Demystifying Chronic Obstructive Lung Disease
Each November, National COPD Awareness Month provides the opportunity to spotlight a common preventable disease that makes it difficult for people to breathe because air cannot flow into the lungs. According to the World Health Organization, COPD (chronic obstructive pulmonary disease) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019, after heart attack and stroke. The American Lung Association reported in 2018 that an estimated 16.4 million people received a diagnosis of COPD. The most common cause of COPD is tobacco smoking. COPD can also occur in people who do not smoke but have been exposed to smoking, fumes from burning fuel for cooking, or harmful particles at work. Patients usually present with cough, increased amount of mucus production, difficulty breathing and wheezing. Some individuals may also experience weight loss.
COPD is sometimes called chronic bronchitis or emphysema. Patients diagnosed with chronic bronchitis exhibit inflammation in the small breathing tubes inside the lungs, which results in a cough with mucus production. In people with emphysema, the air sacs in the lungs, called alveoli, are damaged.
COPD worsens over time, especially if left untreated. While treatment cannot reverse any existing damage, it is important to diagnose and begin the right treatment to gain control of symptoms and improve the patient’s quality of life. A primary doctor or lung specialist can confirm a diagnosis using a breathing test called a pulmonary function test. The doctor may also order a chest X-ray or special test called a CT scan of the lungs. After confirming a diagnosis, the patient is educated on the different kinds of inhalers available to help with breathing. It is essential to learn how to use the inhaler properly so that medication goes to the lungs and less remains in the back of the mouth. For smokers, one of the most important steps is to quit smoking. There are less chances of COPD getting worse in patients that quit smoking. There are smoking cessation clinics/hotlines available to help people who are interested in quitting.
COPD patients with severe disease may need to use oxygen at home. A machine called a BPAP (bilevel positive airway pressure) often improves breathing. “BiPAP” is a trade name, while BPAP is the type of device. This device is a type of ventilator that features a tube connecting to a mask worn over the nose and mouth. Keep in mind that a BPAP is different from a CPAP used to treat sleep apnea. A BPAP delivers a two-level positive airway pressure (inhale and exhale) versus a CPAP, which generally delivers single pressure. COPD patients should also get certain vaccines to prevent them from developing serious illnesses. Health professionals recommend the pneumonia vaccine, yearly influenza and now the COVID-19 vaccine. Patients with more problems breathing may also benefit from an exercise program called pulmonary rehabilitation.
During the course of the disease, patients may have a flare-up in which their symptoms will worsen. The flareups experienced may lead to the patient being admitted to the hospital for treatment using steroids and antibiotics. If a flare-up is severe, patients may need a breathing tube placed into their windpipe and connected to a ventilator, which is a machine that delivers air into their lungs. It is important to identify and start treatment on a flare-up to reduce complications.
Some patients diagnosed with COPD may see improvement with surgical procedures. An experienced interventional pulmonology team, such as the LSU Health Shreveport faculty, who provide services at Ochsner LSU Health Shreveport, are experienced in valve placement in the lungs while doing a procedure called bronchoscopy. The valves allow air to come out but not reenter the diseased lung so the healthier part can work better. This method is often preferred over other surgical options. Certain patients with advanced disease may need evaluation for lung volume reduction surgery (LVRS), a procedure to remove diseased, emphysematous lung tissue, allowing the functional lung to expand. Not all COPD patients with advanced disease are eligible for lung volume reduction surgery as they may require evaluation for a lung transplant, which is a surgery to remove and replace a diseased lung with a healthy human lung from a donor.
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For questions or to learn more about COPD, please visit https://www.cdc.copd or contact LSU Health Shreveport faculty members at prangthip.charoenpong@lsuhs.edu or neerja.gulati@lsuhs.edu.
Neerja Gulati, MD, is an assistant professor of clinical internal medicine, LSU Health Shreveport. Prangthip Charoenpong, MD, is an assistant professor of clinical internal medicine LSU Health Shreveport.
