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All about COPD

Chronic obstructive pulmonary disease (COPD) is an umbrella term for a collection of progressive respiratory conditions, all of which cause breathing difficulties.

Two of the most common forms of COPD are chronic bronchitis and emphysema.

The most prevalent symptoms of COPD are shortness of breath and a cough. Over time, even everyday activities, such as getting dressed, can become challenging.

1. COPD is rare

According to the World Health Organization (WHO), COPD caused 3.23 million deaths in 2019, making it the third leading cause of death worldwide.

In the United States, COPD “is the fourth leading cause of death. More than 16 million Americans are diagnosed, and millions more people may be undiagnosed.”

The American Lung Association (ALA) recommends that anyone who is “experiencing COPD symptoms — chronic cough, shortness of breath, frequent respiratory infections, significant mucus production (also called phlegm or sputum), and/or wheezing — speak with [a] doctor about obtaining a breathing test called ‘spirometry,’ which can help diagnose COPD.”

2. Only smokers develop COPD

It is true that smoking tobacco is the leading cause of COPD, but as Dr. Schachter told MNT, “There are many other risk factors that contribute to the development of the disease, including air pollution, work-related pollution, infection, and some forms of asthma.”

Approximately 10–20% of COPD patients never smoked. Some of these never-smokers include significant secondhand smoke exposure; genetic predisposition, primarily through alpha-1 antitrypsin deficiency; or substantial exposure to air pollution.

Alpha-1 antitrypsin is an enzyme that protects the body from an immune attack. Some people have a mutation in the gene that codes for this enzyme; this causes alpha-1 antitrypsin deficiency.

Deficiency of alpha-1 antitrypsin increases the risk of developing COPD and other conditions that affect a range of bodily systems.

3. Only older adults develop COPD

COPD is certainly more common in older adults than in younger people, but younger people are not immune to the condition.

For instance, in the U.S., between 2007 and 2009, COPD affected 2% of males and 4.1% of females aged 24–44 years. Similarly, the condition affected 2% of males and 3% of females aged 18–24 years.

A significant proportion of those individuals diagnosed before the age of 50 have a hereditary form of the disease that causes a deficiency of alpha-1 antitrypsin.

4. COPD only affects the lungs

“False,” said Dr. Schachter. “COPD coexists with many comorbidities, including heart disease, lung cancer, hypertension, osteoporosis, and diabetes. The association may be due to common causative factors, as well as ‘systemic inflammation.’”

In other words, some of these conditions share risk factors, which makes them more likely to occur with COPD. For instance, smoking is a risk factor for both COPD and heart disease.

At the same time, health experts associate COPD with systemic inflammation, which can also independently increase the risk of other conditions.

5. People with COPD cannot exercise

According to Dr. Yadegar, “Without proper guidance, patients with COPD may have difficulty completing physical exercises.”

However, he also explained that doctors recommend people with COPD do exercise, as it can help “increase their breathing capacity and improve their daily symptoms.”

“Pulmonary rehabilitation programs typically offer guided breathing techniques in conjunction with physical exercise in order to maximize better patient outcomes,” he continued.

In a nutshell, Dr. Schachter told us that “exercise is therapeutic for COPD, reducing the number of exacerbations and improving quality of life.”

The ALA notes:

“You might feel like it is not safe or even possible to exercise, but the right amount and type of exercise has many benefits. Be sure to ask your doctor before you start or make changes to your exercise routine.”

6. There are no treatments for COPD

This, thankfully, is a myth. “There are numerous therapies and strategies that improve the course of the disease,” Dr. Schachter told MNT, “including medications, rehabilitation, diet, and vaccines that protect against respiratory infections that accelerate the course of the disease.”

Dr. Yadegar said, “With a spectrum of presentations, patients may benefit from inhaled bronchodilators, anticholinergics, corticosteroids, and supplemental oxygen.” These, he said, can be tailored uniquely to each person.

“Certain patients may also benefit from alpha-1 antitrypsin augmentation or even lung transplants,” he added.

7. COPD is the same as asthma

“While both diseases are considered obstructive lung diseases, there are several differences between COPD and asthma,” Dr. Yadegar explained.

“Asthma most commonly begins in childhood, where it is frequently associated with allergies and problems of inflammation. COPD usually begins in the 60s and is associated with smoking. There is, however, an overlap syndrome, which has features of both.”

– Dr. Neil Schachter

Dr. Yadegar dove into the details: “COPD is a disease of the alveoli, mostly […] a result of elasticity loss induced primarily by smoking. Asthma is a disease of the airways, primarily […] a result of chronic airway inflammation.”

“While clinical symptoms may overlap between the two diseases,” he continued, “treatments vary in order to best help patients in the short and long term.”

8. Body weight does not affect COPD

This is not true. Dr. Schachter told us that carrying excess body weight can increase the disability associated with COPD.

Conversely, if people have a body weight that is below moderate, it can be “a sign of emphysema and also indicates a poor prognosis.”

9. If you have COPD, there is no point quitting smoking

This is another myth. As Dr. Schachter told MNT, “It is never too late to quit.”

He explained that “smoking accelerates the loss of lung function that accompanies COPD.” He also said that smoking tobacco can promote exacerbations of the symptoms.

10. Shortness of breath is the only symptom of COPD

“Shortness of breath is a major presenting symptom but hardly the only one,” according to Dr. Schachter.

“Cough, excess phlegm production, respiratory infections, and all the symptoms of the comorbidities are often signs of progressing COPD.”

Other symptoms can include sleep problems, anxiety, depression, pain, and cognitive decline.

11. A healthy diet cannot help with COPD

As a matter of fact, a healthy diet can make a difference for people living with COPD. Dr. Schachter told MNT that a healthy diet promotes “general health and can protect against exacerbations of COPD itself and its comorbidities.”

For example, a 2020 meta-analysis of eight observational studies investigated the role of diet in COPD. The authors conclude that “healthy dietary patterns are associated with a lower prevalence of COPD, while unhealthy dietary patterns are not.”

Similarly, the data generated in another review suggest that “a higher intake of fruits, probably dietary fiber, and fish reduce the risk of COPD.”

In summary, although there is no cure for COPD, treatments are available, and lifestyle changes can reduce symptom severity.


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