by Stewart B. Segal, MD
SERVICE MANUAL – COPD
Patients with Chronic Obstructive Lung Disease (better known as Emphysema and Chronic Bronchitis) require the same routine yearly preventative exams as those without COPD. In addition, they require daily exercise, maintenance of a smoke and toxin free environment and quarterly office visits to maximize their care. COPD, unlike many other diseases, can be somewhat controlled if the patient, his family and doctor work in tandem. COPD is a progressive disease and the goal of treatment is to slow the progression and improve quality of life.
Normal lung function diminishes slowly as we age. Patients with COPD experience a more rapid loss of lung function. During the early stages of the illness, lost lung function is not appreciated by the patient. Humans have a huge reserve of surplus lung function. As COPD progresses, patients often decrease their activity level until one day they realize that simple tasks cause them to be short of breath. Unfortunately, COPD is not reversible. Losses are permanent. In the United States, COPD is most often diagnosed in its late stages. Medication and exercise help slow its progression and improve quality of life parameters.
Patients with COPD should be seen every time their symptoms worsen. An acute worsening of COPD (exacerbation) should be treated aggressively as with each exacerbation, more lung function is forever lost. Think of an exacerbation as a heart attack. Increased coughs, shortness of breath or fever are warning signs!
Quarterly medical checkups should include a careful review of your home activity levels and limitations, blood pressure monitoring, pulse oximetry monitoring (oxygen level), an exam of heart and lungs, as well as pulmonary function testing (spirometry).
Yearly, patients with COPD should have spirometry, a complete physical with appropriate laboratory testing and other tests as dictated by age and severity of the disease.
If caught early and treated aggressively with smoking cessation, avoidance of inhaled irritants, exercise and medication (when necessary), the scope of the disease can be seriously limited and the hope of salvaging enough lung capacity to live a normal life is possible. The trick is to diagnose the disease early.
Your lungs are precious. Breathing air is essential. Stop smoking now. The benefits of not smoking are real at any stage of COPD. If you smoke, ask your doctor for a spirometry test. If it is normal, you are lucky. Stop smoking now! If it is abnormal, stop smoking now and then go to work at preserving what you have left.
Today I saw a 65 year old with the lung age of an 85 year old. He quit smoking 7 years ago. He lamented about how bad his lungs are. He gets short of breath walking steps. It makes him feel old. Today, we started him on medication to try to improve his lung function. I hope he will start exercising. Exercising is a form of pulmonary rehabilitation and can help bolster his remaining lung. With care and proper follow-up, I expect he will have many good years to come.
COPD often goes undiagnosed and is mistaken for recurrent upper respiratory tract infections and bronchitis. If you have repeated respiratory infections, find yourself short of breath with exercise or simply cough too much, see your doctor. A simple spirometry test can help diagnose COPD or Asthma.