Risk Factors for COPD Patients

What is COPD? Are all COPD patients either smokers or former smokers? The answer, primarily, is yes. But there are other ways to get chronic obstructive pulmonary disease. Lighting up is the most common trigger, but read on for other possible causes and treatments. Plus, how much do you know about COPD? Take our quiz to find out...

Chronic obstructive pulmonary disease (COPD) isn’t just for smokers. Although smoking increases your risk drastically, there are other ways to get the disease, which is actually a combination of disorders.

“There are a lot of terms we use loosely in COPD,” says Mark Millard, M.D., medical director of the Martha Foster Lung Care Center at Baylor University Medical Center in Dallas, Tex.

“Emphysema is one [and] chronic obstructive bronchitis is another,” he says. “But all of these are characterized by airflow obstruction that’s not fully reversible.”

Identifying the cause is important because it affects your treatment.

In this Lifescript exclusive interview, Millard discusses risks factors for COPD, as well as how the disease is diagnosed and treated.
What is COPD?
COPD is an acronym.

C stands for chronic – in other words, this doesn’t go away. It’s always there.

O stands for obstruction, which defines the problem. When you blow out, you can’t get enough air out of the airways. You can get air in, but getting air out is the problem.

P stands for pulmonary, which is a lung problem.

And D means it’s a disease.

How do patients get a COPD diagnosis?
The only way to make a definitive COPD diagnosis is through a breathing test with a [device called a] spirometer.

It measures airflow obstruction, and the time to do it is when [the patient is] sick with bronchitis.

That’s when you find out if this is somebody with just a cold – in which case the breathing test may be normal – or if this is someone with COPD.
Exhaling issues are a symptom of asthma. What’s the difference between COPD and asthma?
In asthma, it may be fully reversible. An asthmatic [patient] may have a problem getting air out because the airway is narrowed by a bronchospasm [an abnormal contraction of muscles in the bronchi, large air tubes in the lungs].

However, when you take your quick-relief medicine or a daily controller drug, suddenly airways are open and normal.

Asthma is characterized by significant improvement, if not normalization, after treatment.

And COPD doesn’t normalize after treatment?
COPD is characterized by airflow obstruction that’s not fully reversible. It may get a little better with medication, but if it doesn’t get [significantly] better, that’s COPD.

Are COPD patients more likely to be smokers?
If you look in the U.S., 95% of COPD patients have smoked at least a pack a day for 10 years.

If you never smoked and have a COPD diagnosis and you live in this country, it’s one of three things:

The most common is the doctor made the wrong diagnosis. We’re not supposed to admit mistakes, but, frankly, we make mistakes in medicine.
The second is a [genetic] alpha-1-antitrypsin deficiency that predisposes some people to emphysema. People can develop emphysema at an early age if they smoke, and in older years even if they never smoked.

A very heavily polluted environment is the third way people can get chronic obstructive pulmonary disease.

The most common cause in the Third World is tobacco smoke, but there are also women who live in one-room huts and have open-source heating and cooking.

They heat and cook on a stove that’s not ventilated. It dumps pollution into the enclosed environment in high concentrations.

They become COPD patients without ever having smoked a cigarette because they’re in that smoke all the time.

So those environmental causes are mostly in Third World nations?
The majority of them are. That doesn’t mean air pollution and secondhand tobacco smoke can’t exacerbate lung disease, but it’s usually not a primary cause of COPD.

Is alpha-1-antitrypsin a missing component to the genetic makeup of some COPD patients?
It’s kind of like blue eyes, a recessive gene. You have to have two alpha-1-antitrypsin deficient genes to get emphysema.

Or, if you smoke crazily and have maybe one gene, you’re predisposed [to COPD].

But the classic alpha-1-antritrypsin person is younger when [they] develop emphysema without smoking or just with trivial smoking.
Is there a group of people who are predisposed to the alpha-1-antitrypsin deficiency?
It happens more in Scandinavians or northern Europeans. So areas of the U.S. that have more northern Europeans are more likely to get it than [areas with more] Latinos, African-Americans or Native Americans.

Is there a treatment for COPD patients that addresses the alpha-1-antitrypsin deficiency?
Treatment includes replacing the enzyme. You can blunt the decline of disease by monthly infusions.

The alpha-1-antitrypsin enzyme is very important to reduce stress on the airways and prevent inflammation from damaging air sacks.

When you don’t have it, the bad enzymes act like Pac-Men and chew up your lungs as opposed to being squelched by the good enzymes.

If enzyme therapy is effective in people with the genetic deficiency, why can’t it be used in COPD patients who have smoked?
It doesn’t work. We don’t understand all the genetic factors that go into why people get COPD.

We understand that it runs in families [and] it’s clearly triggered by tobacco and usually heavy smoking.

There are a lot of intriguing theories as to why [COPD happens to smokers]. The lungs may actually be sensitized.

The tobacco smoke may in some way cause the body to think the lung is a foreign substance and go after it, in the same way [your body] would reject a transplanted kidney or liver.

Is a COPD diagnosis more prevalent in women than men?
The Virginia Slims revolution really turned nasty because women may be more susceptible to the effects of tobacco smoke than men.

Why?
We don’t know why – but we do know that more women die of lung cancer now than men.
Lung cancer is the leading cause of death from cancer in men and women. Lung cancer surpasses breast cancer in women in terms of its lethality.

Women seem to be more susceptible to the effects of tobacco smoke, and we’re seeing many [more] women COPD patients than men.

What treatments are available for those who don’t respond to enzyme replacement therapy?
The most important treatment for COPD patients is to stop smoking. Your lung function may not improve that much when you stop smoking, but it doesn’t get worse – and the disease certainly won’t progress any faster in a nonsmoker than a patient who is still lighting up.

Do the lungs still decline in function?
COPD is a two-sided coin. The first part is shortness of breath, but the second is exacerbation, which is essentially an acute episode of bronchitis.

If you have COPD and continue to have repeated episodes of bronchitis – where you need antibiotics and prednisone, and you seem to be sick forever several times a year – you may have continued decline of lung function even if you stop smoking.

How does that affect treatment?
COPD [treatments] are almost all inhaled medications that reduce shortness of breath.

We have two classes of bronchodilators [which open the bronchi] and combinations of bronchodilators and cortisone derivatives that are somewhat like the ones used to treat asthma.

They’re usually at a higher strength, however, to reduce shortness of breath in COPD patients.
Can exercise help COPD patients?
It can be a struggle. COPD patients have to keep moving.

The problem is that if they move too fast or breathe so they’re panting, their lungs will hyperinflate (fill up with too much air that cannot be exhaled) and they stop.

Then, they get depressed because they’re afraid to do any more. But they get out of shape, so when they try to do something it takes even more air because their muscles are very inefficient and they’re breathing faster.

Pretty soon they can’t get out of the chair without panting, much less go to the bathroom.

What can COPD patients do to avoid that vicious cycle?
[They can get] pulmonary rehabilitation – and that’s why it’s now a covered Medicare benefit.

A little less than half of COPD patients have Medicare, and slightly more than 50% are below the age of Medicare. The younger ones usually have a milder form of the disease.

In a six-week rehab program tailored to people who get short of breath with activity, they teach strategies for getting from here to there without feeling like you’re going to die.
What does that rehab entail?
Pacing yourself. Don’t do a sprint. Take it easy and practice a breathing technique called “pursed-lip breathing.” Breathe in through your nose and then out through your mouth with your lips pursed as though you’re whistling.

That creates enough backpressure in your airways to keep them from collapsing or narrowing as you exhale.

Do COPD patients get stronger as they exercise?
You’ll be able to get much farther down the road before you have to stop. Then you can start to train yourself as you increase activity.

If you train your muscles, it takes less air for the same amount of activity so you can recapture some of that territory you’ve lost because of de-conditioning and muscle inactivity.

What lifestyle changes and home remedies are available?
Don’t smoke. If you don’t smoke there are a whole host of diseases you can cross off your list.

Lightning can strike, but it’s rare. If you don’t smoke, your likelihood of getting COPD is the same as winning the Texas lottery.

For more information, visit our COPD Health Center.
How Much Do You Know About COPD?
Chronic obstructive pulmonary disease (COPD) is on the rise, according to the National Institutes of Health. More than 12 million people in the U.S. are currently diagnosed with it, and another 12 million may have it but don’t know.