Current and former smokers aren’t the only ones at risk

Most people are only vaguely aware of chronic obstructive pulmonary disease (COPD) — even though the Centers for Disease Control and Prevention reports it’s now the third-leading cause of death in American adults, after heart disease and cancer. Deaths due to heart disease and cancer have decreased, but that has not occurred with COPD.

An unexpected threat: Even though current or former smokers are at greatest risk for COPD, as many as one out of six people with the condition never smoked.

Good news: COPD can be managed with early diagnosis and treatment. Even those who have had the condition for years can minimize periodic flare-ups by taking the right medications. What you need to know about COPD…

What Is COPD?

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that blocks airflow and interferes with a person’s ability to breathe. The declining lung function that characterizes COPD is most often caused by emphysema and/or chronic bronchitis.

More than 12 million Americans have been diagnosed with COPD. An additional 12 million may have the disease but not know it.


Approximately 80% to 90% of all cases of COPD in the US are caused by smoking — primarily cigarette smoking, but long-term cigar or pipe smoking also increases risk.

Secondhand smoke (known as passive smoking) increases the risk for COPD by 10% to 45%, depending on the level of exposure, according to estimates from The World Health Organization. Increased risk can occur with daily exposure to secondhand smoke when living with a smoker.

People with long-term exposure to severe air pollution (as occurs in some big cities) and those who work or worked in the presence of dust, chemical fumes and/or vapors also are at increased risk for COPD.

In addition, some research shows a link between gastroesophageal reflux disease (GERD) and COPD. The reflux-causing disorder can worsen COPD or, in rare cases, cause it, though researchers are unsure why.


Shortness of breath, a chronic cough, wheezing and excess sputum production (with or without cough) are the main symptoms of COPD.

However, most people with early-stage COPD don’t even know that they have it. The symptoms come on so slowly — usually over decades — that people get used to them. They think that it’s normal to get short of breath when climbing stairs or to wake up with a mucus-filled cough. Or they attribute the coughing and/or shortness of breath to smoking itself and not to an underlying disease, such as COPD.

Important: The key symptom to watch for is shortness of breath, particularly during exercise or any type of exertion. This often is the first sign of COPD. Other symptoms, such as a chronic cough, usually occur later in the course of the disease.

By the time most people with undiagnosed COPD realize that something’s wrong, a significant amount of lung tissue has already been irreversibly damaged.

In the advanced stages of COPD, patients may find that even simple tasks, such as walking to the mailbox or rising from a chair, will leave them short of breath.


I suggest that everyone age 45 or older get tested at least once for COPD. Those with COPD risk factors — current or former smokers, for example, or those who are (or have been) exposed to dust/chemicals in the workplace — should be tested annually.

Spirometry is the main test for COPD. It’s inexpensive and painless and can be done in the doctor’s office in a few minutes. Few doctors routinely test patients with spirometry, but you should insist on it.

What the test involves: You blow into a spirometer, which measures your forced vital capacity (the total amount exhaled) and forced expiratory volume (the amount exhaled in the first second).

A “normal” reading will vary, depending on your age, sex and height. For example, an average, healthy 50-year-old man should be able to exhale about four liters of air in one second. A person with COPD might exhale only about 2.5 liters per second, or less.

Asthma can cause symptoms similar to those caused by COPD. Therefore, if you have asthma, your doctor may have you use an inhaled bronchodilator, then repeat the spirometry test. The spirometry readings will improve immediately in people who have asthma. With COPD, the readings remain the same or improve only slightly.

Insurance typically covers the cost of spirometry.


Not smoking is the most important step you can take to protect your lungs. Those at highest risk for COPD have accumulated 20 “pack years” — a measurement calculated by multiplying the number of packs of cigarettes smoked per day by the number of years that you’ve smoked.

People who quit smoking may regain close to normal lung function if they have very early-stage COPD. Those who quit later can preserve more of their normal lung function and slow the rate at which the disease progresses. Even if you quit smoking years ago, it’s possible to have undetected COPD without symptoms.

Since occupational pollutants are the second-leading cause of COPD, people who work in industrial jobs, such as mining or welding, or livestock farming, should always wear the appropriate protective equipment, such as particulate (air-purifying) respirator face masks.

Even in nonwork settings, you should wear a mask if painting, spreading fertilizer or doing any task that may involve dust or fumes.

Caution: Do not wear a mask if you have shortness of breath.


If you’ve already been diagnosed with COPD, your doctor will probably prescribe medications to reduce symptoms — coughing, difficulty breathing, wheezing and/or mucus production — during flare-ups.

Important: Such drugs should be taken at the first signs of a flare-up to minimize lung inflammation and help reduce long-term damage.

An alternative to medication may involve simple breathing exercises and supervised rehabilitation. As the condition progresses, it is customary to use medication and breathing exercises together.

Best COPD medications…

Bronchodilators that contain a short-acting beta-agonist, such as albuterol (Proventil) or tiotropium (Spiriva), expand and relax muscles around the airways and make it easier to inhale and exhale. Side effects may include vomiting and muscle pain.

Inhaled steroids, such as fluticasone (Flovent), reduce inflammation and may improve airflow when used in combination with other medications. Side effects of inhaled steroids may include headache, sore throat and, according to recent research, increased diabetes risk.

During flare-ups, oral steroids may be used for a short course (about 10 days), especially if a bronchodilator alone is not sufficient.

Other treatments…

Supplemental oxygen is sometimes needed to improve breathing and exercise tolerance in those with advanced COPD.

Lung volume reduction surgery may be recommended in rare cases of severe emphysema. It involves removal of the damaged sections of the lungs to allow the remaining lung tissue to work more efficiently. This treatment is effective only when patients have sufficient amounts of healthy lung tissue left after surgery.

Important: If you have COPD, any respiratory illness increases the risk for lung damage and may cause a more rapid decline in lung function. That’s why every person with COPD should get an influenza vaccination annually. Your doctor might also recommend a pneumococcal pneumonia vaccination every five years or so.