COPD: It’s an Often Deadly Condition, But There Is Relief

Chronic Obstructive Pulmonary Disorder (COPD) is the third leading cause of death in the United States. It’s a progressive disease (that means it gets worse over time) that includes two main forms:

• Chronic bronchitis: A persistent, long-term cough that produces mucus
• Emphysema: The gradual destruction of the lung’s air sacs

There’s no cure, but there are treatments that can help with symptoms.

We talked to Cynthia Brown, MD, board-certified in pulmonary, critical care and sleep medicine, to find out more about COPD and learn about research going on at UVA.

What Are the Common Causes of COPD?

Smoking is by far the most common cause of COPD, and secondhand smoke is also a risk factor.

Brown often sees people who stopped smoking 10, 15 or even 20 years ago. In fact, two-thirds of her patients no longer smoke. “They say, ‘Why am I developing symptoms now?’ People are first diagnosed usually in their 60s, sometimes many years after they stopped smoking,” she says.

Interestingly enough, more women die from the disease than men. Why are women more susceptible to the effects of cigarette smoking? “It may be that women just generally have smaller lungs. So if a man and a woman are smoking a pack a day, the woman gets more exposure,” Brown says.

It’s likely more women are dying now from COPD because the 1960s and 1970s were when many women in the United States started smoking.

Brown says there are other, less common risk factors for COPD. HIV patients who smoke even a little bit are more likely to get COPD. Severe malnutrition is a factor, and people who’ve had anorexia can get the disease whether they smoked or not, Brown says.

How Does COPD Affect Sleep?

We all tend to breathe less during sleep than when we’re awake, and when COPD patients go to sleep, their breathing problems increase.

“As their symptoms get worse, they have to choose to sleep or breathe,” Brown says. “Their oxygen levels drop and carbon dioxide levels rise, causing them to wake up frequently. They can’t maintain an appropriate level of breathing.”

So what can COPD patients do to get a better night’s sleep?

• Long-acting inhalers (12 to 18 hours of effect) can help.
• Some medications can help improve oxygen levels at night.
• Patients with other sleep disorders (like sleep apnea) may benefit from having oxygen or positive pressure (ventilation) delivered throughout the night via a mask.

What Are the Other Side Effects of COPD?

COPD is a lung disease, a respiratory disorder with far-reaching effects on the body, according to Brown. Patients with COPD can have more inflammation in their body, and people with COPD are generally at greater risk of developing lung cancer. COPD also carries with it a higher risk for heart disease and high blood pressure (hypertension).

How Do You Know If You Have COPD?

The two main symptoms of COPD are:

• Feeling short-winded
• Chronic coughing

If you do start feeling short-winded, don’t automatically attribute that to getting older, Brown says.

“If they find it used to take them 2 hours to mow the grass, and now it takes 4 or 5 hours because they have to take breaks because they can’t breathe, then that’s not normal and they should talk to their doctor,” Brown says. Another reason to see your doctor: If you’re coughing for 3 months and bringing up something with the cough.

Only way to know for sure if you have COPD, though, is to have a breathing test called a spirometry to find out your percentage of lung function.

COPD Research at UVA

Brown is doing research to help people find ways to sleep better with a more comfortable device. She’s currently conducting a clinical trial to test nasal insufflation.  “It’s a fancy way of saying we’re going to use air, not oxygen, at higher flow rates so the air flows through the nose very fast,” she says. Instead of using a tight-fitting mask (similar to the mask used to treat sleep apnea), this treatment uses a nasal prong (a little tube that fits into your nose). The tube is more comfortable than a mask. Brown’s device isn’t approved by the FDA, but she says there are similar devices that are approved.

“Air comes through at a higher flow rate and helps get rid of CO2 in the body. We want to see if that’s enough to ease breathing during sleep,” she says.

This study is open through 2015 and requires three overnight stays at the hospital.