In this part . . .
**IN a DROPCAP**We also take you inside your bodyâs respiratory system to show you how it functions when itâs healthy and when itâs not, and we look at factors that influence how well your lungs function. Then we give you detailed information about the risk factors for COPD â from smoking to gender to individual medical history â so you can assess how many of these factors apply to you.
Chapter 1
Understanding COPD
In This Chapter
Defining what COPD is and isnât
Looking at how COPD affects your body
Understanding COPDâs impact on your life
Chronic obstructive pulmonary disease, or COPD, is the fourth leading cause of death in the United States and the second leading cause of disability. The costs associated with COPD are enormous â more than $37 billion a year, including $20 billion a year just in direct healthcare costs. Some 12 million American adults have been diagnosed with COPD, and another 12 million may have it but donât know it.
How can there be so many undiagnosed cases of a life-threatening illness? For the same reason that many diabetics and people with high blood pressure go undiagnosed: The symptoms, especially early on, are so vague that theyâre easy to ignore. And when COPD symptoms do appear, they can be mistaken for other conditions, like asthma.
In fact, until fairly recently, most people outside the health profession had never heard of COPD, and those who had heard of it very often dismissed it as a âsmokerâs disease.â Smoking is the number-one risk factor for COPD, but it is by no means the only one. Long-term exposure to dust, chemical fumes, secondhand smoke, and other pollutants can lead to COPD, and thereâs even a genetic condition that, though rare, can cause the disease.
COPD also was long considered a manâs disease. But since 2003, more women than men have died every year from COPD. Many experts attribute this shift to the fact that, while smoking rates among men have dropped over the past two or three decades, the smoking rates for women have crept upward. Women also seem to suffer more than men from many of the health-sapping effects of COPD, so it tends to progress faster in women than it does in men.
Thatâs the insidious thing about COPD: Itâs a progressive disease. New treatments and better understanding have improved management of its symptoms, but there is no cure, and the average life expectancy after diagnosis is about five years, depending on the severity of the COPD and other health factors.
Faced with these sobering facts, many people feel overwhelmed, even discouraged or depressed, when they first learn they have COPD. But you arenât completely powerless. There are all kinds of steps you can take to manage your COPD symptoms and improve your quality of life. The first step is understanding COPD and how it affects your body.
What COPD Is and Isnât
COPD is an umbrella term covering any long-term, irreversible damage to the lungs that interferes with breathing, specifically with getting air out of the lungs.
If you break the term down into its four parts, hereâs what chronic obstructive pulmonary disease means:
Chronic means âalways presentâ (as opposed to
acute, which refers to a short-term condition that disappears after treatment).
Obstructive means âblocking.â
Pulmonary refers to the lungs, including the airways and tissues that allow your body to pull in oxygen and push out carbon dioxide and other gases.
Disease is a condition that harms a specific bodily function and/or your overall health.
So chronic obstructive pulmonary disease is a condition in which you have trouble getting air out of your lungs because your airways are continually blocked.
Not being able to get air out is a problem because, when that air is trapped in your lungs, you canât inhale enough air to supply your body with oxygen. (Chapter 2 describes the gas exchange process in detail.) Your body senses that you arenât getting enough oxygen and sends signals telling you to breathe faster to correct the problem. This process is what makes you feel like you canât catch your breath.
Smoking just adds to the problem. Smoking increases mucous production in your lungs and paralyzes the cilia â the little âbroomsâ whose job it is to sweep mucus and particles up your airways so they can be coughed out. Too much mucus clogs the gas-exchange function of your air sacs, so you feel short of breath.
When you canât cough out mucus and particles, you have a higher risk of developing lung infections like pneumonia â a serious problem for COPD patients.
Coughing is one of your respiratory systemâs most important defense mechanisms. But smoking can interfere with your ability to cough effectively. You may not be able to cough out as much air, and you may not be able to put enough force behind your cough to expel mucus and irritants. The smokerâs hack, though more frequent than a nonsmokerâs cough, isnât nearly as effective.
What COPD is: The deadly combo
In the vast majority of patients, at least in the United States, COPD refers to a combination of chronic bronchitis and emphysema. (Other countries have higher incidences of other lung diseases that can fall under the definition of COPD.) Most COPD patients have both conditions, although one may be more advanced than the other.
Chronic bronchitis
Bronchitis is a condition in which the airways in your lungs are inflamed, making them narrower. Inflammation is usually a response to an irritant, like cigarette smoke, dust, or pollen. When your airways are irritated, they create more mucus in an effort to rid your lungs of the irritants. But this extra mucus, combined with the narrowing of the airways themselves, can end up blocking your airways. Air then gets trapped in your lungs, and you feel short of breath.
In chronic bronchitis, your airways become scarred and the partial blockage is permanent. Extra mucus is produced all the time, which can make you feel congested and prompt continual coughing. You become more susceptible to respiratory infections because the extra mucus in your airways provides an admirable breeding ground for bacteria and viruses. Figure 1-1 shows how chronic bronchitis affects your airways.
Chronic bronchitis develops over several years. It can affect people of any age, but it is most common in smokers who are in their 40s or older. About 9 million Americans have been diagnosed with chronic bronchitis; two-thirds of them are female.
Symptoms include chronic coughing and throat clearing, increased mucus, and shortness of breath. To meet the clinical definition of chronic bronchitis, you must cough up mucus most days for at least three months of the year for two consecutive years.
Many people ignore their chronic bronchitis symptoms because they mistakenly believe it isnât serious. The earlier you see your doctor, the better your chances of preventing serious damage to your lungs.
| Figure 1-1: Chronic bronchitis inflames and narrows your airways. | |
Emphysema
Chronic bronchitis affects your airways, the tubes that branch out into your lungs. Emphysema affects the tiny air sacs at the ends of your airways. This is where the oxygen in the air you inhale is exchanged for carbon dioxide and other waste material in your blood. To facilitate this exchange, the walls of your air sacs naturally are quit...
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