COPD throws challenges in the way of patients

About 24 million Americans suffer from chronic obstructive pulmonary disease, commonly known as COPD. It’s a condition with generic-sounding symptoms — sudden episodes of shortness of breath and extended bouts of bronchitis and cough that last more than three months. Most sufferers can also point to smoking earlier in their life as a culprit, even if they quit long ago.

“Those who have smoked 15 or 20 years, it can show up later,” said Bruce Leonard, an associate professor at UNLV’s School of Nursing.

About half of the 24 million Americans battling COPD don’t know they have it. Often, people go undiagnosed, mistaking the condition for asthma, which also involves airflow obstruction. However, airflow obstruction in asthma can be reversed while the type found in COPD is irreversible, experts say.

Leonard and others like the COPD Foundation, an education, research and advocacy group founded in 2004, call early diagnosis a necessity. The condition leaves many sufferers with severely compromised lives, but the hope is that early and appropriate intervention can help them lead somewhat normal ones.

“This really is more of a damage control situation,” added Dr. Fadi Braiteh, director of translational oncology at Comprehensive Cancer Centers of Nevada. “The

bottom line is that it’s a chronic illness that runs its course over years and decades and can severely impact your quality of life.”

PREVALENCE, TESTING

More than half of COPD sufferers are older than 65, according to the COPD Foundation. On its website, copdfoundation.org, a questionnaire can help visitors gauge their COPD risk and whether they should be tested for the condition.

The state with the highest prevalence of COPD cases is Kentucky, where 9.3 percent of the population has it. While Nevada gets its share of negative health grades because of its smoky casinos, the Silver State shows 6.9 percent of the population with COPD. Washington and Minnesota have the lowest rates with only 3.9 percent.

Dr. Naresh Singh, a valley pulmonologist and clinical assistant professor of medicine at the University of Nevada School of Medicine, said COPD treatment is tied to the severity of the condition.

A spirometry test is used to gauge whether a person is a mild, moderate or severe case. The test requires a patient to blow into a tube connected to a computer that houses information about the patient’s age, height, weight, gender and race.

These five parameters help to assign a “predicted value,” explained Singh, for how much forced expiratory volume (FEV-1) of air a person should release when blowing into the tube. A normal FEV-1 is above 80 percent, Singh said. He says a mild COPD rating is between 70 percent and 80 percent, moderate is between 50 percent and 70 percent, and 30 percent to 50 percent is considered a severe case. Below 35 percent, Singh considers “very severe.”

“When you change your classification, your life expectancy can also change,” he said.

This is an important point, he said, as some COPD patients shopping for a life insurance policy could be accepted if their readings show a lesser severity.

WHEN TO TEST

COPD symptoms such as coughs or bronchitis are common during cold and flu seasons, and gauging whether the situation is serious enough to warrant a test is difficult. Leonard warns of the suddenness of the condition.

“A lot of times it happens quickly,” he said. “You could be low on the oxygen saturation curve to where lung function decreases a little but by the next day you can’t climb the stairs.”

Leonard also said COPD patients can have very different physical profiles: “bloaters,” or those who are overweight with bronchitis symptoms, or “pink puffers,” who may have a redness to their skin tone and be losing weight while battling emphysema — the destruction of the lungs — as well.

Physicians often look to blood oxygen levels as early indicators of a problem. These tests are routinely done during doctor visits. As a patient’s blood pressure is being taken a plastic clip is usually put on a finger to gauge oxygen levels.

But oxygen levels are best checked after a person undergoes a six-minute walk, Leonard added. Too often, the test is administered after the person has been resting for a long time, instead. Leonard said that reading isn’t a great indicator of a person’s true blood oxygen levels.

Roughly 100,000 Americans also have a genetic predisposition known as Alpha-1 antitrypsin deficiency, making them susceptible to COPD whether they’ve smoked or not. And those working in environments with heavy secondhand smoke exposure, such as casinos, are also susceptible to COPD.

“Even though you’re living a healthy life and shopping at Whole Foods and Trader Joe’s, you can still get it,” Singh added.

CARE, INSURANCE

For COPD patients, environmental factors exacerbating the condition must first be removed. Singh recommends patients also buy masks to wear over their mouths and noses on windy days. For those who work in environments with secondhand smoke, it may mean a career change.

“The hard part with COPD is if it shows up midcareer, you may have to give up your career,” Leonard added. “You can go from middle class to poverty if you have to give up work entirely and are not be eligible for Medicare.”

After environmental changes come inhalers. Steroid inhalers such as Pulmicort and Flovent, which are often used by asthma sufferers, can help in milder COPD cases. Anticholinergic bronchodilators such as Tudorza and Spiriva are popular and effective for COPD patients, as are corticosteroid beta agonists such as Symbicort and Advair, Singh said.

More severe cases may require pulmonary rehabilitation. In most cases, the patient visits a pulmonary specialist two to three times a week. Respiratory, occupational and physical therapists can also be involved in the care.

COPD sufferers tend to take rapid, shallow breaths, and a respiratory therapist can teach patients how to take slower, deeper, quality breaths. Some patients require oxygen therapy, too, and physical and occupational therapists can help patients learn to make daily tasks easier through exercise and home environment changes.

“For some,” Singh said, “It’s a case of getting their energy level to where they used to be able to do one load of laundry in a day. Now they can do two.”

But insurance doesn’t always cover pulmonary rehabilitation.

“Unfortunately, this is something that has a great demand and benefit but there are significant barriers with insurance providers to authorize pulmonary rehab,” Singh said. “It is an underauthorized service that could really help people with COPD.”

DIET, EXERCISE

Dealing with COPD may mean changing diet. Braiteh said COPD patients who are on chronic steroid medicine should consider calcium supplementation to avoid osteoporosis, which has been associated with excessive steroid medicine use. He also recommends an influenza vaccine for COPD sufferers, as bouts of the flu can cause serious problems for those with compromised lungs.

Leonard also recommends COPD patients add extra protein to the diet. Because they are using so much energy to breathe, they often don’t realize how much energy is being spent. That’s why many COPD patients with emphysema also lose considerable weight, he said.

He also recommends multivitamins and B vitamin supplements to help with energy levels.

As a part of pulmonary rehabilitation, Singh said most programs emphasize eating a low carbohydrate diet, too.

“You’ll see a lot of people with COPD eating candy bars,” he said. “After 45 minutes to an hour, when the body metabolizes it, they feel a shortness of breath. A high-carbohydrate diet does aggravate shortness of breath.”

Leonard also recommends exercising for 20 minutes, three to four times a week.

“It’s one of the few things that can help improve quality of life and the perception of quality of life,” the professor said. “It won’t heal the lungs, but it can help energy levels.”