Pulmonary Disease

Doctor examining patient with stethoscope


If there is a single message that physicians want to send regarding COPD (Chronic Obstructive Pulmonary Disease), it’s this: Don’t smoke.

    “COPD encompasses emphysema, chronic bronchitis and chronic asthma,” says Dr. Dan Potts, co-director of pulmonary services at St. Luke’s Hospital and a pulmonologist with Cardio Pulmonary Associates in Chesterfield. “We do have medications that can help, but smokers have to stop.”

    There are at least 3,000 chemicals in tobacco smoke and only about 10 chemicals used as medications to combat the damage smoking does to the airways, Potts notes. Removing the constant barrage of harmful substances in cigarettes through smoking cessation is the first real step in treatment.

    Of course, the best health strategy is prevention. “If smokers stop, they could prevent the onset of COPD,” says Dr. Joseph Espiritu, a SLUCare pulmonologist and assistant professor of pulmonary critical care and sleep medicine at Saint Louis University School of Medicine. Limiting exposure to occupational dust, fumes or chemicals and to secondhand smoke also can help reduce COPD incidence.

    About 12 million Americans have been diagnosed with COPD, and an equal number probably remains undiagnosed, according to the National Heart Lung and Blood Institute. Symptoms usually are subtle or nonexistent in the early stages of disease, which means most patients have moderate to severe COPD by the time they seek medical attention.

    “People often don’t see their doctor until they notice shortness of breath even when they’re at rest,” Espiritu says. However, difficulty breathing during day-to-day exertion, such as while climbing a single flight of stairs, is a sign that airflow capacity is compromised. Other symptoms may include an intermittent cough that lasts for weeks or months, an increase in sputum production, wheezing and fatigue.

    A physical exam alone is not enough to make a firm diagnosis. “You really have to measure lung function with a special test called spirometry,” Potts says. Spirometry is non-invasive and measures both the volume and flow of air moving through the lungs. During the test, patients take a deep breath and then blow as hard as they can into a spirometer. After several such breaths, the machine calculates and graphs the results. Most patients are not symptomatic until their airflow is already decreased by 50 percent, Potts notes.

        Once diagnosed, COPD treatment seeks to control the symptoms, explains Dr. Adrian Shifren, an assistant professor of pulmonary and critical care medicine at Washington University School of Medicine. “We can’t cure COPD. It’s a progressive disease that causes lung function to decline over time, even with very good medical care. If you smoke, stopping is the single most effective form of therapy,” he says.

    Treatments include inhaled medications that help dilate bronchial passages to ease airflow. Inhaled corticosteroids are used to help reduce inflammation in lung passages. Oxygen therapy is beneficial for some patients, although most patients have exacerbations in which symptoms flare up and medications must be adjusted accordingly, Shifren adds.

    Pulmonary rehabilitation also helps patients improve their ability to function without becoming breathless. “It helps reduce hospitalizations and exacerbations,” Espiritu says. Muscles that are conditioned become more efficient and require less oxygen. In addition, moderate cardiovascular exercise, such as taking regular walks, is recommended.

    “This is a serious disease that has quite an effect on people’s lives. We can treat the symptoms relatively well, but prevention is important,” Shifren sums up. The bottom line: If you smoke, stop; if you don’t, don’t start. LN