COPD is now the third leading cause of death in the US. COPD is an abbreviation for Chronic Obstructive Pulmonary Disease, and includes both emphysema and chronic bronchitis. Obstruction refers to the delay in getting air out of the lungs. In COPD, the airflow obstruction is caused by a combination of changes in the airways, including (1) structural changes that make the airways more collapsible when air is being forced out of the lungs, (2) scarring of the airways, (3) abnormal secretions within the airways, (4) airway swelling caused by inflammation or irritation of the airways. Although the word Chronic does indicate most of the changes are not reversible, a combination of medications and lifestyle changes (stop smoking) can often lead to significant improvement in both symptoms and measurements of Lung Function.
COPD is most commonly caused by long-term cigarette smoking (also heavy pipe and cigar smoking) because tobacco smoke contains many ingredients that injure the airways over years of exposure. It is important to realize that COPD also develops in ex-smokers, sometimes years after they have quit smoking. There are some less common situations in which lifelong non-smokers can get COPD including severe chronic asthma, genetic emphysema (alpha-1 antitrypsin deficiency), or some workplace exposures (silicosis, coal-workers pneumonconiosis or “black lung”).
The diagnosis of COPD requires a breathing test called spirometry, in which a full breath is taken and blown out fast and hard into a tube that measures the volume of air expelled over time, typically 6-12 seconds. Two measurements from spirometry are most important in the evaluation for possible COPD: the FEV1 (Forced Expiratory Volume in 1st second of expiration) and FVC (Forced Vital Capacity, the total volume of air expelled during the 6-12 seconds of blowing out). Normal values have been determined from healthy normal volunteers categorized by height, sex and age. In this way, we can take a 50 year old man 6 feet tall and identify whether his FEV1 and FVC are normal or abnormal. In COPD, the FEV1 is reduced more than the FVC, such that we evaluate both the FEV1 as % of normal – as well as the ratio of the FEV1 divided by FVC. Well-established values are used to define the absence or presence of airway obstruction, and the magnitude of the obstruction. COPD cannot be accurately diagnosed without spirometry.
At SEC Lung, our initial evaluation always includes comprehensive Lung Function tests that include spirometry. Once we have identified an individual with COPD, we develop a comprehensive treatment plan along with efforts to help our patients quit smoking. Medications most commonly used for treating COPD are inhalers containing medicines that dilate the airways (“bronchodilators”) to reduce the obstruction of airflow, and medications that reduce irritation/inflammation of the airways (“inhaled corticosteroids”). A growing variety of short and long – acting bronchodilators, in various combinations are now available. At SEC Lung we follow international in the prescribing of COPD medications guidelines (Global Obstructive Lung Disease). SEC Lung also has an active clinical research program focused primarily on the evaluation of COPD Medications; participation in clinical research studies is strictly voluntary.
For additional information and resources relating to COPD, please go to COPD Foundation.