Ask the Doctors: COPD most often associated with smoking

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Q: I'm 66 years old, and I seem to be of an age at which the people I know are being diagnosed with COPD. I've heard it mentioned in TV ads, but I still don't really understand what it is. Who gets COPD? Is there a cure?

A: Chronic obstructive pulmonary disease, commonly referred to as COPD, is the name for a group of lung diseases in which it becomes difficult to breathe. It is caused by lung damage and chronic lung inflammation, which produce symptoms that include wheezing, persistent coughing, an excess of mucus in the lungs, a sensation of tightness in the chest and shortness of breath, particularly during and after physical exertion.

Because COPD diminishes lung function, the amount of oxygen that is available to the body is reduced. This leads to symptoms like weakness and fatigue, and it can even cause the lips or fingernails to take on a blueish color.

The two most common types of COPD are emphysema and chronic bronchitis. In emphysema, the tissues in the smaller airways and air sacs in the lungs become damaged, which makes breathing increasingly difficult. Chronic bronchitis results in the over-production of mucus in the airways due to inflammation. This causes a persistent cough as the lungs attempt to clear the mucus. It also leaves the individual at increased risk for repeated respiratory infections. The disease is caused by long-term exposure to fine particulates and other irritants that damage the airways and the lungs.

The leading cause of COPD is a history of smoking cigarettes. It can also be caused by environmental exposure, such as air pollution and second-hand smoke, or industrial exposure, such as in coal mining, tunnel work and certain manufacturing and chemical processes. People with a deficiency of alpha-1 antitrypsin, a protein that protects the lungs, also can develop COPD despite having no other risk factors.

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To diagnose COPD, your doctor begins with a detailed medical history to assess exposure to pollutants, including cigarettes. Lung function tests are used to measure the amount of air someone can inhale and exhale and whether or not adequate amounts of oxygen are being delivered to the blood. The most common of these is spirometry, in which the person blows through a tube and into a gauge called a spirometer. The spirometer measures two markers of lung function -- the volume of air the lungs can hold and how efficient they are at expelling that air.

Scans such as a chest X-ray or CT scan may be used to detect emphysema, and to rule out cancer or heart failure. A blood test known as an arterial blood gas analysis reveals how efficient the lungs are at delivering oxygen to the blood and removing carbon dioxide, a waste product.

Treatment includes medications known as bronchodilators, which relax and open the airways to make breathing easier. In more severe cases, oxygen therapy and inhaled steroids to reduce inflammation may be recommended.

Lifestyle changes are just as important. These include quitting smoking. Staying active is important, and your doctor can help craft an appropriate exercise plan. Remember, COPD is a progressive disease, and patients who receive consistent medical care have the best outcomes.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.


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