COPD Describes a Range of Symptoms

Q:  My dad's doctor told him he has COPD, which he said was a combination of "emphysema," "chronic bronchitis," and "asthma." He smoked for about 40 years but has quit for about 20. Is COPD more serious than emphysema? Is there a cure?

A:  COPD stands for "chronic obstructive pulmonary disease," a term developed to describe pulmonary (or lung) diseases that are "obstructive" (can cause wheezing or trouble with air flow) and "chronic" (long-standing). Asthma is typically considered separate from COPD - asthma is often characterized by episodes of wheezing related to allergic triggers, and COPD is generally a consequence of smoking.

COPD is often characterized by shortness of breath, constant coughing (sometimes called "smoker's cough"), and excess sputum production.

In emphysema, lung damage prevents adequate oxygen absorption and causes shortness of breath. Bronchitis is usually manifested by cough and phlegm, and asthma by wheezing. These conditions often overlap, like in your dad. They require different treatments, and so it is useful to make a distinction, but such a distinction is not always easy to make. That's why the term COPD can be the best fit.

Your dad shouldn't feel like he has three separate problems, and therefore a more severe illness. But the constellation of symptoms he has does suggest a more advanced COPD. Lung function improves with smoking cessation, but declines with aging. It is difficult to cure COPD once advanced, but many of the current therapies help the symptoms greatly.

The treatments can also improve exercise capacity and prolong life. Advances in the treatment of nicotine addiction have led to greater success in smoking cessation - a critical intervention in COPD. Other treatments include inhaled bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and oxygen therapy for those with severe COPD. All these treatments have been shown to improve the quality of life of patients with COPD.

In January, the National Heart, Lung, and Blood Institute launched "COPD: Learn More, Breathe Better," a national campaign designed to improve awareness among those at greatest risk for the disease.

More than 12 million people are currently diagnosed with COPD, and it is estimated that another 12 million may have it but remain undiagnosed. People over age 45 with a history of smoking are at risk for COPD. In addition to smoking, other environmental exposures like pollutants or secondhand smoke can contribute to the disease. In decades past, COPD was predominantly a disease of older men. Now, the disease affects men and women equally, with more women now dying of COPD each year than men.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.