By Corinne R. Young, MSN, FNP-C, FCCP
Every November, members of the Chronic Obstructive Pulmonary Disease (COPD) community come together to spread awareness and education regarding COPD. This is a condition in which the airways and/or air sacks of the lung have been permanently and irreversibly damaged, causing a combination of symptoms that could include difficulty breathing, inability to empty air out of the lungs, cough, chronic mucus production, and sometimes the need for supplemental oxygen use. COPD is the most prominent in your 6th or 7th decade of life but can appear as early as in your 40s. Unfortunately, there is no cure for COPD and it is the 3rd leading cause of death worldwide responsible for approximately 3.2 million deaths in the year 2019 alone.
When most people hear the term COPD or emphysema, which lives under the umbrella of COPD, they think of smokers. Although true, with up to 75% of COPD sufferers current or former smokers, up to 25% of people with COPD never smoked. If you never smoked, could you be at risk for developing COPD? If you have a significant history of exposure to certain occupational, environmental, or genetic risk factors, then the answer is yes. Our lungs, skin and eyes are directly exposed to our environment, therefore are vulnerable to toxic insults. Chronic exposure to pollution, fumes, chemicals, dusts and smoke exposure (wood burning smoke or secondhand cigarette smoke) have all been linked to the development of COPD in nonsmokers. Regarding genetics, the COPDGene study is looking at genetic causes related to the development of COPD in smokers; however, a genetic disorder called Alpha 1 Antitrypsin deficiency (AAT) has been identified as cause of COPD in never smokers as young as age 30.
How do you know if you have COPD? The only way to appropriately diagnose and stage COPD is to have a pulmonary function test (PFT). In this test, you perform a series of breathing maneuvers that measure how much air you can expel from your lungs in a certain amount of time. There is a standard predicted score based on your height, weight, age, race and sex. If your performance on the PFT falls below a specific ratio you are then diagnosed with COPD. How far below the standard measurements you fall is how the severity of COPD is defined, and levels include Mild, Moderate, Severe, or Very Severe. Sometimes CT scans or chest X-rays can show evidence of emphysema; however, PFTs remain the standard of diagnosing and staging the disease. Genetic screening for AAT can be diagnosed by cheek swab or blood sample.
For the most part, COPD is a preventable disease. Avoiding smoking, secondhand smoke, fires, bad air quality and occupational exposures dramatically reduces your risk of developing COPD. However, if COPD does develop, there have been great advancements in treatments to include medications, non-drug therapies like pulmonary rehab, and procedures such as pulmonary valves, lung volume reduction surgery and lung transplant. If you feel you may be at risk for COPD or have symptoms compatible with COPD, see your health care provider to be screened. Early intervention in both prevention and treatment of COPD have been shown to make a significant impact on morbidity, mortality, and overall improvement in quality of life. Both your nurse practitioner or a lung specialist, called a pulmonologist, can assist you in determining your risk of developing COPD, diagnosing the condition, and setting a plan for treatment.