Chronic obstructive pulmonary disease involves chronic inflammation of the lungs and remodeling of the small airways, making it increasingly difficult to breathe. COPD is now the fourth leading cause of death in the United States after heart disease, cancer and stroke, and it causes considerable disability. About 12 million Americans have been diagnosed with COPD, and another 12 million are believed to have impaired lung function without knowing they have a progressive disease.
Bronchitis is an inflammation of the bronchi or medium-sized airways of the lungs, and coughing is the body’s reaction in an effort to keep these airways clean and capable of delivering oxygen to the cells of the body. When coughing occurs for several days or even several weeks at a time as part of a viral infection such as a cold, there’s nothing to worry about. Once the infection clears, the cough disappears.
When coughing persists, it’s a sign that something else is causing the inflammation. In five of six cases, smoking is the cause. Other causes of chronic bronchitis include air pollution, industrial or chemical fumes and a hereditary deficiency of an enzyme, alpha-1-antitrypsin.
Eventually, the inflammation and coughing damage the cilia or tiny hair like projections inside the airways that trap and eliminate foreign matter. When these cilia become damaged, the result is a buildup of mucus, which clogs air passages and causes the heavy “smoker’s cough.” If you cough up sputum most days of the week for a three-month period, and the condition continues for two consecutive years, you have chronic bronchitis.
Gradual but Relentless
The other major manifestation of COPD is emphysema, which involves progressive damage to the lungs related to chronic bronchitis as well as to the chemicals in cigarette smoke.
Emphysema involves destruction of tissue and loss of elasticity in the alveoli, tiny air sacs deep within the lungs that are responsible for the exchange of oxygen and carbon dioxide from the blood. As these sacs become unable to deliver sufficient oxygen to the blood, a person experiences shortness of breath and inability to exercise or manage even routine daily activities. The cough associated with emphysema is a dry one but no less destructive.
The process is gradual but relentless. One day, you’re complaining about the smoker’s cough; several years later, you’re unable to get up a flight of stairs without stopping to catch your breath.
In one survey, 45 percent of COPD patients had trouble washing, dressing or performing light housework without experiencing shortness of breath. Yet nearly all tended to underestimate the severity of their symptoms–perhaps because they had become accustomed to the progressive loss of function.
Other consequences of COPD include swollen legs and ankles from right-sided heart failure; extreme reactions to poor air quality, hot or cold temperatures or respiratory infections; malnutrition from loss of appetite; and muscle wasting from lack of physical activity.
It’s never too early to take action about a smoker’s cough. In fact, it’s now known that chronic inflammation and COPD can occur even without the signs of bronchitis or emphysema. And the disorder sometimes develops in individuals who quit smoking years earlier.
The effects of chronic obstructive pulmonary disease cannot be reversed, but not smoking can stop the damage, improve your symptoms and give you more stamina. It’s important to realize that only about eight percent of smokers are capable of quitting with will power alone.
Talk to your doctor, try over-the-counter products or join a support group. And even after you quit, avoid second hand smoke.
If you’re in the early stages of COPD, regular exercise can help you preserve strength and breathing capacity. If you’re in an advanced stage, it can help you regain some of the function that you’ve lost. Aerobic exercise will improve your breathing, and strength training helps you maintain muscle mass and strength. But don’t exercise outside when the air quality is poor.
About 60 percent of COPD patients do not get enough nutrition–in part because eating simply requires too much energy. The solution is to choose nutrition- and calorie-dense foods such as nuts and to eat frequent small meals rather than one or two large ones. Sometimes a high-calorie nutrition supplement is recommended.
Since COPD is an inflammatory disease, it’s important to focus on foods rich in antioxidants–deep green, yellow-orange and other brightly colored fruits and vegetables. Foods rich in beta-carotene are fine, but beta-carotene supplements have been found to increase the risk of lung cancer in persons who have smoked.
Pulmonary rehabilitation or breath training is often recommended for COPD patients. The goal is to relieve symptoms and make breathing more efficient.
Inhaling through your nose and then exhaling with lips pursed as you would if you were whistling relieves symptoms for some patients. You can make your breathing more efficient by focusing on use of your diaphragm rather than the muscles in your rib cage, neck and abdomen. Bending slightly forward relieves symptoms by giving the diaphragm more room to expand.
When emphysema has reached an advanced stage, some patients have to carry oxygen while shopping or performing routine daily activities. Lung reduction surgery or a lung transplant may ultimately be needed.
COPD is a serious, life threatening disease. There is no cure and no way to reverse the loss of lung capacity, but the damage can be limited through early preventive action. Chronic bronchitis and emphysema do not appear overnight but rather as a result of many years of neglect–ignoring the danger to the lungs of smoking a cigarette. If you know it’s a smoker’s cough, you should know that it’s time to stop.
Tana N Kaefer, PharmD
