Understanding COPD Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease or COPD is an umbrella term for a number of chronic lung conditions. The most common are chronic bronchitis and emphysema. Chronic asthma can also lead to permanent changes in the lungs resulting in the same symptoms as COPD. Each condition can occur on its own, but many people have a combination of two problems.
The symptoms of COPD include breathlessness on exertion, cough, chest tightness and wheeze. Some people with COPD in the early stages show no symptoms at all. COPD is a condition that can affect people as young as 30 – 40 years of age but increases in frequency in older age groups.
The main cause of COPD is inhalation of noxious particles or gases that irritate airways. The irritation causes inflammation of the airways which makes the inner lining of the bronchial tubes swell and become narrowed, making it more difficult for air to flow through. Excess phlegm production further narrows the airways and together these effects lead to excessive coughing. The inflammation also destroys the elastic fibres that allow lungs to stretch and rest. The end result of all these changes is difficulty with breathing. The main irritant is cigarette smoke but others include long term exposure to dust and chemical fumes in the workplace and pollution. Other causes include recurrent chest infections in childhood or genetic problems that can affect the lungs.
Associate Professor Paul Reynolds is a Respiratory Physician and Senior Consultant at the Royal Adelaide Hospital, Chair of the Asthma Foundation of SA Medical and Scientific Advisory Committee, and an Asthma Foundation of SA Board Vice President. The AFSA, asked him about COPD.
Are the numbers of people with COPD increasing? If so, who is most likely to be affected in the future?
COPD is a highly prevalent disease which costs the Australian community over $800 million per year. It is currently the fourth major cause of chronic disease mortality. Worldwide, the numbers are definitely increasing, with COPD expected to become the third leading cause of death by 2020.
Much of this increase is due to increased smoking in the third world. In Australia, anti-smoking campaigns appear to be having some effect with rates of COPD possibly starting to plateau. However, more research is needed because there is a large amount of unrecognised disease in the community. Preliminary studies indicate that unrecognised COPD may be of particular concern in elderly women.
With greater attention to diagnosis, it is expected that the amount of doctor-diagnosed COPD will rise. Through this mechanism, earlier use of treatment should see improvements in the quality of life for these patients.
What is the best way to manage COPD?
Discuss any breathing difficulties with your doctor and if you smoke, stop smoking. Further testing including breathing tests and x-rays, may be needed. Specific inhaler medications prescribed by your General Practitioner are of proven benefit in improving quality of life and reducing exacerbations (or “attacks”). Exercise and pulmonary rehabilitation programs which are run through the major hospitals can also be of great help.
Research says COPD is an under diagnosed disease. What is the key to changing this?
The key to changing this problem is that people should realise that shortness of breath doing usual daily activities is not normal. Obviously there are limits, and with severe exercise even the healthiest person becomes short of breath. However, too many people accept undue breathlessness as a normal part of ageing and ignore it. If there are any concerns, people should discuss them with their local doctor. There are simple breathing tests available which are very useful in detecting early signs of problems.
What is the most important thing South Australians need to know about COPD?
COPD has long suffered from a lack of interest because it has been perceived as self-inflicted and that little could be done to benefit patients. Attitudes have changed and moved away from this victim-blaming mentality. Smoking is an addiction and smokers should be given the support they need to quit – although this does not absolve the individual of the responsibility for taking the first steps and sticking to the plan.
Even after smoking cessation, people with advanced disease continue to suffer. That is why the sooner one quits, the better. Modern medications and treatment programs have achieved significant improvements in the quality of life of patients with even the most severe COPD. Patients should not be embarrassed to see their doctor about breathing difficulties related to smoking. Help is available.
If you had one key message to give to the public about looking after their respiratory health, what would it be?
By far the most important thing is the elimination of cigarette smoking.