Breathing is essential to life. Which is why it is important to be aware of COPD, or chronic obstructive pulmonary disease. November is COPD Awareness Month, and Kentucky bears a particularly high burden with the disease, with the highest adult prevalence rate in the country. More than 9 percent of the state’s adult population is estimated to have COPD, according to the U.S. Centers for Disease Control and Prevention.
The state also ranks No. 1 in cigarette use, according to the CDC, with a prevalence rate of more than 28 percent.
COPD is the third-leading cause of death in the United States, and the World Health Organization predicts that by 2030, it will also be the third-leading cause of death worldwide. WHO estimates 65 million people worldwide have moderate to severe COPD.
More than 12 million Americans have COPD, and an additional 12 million likely have it but don’t know it, according to the National Heart, Lung and Blood Institute. The disease kills more than 120,000 Americans each year, or one every four minutes.
Bryan Beatty, a respiratory therapist with University of Louisville Physicians and research manager for the Division of Pulmonary, Critical Care & Sleep Disorders Medicine at the UofL School of Medicine, said though the risks of smoking are well known, many people still don’t truly understand them.
He said that when he asks patients why they continue to smoke, “What they often say is, ‘My grandfather smoked all his life, and he didn’t die of cancer.’ But then I ask, ‘Did he have a heart attack?’ ‘Did he have COPD?’ and the answer is almost always ‘Yes.’
“If it isn’t cancer that kills you, COPD or a stroke or a heart attack will. There are so many risk factors associated with smoking, you can take your pick on which one proves fatal.”
COPD is an umbrella that includes emphysema, chronic bronchitis, or a combination of both. These conditions make it difficult to empty air out of the lungs, and cannot be fully reversed. People with COPD experience shortness of breath, cough, fatigue and sometimes excessive mucus, symptoms which usually worsen over time. If you have COPD, there is an increased chance of having cardiovascular disease, osteoporosis, lung cancer, depression, metabolic syndrome and skeletal muscle weakness, said Dr. Rodney Folz, a pulmonologist with UofL Physicians.
Most people develop COPD by smoking or being exposed to second-hand smoke. A small group of people are genetically predisposed to COPD through the deficiency of a protein called alpha-1 antitrypsin. While smoking is the main risk factor for COPD, other risk factors include exposure to dust, chemicals and air pollution.
The most effective strategy to prevent COPD is to quit smoking, which is also important for those who have COPD in order to manage the condition. Dr. Folz said there are numerous benefits to stop smoking with the most obvious being more money left in your pocket to buy things other than cigarettes. “The health benefits are well known and numerous including reduced risk for lung cancer and other types of cancer (bladder, head and neck, etc.) and reduced risk for stroke, heart attack, hypertension and other forms of peripheral vascular disease,” Dr. Folz said. “Smokers who stop smoking also benefit from reducing their risk of developing chronic obstructive pulmonary disease. In addition, if you stop smoking you are more likely to reduce common respiratory symptoms such as cough, wheezing, shortness of breath.”
According to Dr. Folz, the main issue with the person who smokes and subsequently develops COPD is that this individual reacts negatively to the components of cigarette smoke in such a way that they develop an abnormal inflammatory response when it is inhaled. “This inflammatory response not only is seen in the lungs, which over time results in COPD, but also occurs throughout the body raising the risk of heart disease, cancer, peripheral vascular disease, stroke, depression, skeletal muscle dysfunction, etc.,” Dr. Folz said. ” It is also true that there are some people who do not react in a negative way to inhaled tobacco smoke and do not show signs or symptoms of COPD. What these factors are, are presently unknown.”
Despite its prevalence and risks, COPD is underdiagnosed and undertreated, especially in women, who have a harder time getting a proper diagnosis, Dr. Folz said. This may be partly due to the stigma of COPD as being a self-imposed disease through smoking, though that stigma is changing, he said. COPD is sometimes misdiagnosed as asthma or another problem.
Women also are 37 percent more likely to have COPD and account for more than half of COPD deaths in America, Dr. Folz said.
The best way to screen for COPD is to perform a simple office-based measurement of pulmonary function known as spirometry.
For those who are diagnosed with COPD, there is hope. Smoking cessation, pulmonary rehabilitation, medications, daily exercise, staying up-to-date on vaccinations and following a diet that is healthy for the heart and maintains healthy bones may help manage symptoms and improve quality of life.