Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition that affects more than 15 million people in the U.S. COPD, which includes emphysema and chronic bronchitis, is characterized by a loss of lung capacity, meaning there isn’t as much room in your lungs for oxygen.
“I describe it to my patients like this: the air space in your lungs is like clusters of grapes. With COPD they turn from clusters of grapes to clusters of tangerines, which means you lose surface area to take in oxygen,” says Joyce Leon, M.D., an internal medicine doctor and an expert in treating COPD.
Here, Dr. Leon shares facts about COPD and answers common questions people have.
Q: What causes COPD?
Dr. Leon: In the U.S., it’s almost entirely caused by a significant smoking history. That means those who have smoked a pack a day for 20 years (or two packs for 10 years, and so on). It is possible to get COPD from secondhand smoke. This usually happens with adults whose spouse or someone they are around for a significant amount of time smokes. There are a few very rare inherited disorders that can cause it; also, ongoing exposure to particulates, like when someone works in a certain kind of factory, can contribute to developing COPD.
Q. How is COPD diagnosed?
Dr. Leon: It’s diagnosed by symptoms and a pulmonary function test, which measures how much air gets stuck in the lungs and how much air you can move in and out of your lungs.
Q: What are the most common symptoms?
Dr. Leon: Some of the most common are: a cough that won’t go away, increased coughing or shortness of breath with activity and shortness of breath while doing the same activity as your peers. These symptoms are kind of in the middle stage of the disease, though. With COPD, there are no symptoms early on. But if a person has the risk factors for COPD and is concerned, it is completely reasonable for them to talk to their doctor about getting a pulmonary function test even if they are experiencing no symptoms.
Q: When the doctor listens to your lungs, can they hear any signs of COPD?
Dr. Leon: No. The only changes in the way the lung sounds come very, very late in the disease.
Q: You’ve mentioned a pulmonary function test. Exactly what happens during one of those?
Dr. Leon: You go to a lab and it takes about a half hour. Usually the way it goes is you have someone standing over you, acting like your cheerleader, telling you to blow into this tube. When you blow in to the tube, they can measure the amount of air that stays in the lungs and the amount of air that can move through the lungs in a certain period of time. This data is then used to determine if your lungs work as well as they should.
Q: Can something be done to stop COPD once it is diagnosed?
Dr. Leon: First of all, it’s important to know that everyone loses lung function as they get older. Regarding COPD, if we can diagnose it early, we can slow the loss of lung tissue by using medication, so it is very important to talk to your doctor about these symptoms as soon as they start. We have very good medications that can prevent complications and delay the worsening of the disease. In a nutshell, the test to diagnose it is blowing into a tube, and the way to treat it is getting an inhaler.
Q. Can you please talk about inhalers – what they cost and how effective they are?
Dr. Leon: Medicare and insurance plans usually cover inhalers but the cost varies. The most important thing is to use the inhaler properly. As odd as it sounds, most people who use an inhaler are using it improperly. This means they are not getting the medication – or enough of the medication – into their lungs. The result is that they think the medication doesn’t work, or it’s not working as well as it could. But I tell my patients not to feel bad. Many healthcare workers who use an inhaler don’t use it correctly!
Q. How can you make sure you’re using your inhaler correctly?
Dr. Leon: First of all, it’s important for patients to not be shy about asking questions regarding their inhaler and its proper use. At Henry Ford, we launched an educational program last year where we trained all of our medical assistants and nurses in primary care offices on the proper use of an inhaler so they can better help our patients learn to do it on their own. We also educated them on how to notice if a patient has the wrong inhaler. For instance, if someone has arthritis, they may need a different type of delivery system.
There are many videos posted online by the manufacturers of the inhalers that show the proper use, as well. We make these available in our clinics and online.
Q. Are there any other steps someone with COPD can take to help them manage the disease or prevent flare-ups?
Dr. Leon: Because you can have increased susceptibility to upper respiratory illnesses such as influenza and pneumonia, it’s very important to make sure you are up-to-date on your flu and pneumonia vaccines. There is also pulmonary rehabilitation programs available, which can allow you to maintain your activity level. I’ve had patients who were able to still walk 3 miles every day. The earlier you start treatment, coupled with maintaining physical activity, will help you manage COPD more effectively.
Q. So is cardiovascular exercise good for someone with COPD?
Dr. Leon: Yes. If you don’t take deep breaths – which occurs during cardiovascular exercise like walking, running, bicycling, swimming, water aerobics -- the areas of your lungs that don’t receive oxygen will stop getting the flow of blood to those areas. That will make it very hard for it exchange gasses like oxygen and carbon dioxide. Eventually you will have areas of the lungs not well circulated that you could have benefited from.
If you are concerned about symptoms or risk factors for COPD, talk with your primary care physician.
To make an appointment with a Henry Ford doctor, visit henryford.com or call 1-800-HENRYFORD (436-7936).
Dr. Joyce Leon is an internal medicine physician seeing patient at Henry Ford Wyandotte Family Practice – Riverside in Trenton.