
After that, your doctor will send you for a pulmonary function test to assess lung health. You’ll do a spirometry test, which involves blowing air through a mouthpiece and into a machine that determines the amount of air you can exhale and the rate you can expel it. (The machine is also used to determine whether treatments are working, and as a tool to understand how COPD is progressing.)
In the future, the Peak Flow Test, currently used to monitor asthma patients, may also be used to evaluate COPD (studies are underway on its effectiveness for COPD diagnosis). The advantage is that it’s simpler to administer and less costly.
Additionally, a chest x-ray or computed tomography (CT) scan can detect emphysema and an arterial blood gas test, which measures how much oxygen is in the blood, and can indicate whether your lungs are doing a good job of oxygenating the body while removing carbon dioxide. Your doctor may want to do further blood work to see if there are other issues going on, such as allergies, that may be contributing to COPD symptoms.
With a diagnosis in hand, your physician may then talk to you about staging your COPD. For many years, pulmonologists used the GOLD Stages, one through four, to describe a person’s lung function. The Global Initiative for Chronic Obstructive Lung Disease, which established the system, is moving away from that approach and toward a refined grading system that focuses more on symptoms rather than lung function. The reason: Lung function doesn’t always correlate with how a person feels, nor is it great at predicting their outcomes.
The grading system for COPD is letter-based, and looks like this:
A: less symptoms, low risk
B: more symptoms, low risk
C: less symptoms, high risk
D: more symptoms, high risk
There are several assessment tools available to figure out where you fall on the list. But whatever your grade, don’t get hung up on it—it’s not like cancer staging in that way. Rather, the grading system helps your doctor think about what therapies should be on the table to help you achieve longer periods without breathlessness, and less exacerbations or flares—times in which the symptoms get bad enough to need outpatient treatment or admission to a hospital.
A COPD diagnosis is a call for action. There are things your medical team can do to help—like prescribing drug therapies and other treatments, and tracking your lung function over time. And there are things you can do, too, to improve your situation.
What Are the Best COPD Treatments?
There is no cure for COPD, and the approaches to managing this condition will vary depending on your grade and other variables like age and overall health. These are some of the common treatments your doctor might discuss with you:
The single most important thing you can do if you’ve been diagnosed with COPD is to quit smoking (if you do smoke). Yes, we know, if it were easy you would’ve done it by now. Nicotine is highly addictive and a tough habit to kick.
If you’ve tried the cold turkey method without success, don’t give up. The FDA has approved several medications in the past few years that are effective in helping people quit smoking. Talk to your doctor about possible quitting aids. Remember, it’s crucial to managing your COPD symptoms as well as reducing your risk for other issues like cardiac disease and cancer. The earlier you stop, the more you limit damage to the lungs. And try to avoid secondhand smoke, dust, fumes, or other air pollution.
Changing Your Diet
Your pulmonologist will likely talk with you about maintaining (or adopting) a healthy lifestyle, including cleaning up your diet. COPD can be taxing on the body—the muscles that help you breathe sometimes have to work 10 times harder in someone with the disease in order to make it happen. So you want to fuel them, and the rest of your body, with healthy sources of protein, plus a good helping of fiber and healthy fats. While there is no "COPD diet" per se, the Mediterranean diet is widely accepted for being a balanced way of eating.
However, for some people with COPD, the actual act of eating itself can be difficult and cause shortness of breath. If that happens, a few tips: Chew slowly and take small mouthfuls, pausing to breathe between bites, and have small meals throughout the day. If you find you are losing weight, your doctor may connect you with a nutritionist who can offer guidance.
COPD can trigger a vicious cycle. The less you do, the better you feel, because you don’t have to breathe as hard. But living a sedentary lifestyle can have physical repercussions that make COPD worse. Bit by bit, you may feel like your COPD is forcing you to miss out on things like seeing friends and family, in order not to tax your breathing.
Daily physical activity can help combat this, to a certain degree. Exercise builds muscle, and the fitter you are, the less exertion you’ll need for everyday tasks. Your doctor will help you put together an exercise program that’s tailored to your current level of fitness.
The goal of medications is to open up the breathing airways and to decrease inflammation. It’s not unusual for a person with COPD to have asthma as well, and your pulmonologist is trained in treating both of those conditions at the same time. These are a few meds you may consider:
Bronchodilators: Delivered via inhalers, these drugs help relax the muscles around your airways, making breathing easier. There are short-acting ones that last a few hours and are used when needed. If your COPD is moderate or severe, your doctor may prescribe a long-acting bronchodilator, which is effective for 12 hours or more and taken daily.
Glucocorticosteroids: Also delivered via an inhaler, these steroids help reduce inflammation that’s affecting the airways.
These medications can be taken together, in different ratios, to fit your needs. You'll work with your doctor to figure out what's right for you, knowing that your dosage and combinations of meds may change over time as your condition changes.
Other Treatment Options
If your COPD is more advanced, your doctor may talk with you about additional interventions to help improve your breathing. Sometimes, it can take a bit of trial and error to figure out the approach that's best for you. If something’s not working, don’t give up. Eventually, you and your doctor will settle on a system that’s most effective.
This multidisciplinary approach to COPD treatment includes a customized exercise program that is based on your current abilities and your goals. A pulmonary rehabilitation staff member will teach you how to control the pace of your breathing during exercise to increase stamina and strengthen muscles; over time, you’ll be able to exercise for longer.
Pulmonary rehabilitation may also include nurses, physical therapists, respiratory therapists, dieticians, and mental health experts, all of whom will work to put you in charge of your breathing. If you smoke, the program will help in your effort to quit.
Overall, the goal is improving or maintaining lung function for as long as possible. One of the limitations of pulmonary rehabilitation has been around access, including the willingness of insurance companies to cover it, and the effort it takes to attend sessions. Despite its effectiveness, only a small percentage of COPD patients complete a pulmonary rehabilitation program.
If your lungs aren’t able to supply your bloodstream with enough oxygen, your doctor may outfit you with oxygen therapy. There are a few different devices that’ll do the job, depending on your lifestyle and needs. You breathe it in using an oxygen cannula (a little plastic tube with short prongs that sit just inside your nose) or a face mask. Supplemental oxygen can help you feel better and stay active, which can improve your life overall.
For a small number of patients, surgery may be considered. There are a few options.
Bullectomy: A very small number of patients with emphysema will have air sacs that become extremely large—so called bullae. They take up so much extra space that they prevent healthy air sacs from functioning to their fullest. A bullectomy can remove these giant bullae.
Lung volume reduction surgery: Other emphysema patients—but again, a small portion—have healthy air sacs in the bottom portion of the lungs, and more damaged air sacs at the top. Lung volume reduction surgery (LVRS) removes the non-functioning portion of lung. But it’s a pretty major surgery, so you need to have a relatively high fitness level for this to be eligible for it.
Endobronchial valve volume reduction: This procedure involves deflating the portion of diseased lung tissue, to allow the healthy parts to function more effectively. It is a very rare, new, and experimental treatment, and doctors are trying to learn which patients respond well and which don’t.
Lung transplants: These procedures are hardly ever done; patients have to be sick enough to need this extreme intervention, but healthy enough to withstand the surgery (and there’s a dearth of organs). While lung transplants won’t extend a person’s life with COPD, it may increase quality of life.
What’s Life Like With COPD?
If you’ve been newly diagnosed with COPD, you may feel overwhelmed and scared. Depression and anxiety are common among patients with COPD, which makes it difficult to commit to the lifestyle changes that can improve your condition. If you’re feeling down, tell your pulmonologist or your general practitioner. Together, you can come up with a plan to give your mental health the support it needs. Bonus: Treating mental health is easier than ever with the boom in telemedicine, thanks to the pandemic. Insurance companies and Medicare are starting to cover more telemedicine, too. There are a lot of people out there ready to support you in whatever ways you need.
In many ways, living with COPD isn’t so different than dealing with any other chronic condition: Some days are good, some not-so-great. That’s why pulmonary rehabilitation can be so helpful. It’s a form of self-management, giving you the knowledge you need to treat your own disease (in concert with what your pulmonologist and other health care providers are doing). That’s also why going to your scheduled doctor visits is so important. The “chronic” part of COPD is key here: If you miss out on getting regular medical attention, you could be held back by limitations that are controllable with medication and lifestyle changes.
COPD Support Options
COPD360social is an online community created by the COPD Foundation of more than 50,000 members. Once you create a profile, you can receive support, find COPD information, participation in clinical studies, sign up for events, and more. This is great both for people with COPD and their caregivers.
American Lung Association Lung HelpLine and Tobacco QuitLine connects you with a registered nurse, respiratory therapist, or certified tobacco treatment specialist to help you with whatever you need at that moment.
Better Breathers Club is a service of the American Lung Association that has been supporting COPD patients through community and education for 40 years.
COPD Facts: National Heart, Lung, and Blood Institute. (2020). “COPD.” nhlbi.nih.gov/health-topics/copd
Lungs and Alveoli: American Journal of Respiratory and Critical Care Medicine. (2003). “The Number of Alveoli in the Human Lung.” atsjournals.org/doi/full/10.1164/rccm.200308-1107OC
COPD and Nutrition: Cleveland Clinic. (2018). “Nutritional Guidelines for People with COPD.” my.clevelandclinic.org/health/articles/9451-nutritional-guidelines-for-people-with-copd
COPD and Rehab: American Thoracic Society. (n.d.) “Pulmonary Rehabilitation.” thoracic.org/patients/patient-resources/resources/pulmonary-rehab.pdf
COPD and Surgery: American Thoracic Society. (n.d.) “Surgery for COPD.” thoracic.org/patients/patient-resources/resources/surgery-for-COPD.pdf
COPD and Mental Health: Journal of Thoracic Disease. (2014). “Anxiety and Depression: Important Psychological Comorbidities of COPD.” ncbi.nlm.nih.gov/pmc/articles/PMC4255157
COPD and Dairy: COPD Foundation. (n.d.) “Milk Products and Mucus in COPD.” copdfoundation.org/COPD360social/Community/COPD-Digest/Article/293/Milk-Products-and-Mucus-in-COPD.aspx