What Is COPD? Understanding Symptoms & Early Signs

We all get a little sick sometimes. A lingering cough, shortness of breath, recurring bronchitis, tightness in the chest…it’s all too easy to chalk these things up to the changing seasons, the myriad of viruses that come and go and even just to getting older.

But for 16 million American adults currently living with chronic obstructive pulmonary disease (COPD), these illnesses were likely the first signs of a potentially life-limiting disease.

According to Michele Hart, a pulmonary nurse clinician at Baystate Medical Center’s pulmonary rehabilitation program in Springfield, MA, “It’s easy to miss some of the early signs of COPD. Sometimes we even change our habits or routines—like opting to only go up stairs once a day versus several times—to accommodate the symptoms and, in the process, making them even easier to disregard. But as is the case with so many health issues, ignorance is not your friend when it comes to COPD. In fact, one of the keys to living well with COPD is early diagnosis and intervention.”

What is COPD?

COPD is an umbrella term that encompasses several lung diseases including emphysema, asthma, chronic bronchitis, and bronchiectasis. “The common thread between the conditions,” says Hart, “is that they make it difficult to move air in and out of the lungs.”

Common symptoms of COPD include:

• Frequent coughing or wheezing
• Excess phlegm, mucus, or sputum production
• Shortness of breath
• Trouble taking a deep breath

Over time—and especially if untreated—COPD can have severe and negative impacts on an individual’s quality of life. In fact, people with COPD often experience:

• Difficulty walking or climbing stairs
• Challenges maintaining employment
• Increased confusion or memory loss due to decreased flow of oxygen to the brain
• Depression
• Poor overall health incluing an increased risk of heart disease, stroke, heart failure, and diabetes
• A limited ability, or complete inability, to engage in activities outside the home
• An increased need to visit the doctor or emergency department 

Common Forms of COPD

In her 20 years of working with patients with COPD, Hart has found that most patients experience COPD in the form of emphysema, chronic bronchitis, and bronchiectasis. “Each of these diseases impacts the lungs differently but ultimately cause the lungs to not function properly.”

Emphysema

While emphysema is one of the most preventable respiratory illnesses, it still impacts over three million Americans. Hart explains that emphysema is the result of the damage to the walls of the air sacs in the lungs.

“Called alveoli, these air sacs are tiny and abundant in the lungs and normally move in and out with each breath. But when damaged, often by smoking, they lose their elasticity and become floppy, almost like a stretched-out balloon, which makes it hard for air to move in and out. As the walls weaken, collapse and even rupture, it creates larger air spaces instead of many small ones.

When you exhale, the smaller airways adjacent to the alveoli collapse and trap air. This trapped leads to hyperinflation of the lungs and makes it difficult to take a deep breath.”

Chronic Bronchitis

The airways in a healthy lung are lined with mucus and fine hairs called cilia that sweep over the mucus to help remove anything—like dust or pollen—that’s entered the airway.

In the case of chronic bronchitis, your lungs produce too much mucus, which makes it hard for the cilia to do their job. In addition, the excess mucus restricts airflow. Hart explains, “If you think of a normal airway being like a garden hose, chronic bronchitis narrows the amount of space air has to move through the hose. Over time you go from the width of a hose to a straw. As the body fights to get rid of the excess mucus, you develop recurring productive coughs that can last for months and experience shortness of breath, wheezing, and tightness in the chest.”

Bronchiectasis

Bronchiectasis occurs when the walls of your lung’s airways become damaged by abnormal stretching or enlargement. The enlarged spaces allow for mucus to pool. Not only do these pools of mucus block healthy air flow, but they also provide an ideal breeding ground for viruses and bacteria. “People with bronchiectasis often experience frequent respiratory infections. Shortness of breath, fatigue and a productive cough are also common symptoms of the disease,” says Hart.

How is COPD Diagnosed?

Because COPD can present in so many ways, diagnosing it involves reviewing several factors related to your health. These include:

• Clinical history
• Family history of lung disease
• Environmental and occupational exposure history
• Diagnostic testing, including a lung exam and pulmonary function test

A clinical history involves reviewing any symptoms you may be experiencing with your doctor. Common COPD symptoms include:

• Shortness of breath, typically with exertion
• Cough
• Wheezing
• Chest tightness
• Increased mucus production
• Frequent lung infections
• Lack of energy
• Unintended weight loss

The review of family history will focus on determining if any family members have COPD or other lung diseases or if any have an Alpha-1 antitrypsin (AAt) deficiency. This is a hereditary form of emphysema. Hart explains, “Alpha-1 antitrypsin is a proteinase inhibitor produced by the liver that protects the lungs. If your body doesn’t produce normal levels of this proteinase, inhibitor you can develop lung or liver disease.”

Because the damage that leads to COPD is frequently brought on by breathing in contaminants and unhealthy air, it’s helpful to understand an individual’s environmental and occupational exposure history, which can help with both diagnosis and treatment.

What Causes COPD?

While the list of things that can damage the lungs is extremely long, Hart notes the following as common causes of lung damage:

• Cigarette smoking
• Marijuana smoking
• Vaping

Exposures to:

• Secondhand smoke
• Asbestos
• Radon gas
• Toxic fumes
• Solvents
• Dust
• Dirt
• Aerosol household cleaners
• Powders
• Mold and mildew
• Bug spray
• Fireplace smoke
• Plug-in home perfumes

The information gained from the family, clinical, and exposure history works to help your healthcare provider better interpret and understand what’s learned through diagnostic testing. Frequent tests performed to confirm COPD include:

• Chest X-ray: can quickly identify emphysema, other lung problems and even heart failure
• CT Scan: provides a closer look at lung tissues identified in the x-ray and confirm a diagnosis
• Arterial Blood Gas: drawing blood from an artery as opposed to a vein gives your healthcare provider a lot of insight into different COPD-related levels in your blood. This information helps paint a clearer picture of what is and isn’t happening in your lung
• AAt test: your AAt level can be quickly determined by a simple blood test.
• Diagnostic testing: referred to as pulmonary function testing, diagnostic testing for COPD involves six different tests that reveal how your lungs are or aren’t moving air. From how much air you can blow out of your lungs and how much air your lungs can hold to how much air is getting trapped in your lungs and how efficiently air is moving through the alveolar walls of your lungs, diagnostic testing completes the picture of how your lungs are functioning.

COPD Treatment

There is no cure for COPD but there are treatment options that can slow the progression of the disease, help control symptoms, reduce flare ups, and allow you to continue enjoying an active life.

Medication for COPD

A common first treatment option is medication. Depending upon the nature of your COPD, your doctor may prescribe:

• Inhaled medications to decrease inflammation and clear the airways
• Mucolytics to thin and loosen mucus
• Cough syrup to help get mucus out of the lungs
• Antibiotics to treat infection
• Steroids to reduce inflammation
• Oral medication to reduce flare ups

If you are AAt deficient, you may also receive an infusion therapy to build back up the critical levels of this important protein.

Non-Medication COPD Treatment Options

In cases where someone’s oxygen level drops to 88% or lower, oxygen therapy, or supplemental oxygen, is strongly recommended. Depending upon how much oxygen you need, your healthcare provider will recommend the best oxygen delivery method (there are more than just tanks) to help you get your levels up and allow you to remain as active and engaged in life as possible.

Airway clearance techniques are another type of treatment option that works to ensure air is moving as freely as possible in your lungs. These methods rely on techniques and devices to clear and open airways. Specific breathing techniques are effective at moving mucus out of the lungs and reducing risk of infection, such as:

• Huff coughing – a “huffing” technique that is similar to fogging your glasses
• Positive expiratory pressure – using a specific device and breathing technique to clear mucus
• Autogenic drainage - a controlled breathing technique to push mucus up and out of the lungs
• Chest physiotherapy, which involves percussion to the chest and back to loosen mucus

High-frequency chest well oscillation (HFCWO) may also be used. HFCWO involves putting on a vest that inflates and then shakes your upper body to, again, loosen and move mucus out of the lungs.

An important part of all COPD patient treatment plans is pulmonary rehabilitation.

Baystate Health’s Pulmonary Rehabilitation program spans eight weeks and engages patients in:

• Exercise training
• Breathing exercises
• Nutritional counseling
• COPD education
• Management of anxiety, stress, and depression 

Hart, who has been a part of the Baystate program for the past 20 years says, “Pulmonary rehab works to give people back a bit more control of their lives. By building their strength and endurance, improving their diet which improves overall health, patients can improve their quality of life and their mental health.”