Catch Your Breath

COPD refers to two related lung diseases: chronic bronchitis and emphysema. In chronic bronchitis, the bronchi -- the airway tubes leading into the lungs -- become inflamed and irritated. In emphysema, large swaths of alveoli -- the balloon-like air sacs within the lungs that allow the transfer of oxygen into the bloodstream -- are destroyed. “It’s rare to have one form of COPD without the other,” said Duke pulmonologist Lingye Chen, MD. “Most people with COPD have some combination of the two.”

While COPD can be caused or aggravated by environmental pollutants, most cases in the United States are the result of smoking tobacco.

“About a third of smokers develop significant COPD, another third get a mild version, and a third don’t have it at all,” said Dr. Chen. “Obviously, the more you smoke, the more likely you are to develop COPD. But there is a genetic component that determines your susceptibility to the disease that researchers are still trying to tease out.”

Ironically, said Dr. Chen, even though the number of American adults who smoke has declined in recent years, the death rates for COPD are still on the rise. “For people who took up smoking in the 1950s and 1960s, the damage is done.” Importantly, however, if you stop smoking, while existing lung damage may not reverse, future lung damage can be prevented.

The lung loses function over time as a normal part of aging. Most of us don’t lose enough to cause serious damage, but if you’ve damaged lung tissue in your 30s and 40s, you can start developing symptoms of COPD in the decades that follow.

COPD is a leading cause of death and disability in the U.S. and affects somewhere between 10 million and 25 million Americans -- many more than the number of people with lung cancer. It can be easily diagnosed with an X-ray and a pulmonary function test. Yet awareness of the disease is low -- in part, perhaps, because it comes on gradually.

“COPD doesn’t hit you over the head,” said Dr. Chen. “First you notice you’re out of breath when you get to the top of stairs. Then you get winded halfway up the stairs. Then, after a while, you can’t even walk around the room without feeling short of breath. The progress of the disease is slow and insidious, unfolding over several years or even decades.” Other symptoms include frequent coughing and wheezing.

Left untreated, COPD continues to damage the lungs -- sometimes to the point that a case of pneumonia or even a chest cold can be fatal. “But even though the disease is progressive and irreversible, it doesn’t have to become so severe,” she pointed out. “The sooner you address COPD, the more you can improve your quality of life.”