Shelley Iverson, DO / Carolina Pines Regional Medical Center
I medical contributor
What is COPD?
By Shelley Iverson, DO Pulmonary Disease
COPD is an acronym for Chronic Obstructive Pulmonary Disease, which is used to describe diseases such as asthma, chronic bronchitis and emphysema. It is no surprise that in this country, the most common reason for people to develop COPD is tobacco abuse. Currently, there are more than 45 million smokers in the U.S. However, it may surprise you to discover that worldwide, the most common reason isn’t tobacco abuse—it’s actually indoor air pollution. According to the World Health Organization (WHO), approximately 3 billion people cook and heat their homes using open fires, coal and by burning biomass (animal dung, crop waste and wood) in homes that are poorly ventilated. In 2010, COPD affected more than 325 million worldwide compared to 64 million in 2004. The repeated exposure to fumes and biomass is especially problematic for women and small children who are indoors more.
Since most of us aren’t exposed to the degree of indoor air pollution seen in other parts of the world, you might be wondering how common COPD is in the U.S. and what im- pact the disease has on us. As mentioned before, the most common reason for COPD in the U.S. is smoking; there are actually other causes, too. There is a hereditary form of COPD, which is passed from parents to children. COPD can be caused by repeated pulmonary infections, non-tobacco environmental exposures and from secondhand exposure to tobacco. Yes, it is possible to develop COPD having nev- er smoked a cigarette. Currently, approximately 12 million people have been diagnosed with COPD in the U.S. and an- other 12 million have COPD but aren’t diagnosed (therefore, not treated). We have known for many years that COPD mor- tality was rising. It is now the third leading cause of death in the U.S., trailing behind cancer and heart disease. Why is the mortality from COPD rising? People are oſten not diagnosed until late in the disease, and not all who are diagnosed are optimally treated. The first step to diagnosis requires that patients discuss symptoms with their med- ical providers. Common symptoms include cough, short- ness of breath, wheezing and unintentional weight loss. However, these symptoms are very non-specific (they are seen in many other medical conditions). Since there is no single symptom which is unique to COPD, the diagnosis and treatment is oſten delayed. COPD is diagnosed by per- forming a simple breathing test referred to as a pulmonary function test or PFT. One of the hallmark features of COPD is that air gets trapped in the lungs, making it hard for pa- tients to fully exhale and the following breaths difficult to inhale. PFTs enable us to see if air is “trapped,” and it al- lows us to determine how well lungs are able to exchange the inhaled oxygen for the exhaled carbon dioxide. Many different treatment options are available for COPD.
Regardless of how much impairment in lung function there is, the single best intervention that can slow the rate of de- cline of lung function is to stop smoking. There is no med-
Dr. Shelley Iverson is associated with Dr. Jose de Dios at Hartsville Pulmonology and is a member of the medical staff at Carolina Pines Regional Medical Center. Board certified by the American Board of Internal Medicine, Dr. Iverson earned her medical degree from the Virginia College of Osteopathic Medicine and completed her internship, residency and fellowship with Palmetto Richland Memorial Hospital in Columbia.
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ication that can overcome the continued damage that the lungs are encountering if a patient still smokes or if they are exposed to secondhand smoke. As a pulmonologist, I also determine if home oxygen is needed. Oxygen is a drug—it is prescribed in different “doses” or liters, and it is needed at different times of the day. Some people don’t need oxygen at all, others need it only at night while sleeping and some need it during the day with exertion. Medications such as inhalers, nebulizers and pills are combined and used con- comitantly in the treatment of COPD. One of my favorite treatment options used to help COPD patients is pulmo- nary rehabilitation. This is not as well known or utilized as much. Pulmonary rehab is a structured exercise program designed to build up physical endurance for patients who have lung disease. This program does nothing to fix or cure the underlying disease but upon completion, patients are more physically active thereby increasing their quality
of life. Pulmonary rehab is supervised by a nurse and respiratory therapist who work in conjunction with an ex- ercise physiologist and dietitian to ensure that all aspects of a patient are being addressed, including optimizing nu- trition since unintentional weight loss is oſten problemat- ic. Finally, surgical treatments (including lung transplants) can be considered but they are not appropriate for most patients. Unfortunately, even when appropriate, there are not enough organs available to meet the demand. COPD is no longer just a disease of smokers. Treatment options vary and depend on many factors including how symptomatic someone is and what the degree of lung impairment is. Usually, treatment options are combined (i.e. stop smoking, inhalers and pulmonary rehab) to have maximum effect. Speaking with your healthcare provider regarding any symptoms or concerns you might have is the first step in the diagnosis and treatment of COPD.
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