People with COPD signs and symptoms tend to decrease their physical activity as shortness of breath makes exertion more and more difficult. If your COPD prognosis is poor, you also may think you need to cut down on physical activity. However, decreased activity can start a vicious cycle of progressive deconditioning. This leads to a worsening of COPD symptoms and more breathlessness. COPD rehabilitation is aimed at breaking that cycle.

COPD Rehabilitation: Program Basics

COPD rehabilitation is more than an exercise program, although exercise is the most important component. According to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), pulmonary rehabilitation is tailored to the needs of individual patients, and is designed to optimize physical and social performance and autonomy.

A portable spirometer, called an “incentive” spirometer, challenges and recruits reluctant alveolae.

The AACPR lists the following core components for a COPD rehabilitation program:

• Exercise training and other therapeutic exercise (aerobic, strength, and flexibility training)
• Education and skills training (such as breathing retraining)
• Secretion clearance techniques
• Prevention and management of COPD exacerbations
• Control of irritants and allergens
• Instruction in proper use and safety of oxygen systems
• Nutritional assessment and intervention if necessary (Find out how a COPD diet might help you in our article on COPD home remedies.)
• Psychosocial assessment, support, panic control, and professional intervention, if necessary
• Help with smoking cessation if currently smoking
• Education about medication use
• Implementation of a home treatment program follow-up

COPD patients at all stages can benefit from a COPD rehabilitation program—in fact, one study found that patients in the earlier stages of COPD derived greater benefits than those in the later stages.

Although those with less advanced COPD had better results, those with severe COPD signs and symptoms also had improved ability to exercise, and less shortness of breath. This research suggests that when it comes to COPD rehabilitation, the earlier the better. However, all of the patients were helped by the program. Other studies have found that rehabilitation benefits are generally sustained for up to 18 months after the program ends, especially if the exercise training is maintained.

There are many COPD rehabilitation programs around the country. Your doctor can most likely refer you to one—alternately, the American Association for Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org) has a searchable online directory of rehabilitation programs. Health insurance may or may not cover COPD rehabilitation—you’ll need to check with your insurance carrier.

Medicare coverage of COPD rehabilitation can vary from state to state, so check with your doctor or provider to obtain the guidelines in your state.

See also these University Health News posts:

• “Lung Diseases and COPD Facts: Understanding the Breathing Process“
• “Lifestyle Changes Among the Keys to COPD Treatment“
• “Is There Such a Thing as a COPD Diet?“

Originally published in May 2016 and updated.

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Sadly, however, smoking still kills about half a million Americans annually, and it isn’t just the obvious smoking diseases (like lung cancer) that account for these deaths. In fact, more illnesses than you might imagine can be termed “smoking diseases,” and your vulnerability to them varies depending on your age.

Smoking Diseases and Age

More younger Americans smoke—about 16 percent, compared with about 8 percent of adults age 65 and older—but older adults are at particular risk for smoking diseases because they typically have smoked for longer (an average of 40 years). Most smoking diseases strike during older age, and older smokers with a long history of tobacco use face significantly increased health risks as they continue to grow older.

Studies have demonstrated that smokers underestimate their risks of developing smoking diseases, and a few studies have found that smokers age 65 and older have even lower risk perceptions than younger smokers. The disparity in risk perception, experts believe, is due at least in part to the fact that smoking was viewed as acceptable a generation ago.

But it isn’t all negative—studies also suggest that older smokers may be slightly more successful at quitting than younger adults.

How Smoking Diseases Take Hold

Smoking harms the body because inhaled smoke contains many inflammatory substances—such as tar, and dangerous metals (including arsenic and lead)—that damage the body’s cells to the extent they may become cancerous. Smoking increases the risk of at least 14 cancers, including cancer of the breast, lung, larynx, esophagus, mouth, throat, bladder, pancreas, kidney, liver, stomach, bowel, cervix, and ovaries.

Smoke contains carbon monoxide, which displaces oxygen in the blood, and nicotine, which constricts the blood vessels, raising your blood pressure (a major risk factor for stroke), and forcing your heart to work harder to pump blood around your body. It lowers HDL (“good”) cholesterol, which is vital for transporting cholesterol to the liver to be processed for excretion, and elevates LDL (“bad”) cholesterol, which can build up on the walls of your arteries, narrowing and potentially blocking them, and impeding blood flow in the process.

These negative effects on your cardiovascular system mean that heart disease, diabetes, and kidney disease can be categorized as smoking diseases.

Smoking damages not just the lungs, but is implicated in a variety of diseases, from ulcers to arthritis to coronary artery disease.

Smoking Diseases: The Stats

The results of smoking can be seen in the statistics:

• Cigarette smoking, the leading preventable cause of disease and death in the U.S., is linked to 20 percent of all deaths and at least 30 percent of all cancer deaths.
• Of these, most deaths that can be linked to smoking diseases occur among people age 65 and older.
• Men in this age group who smoke are twice as likely to die from a stroke; women smokers are about one and a half times as likely to die from a stroke than their nonsmoking counterparts.
• The risk of dying from a heart attack is 60 percent higher for smokers.
• Smokers are more than twice as likely as nonsmokers to develop dementia of any kind, including Alzheimer’s disease.
• Smokers also have two to three times the risk of developing cataracts, a leading cause of blindness and visual loss.
• And of course, COPD signs and symptoms fall into the category of smoking diseases. If you have COPD signs and symptoms, your COPD life expectancy will increase if you quit smoking.

Why Is It So Hard to Quit Smoking?

About 70 percent of smokers say they want to quit, and about 40 percent try to quit each year. Only 4 to 7 percent, however, succeed without help, even though they’re aware of their risk for smoking diseases. This is partly because the nicotine contained in cigarettes is addictive, and partly because there is a strong psychological aspect to smoking, since it often is associated with social activities.

Cigarette smoking: It’s a dangerous habit that raises one’s risk factor for throat cancer, according to research.

When you try to quit, you’ll suffer from physical and mental withdrawal symptoms that can include headaches, fatigue, and tightness in the chest as well as irritability, depression, and difficulty concentrating. You also might find that your social life suffers as you try to avoid situations in which you might be tempted to smoke.

Withdrawal symptoms can last several weeks, but will lessen every day that you remain smoke-free. If you doubt your willpower, consider using medications—research has shown they can double the chances of success. Your doctor can prescribe drugs that reduce the nicotine craving and you also can opt for nicotine replacement gum, nasal spray, or patches.

How to Quit Smoking

Medicare covers smoking and tobacco use cessation counseling for beneficiaries who have smoking-related illnesses such as a COPD diagnosis, or who are taking medications that are affected by tobacco use. Medicare’s prescription drug benefit also covers smoking cessation treatments prescribed by a physician (over-the-counter treatments, such as nicotine patches or gum, are not covered).

Boost your odds of quitting smoking and help yourself avoid smoking diseases by:

• Setting a quit date and talking to your doctor about medications that may help you.
• Throwing cigarettes, lighters, and ashtrays into the garbage.
• Avoiding situations that may trigger an urge to smoke, and planning in other habits or activities you can engage in instead.
• Stocking up on other things to put in your mouth rather than cigarettes, such as peppermints, carrot sticks, toothpicks, and cinnamon sticks.
• Writing down your reasons for wanting to quit smoking (a list of smoking diseases is a good incentive), and pinning the list where you can see it as a constant reminder.

Originally published in 2016, this post is regularly updated.

The post How to Prevent Smoking Diseases—and Add Years to Your Life appeared first on University Health News.

Inside the lungs, there is a branching system of progressively smaller tubes (called bronchial tubes), at the end of which are air sacs (called alveoli). The alveoli have very thin walls, and are surrounded by capillaries (the smallest blood vessels). When you breathe in, oxygen and carbon dioxide travel through the bronchioles to the alveoli, and then pass through into the capillaries, where they are absorbed by red blood cells. This “oxygenated” blood travels to the heart, and then the rest of the body.

At the same time, carbon dioxide from the blood in the capillaries passes into the alveoli, to be passed out of the body when you exhale. This exchange of gases—oxygen in, and carbon dioxide out—takes just fractions of a second. But chronic bronchitis symptoms can prevent it from happening in the way it should.

Chronic bronchitis is characterized by “recurring bouts of airway inflammation accompanied by a persistent cough and phlegm production,” according to Science Daily. “Although chronic bronchitis has a variety of causes, by far the most common is smoking. Smokers with chronic bronchitis are prone to bacterial infections and face a high risk of developing a more debilitating form of airway inflammation known as chronic obstructive pulmonary disease (COPD).”

What Is Chronic Bronchitis?

Chronic bronchitis symptoms are caused by inflammation in the airways and an increase in the production of mucus. Inhaled tobacco smoke and other noxious particles cause lung inflammation.

When harmful foreign substances (such as bacteria, viruses, and other detrimental substances) enter the body, the immune system often responds by producing inflammation at the site of the threat. This serves to bring disease-fighting cells to the area where they are needed. In the airways, the presence of harmful substances also sparks the increased production of mucus to help move the substance out of the lungs.

Under normal circumstances, once the infection or foreign substance has been eliminated, any inflammation and excess mucus production subside. In people with COPD signs and symptoms, the inflammation and excess mucus production do not completely subside, but instead persist.

In addition, inhaled tobacco smoke can damage the hair-like cilia that normally help to sweep mucus out of the lungs and expel toxic substances. Constant inflammation in the airways and an overabundance of mucus can cause difficulty breathing, and a chronic cough. Other chronic bronchitis symptoms include fatigue and chest discomfort.

Chronic Bronchitis Treatment

Chronic bronchitis treatment involves a similar approach to that used to treat emphysema symptoms and COPD signs and symptoms. Drugs called bronchodilators can ease your breathing by expanding your airways, and you also may be given steroids to soothe airway inflammation.

Find out more on our COPD medications list, and also check out some of the COPD home remedies that can help ease chronic bronchitis symptoms. As with emphysema symptoms, a major cause of chronic bronchitis symptoms is smoking, so you should quit smoking if you are diagnosed with either.

Originally published in 2016, this post is regularly updated.

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Some strategies are as straightforward as getting immunized against influenza and pneumonia. Others are more complex. For example, younger adults who have emphysema as a result of a hereditary deficiency of alpha-1 antitrypsin may be treated with alpha-1 antitrypsin augmentation therapy.

For more severe cases, the COPD care plan is likely to include a specialized exercise program called pulmonary rehabilitation has been shown to improve the ability to exercise and engage in basic daily activities with less shortness of breath. Oxygen therapy may be required for severe disease, while some people with advanced COPD may be candidates for lung volume reduction surgery or for lung transplantation.

COPD Signs and Symptoms: Immunizations

For people with obstructive airway diseases, influenza and some types of pneumonia can be very serious and potentially life-threatening. It is extremely important that everyone in that position follow the recommended vaccination schedule or their doctor’s advice.

People with COPD should receive an influenza vaccination once a year. Flu season runs from around October and November through to March. The ideal time to get a flu shot is in October or November. (See also our post Common Cold and Flu Prevention: 15 Tips to Keep You Healthy.)

The pneumococcal vaccine protects against the bacteria that’s the most common cause of pneumonia (Streptococcus pneumoniae). The pneumococcal vaccine is available in two formulations (Pneumovax, and Prevnar 13), and is recommended for all COPD patients age 65 and older. It also may be given to patients with COPD who are younger than age 65 and have severe or very severe disease (FEV1 COPD less than 40 percent of predicted).

Unlike the flu shot, which must be given every year in the fall, pneumococcal vaccination provides protection for at least five years. It can be given at any time of the year.

Alpha-1 Antitrypsin Therapy

Alpha-1 antitrypsin is a protein that circulates in the blood. Augmentation therapy uses a concentrated form of this protein, which has been removed from donated blood and purified. This therapy cannot reverse damage that has already been done to the lungs, but it may slow down the further decline of lung function.

The therapy must be taken for life, and is very expensive. It must be administered by a healthcare professional in a doctor’s office or hospital clinic, or through home infusion services. The costs may be covered by private health insurance policies, but criteria for coverage can vary widely—before beginning therapy, check with your insurance company. For people age 65 and older, Medicare covers at least part of the cost.

Pulmonary Rehabilitation

A very helpful addition to drug therapy for people who have moderate, severe, or very severe COPD according to the GOLD COPD guidelines is a specialized program called pulmonary rehabilitation.

Pulmonary rehabilitation is a series of educational and structured exercises that allow people to make the most of the remaining capacity of their lungs. People with COPD who engage in these programs have less shortness of breath, an increased ability to exercise, better quality of life, and less frequent hospitalizations than similar COPD patients who do not participate in pulmonary rehabilitation

Importance of Exercise in Stemming COPD Signs and Symptoms

People with COPD signs and symptoms tend to decrease their physical activity, since shortness of breath makes exertion more and more difficult. Decreased activity can start a vicious cycle of progressive deconditioning, and this leads to worsening of symptoms and more breathlessness, with less and less physical activity.

Pulmonary rehabilitation is aimed at breaking that cycle through several core components:

• Exercise training and other therapeutic exercise (aerobic, strength and flexibility training)
• Education and skills training (such as breathing retraining)
• Secretion clearance techniques
• Prevention and management of exacerbations and pulmonary infections
• Control of irritants and allergens
• Instruction in the proper use and safety of oxygen systems
• Nutritional assessment and intervention if necessary
• Psychosocial assessment, support, panic control, and professional intervention if necessary
• Help with smoking cessation if currently smoking
• Education about medication use
• Implementation of a home treatment program follow-up

Is COPD Reversible?

Unfortunately there are no COPD cures. But COPD patients at all stages of the GOLD COPD guidelines can benefit from a pulmonary rehabilitation program—in fact, one study found that patients in the earlier stages of COPD derived greater benefits for their COPD signs and symptoms than those in the later stages. Although those with less-advanced COPD had better results, those with severe COPD also had improved ability to exercise and less shortness of breath.

This research suggests that when it comes to pulmonary rehabilitation, the earlier it is done the better—however, all of the patients were helped by the program. Other studies have found that pulmonary rehabilitation benefits are generally sustained for up to 18 months after the program ends, especially if the exercise training is maintained.

There are many pulmonary rehabilitation programs around the country. Your physician can most likely refer you to one; alternately, contact the American Lung Association (www.lungusa.org) or the American Association for Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org), which has a searchable online directory of pulmonary rehabilitation programs.

Health insurance may or may not cover pulmonary rehabilitation: You’ll need to check with your insurance carrier. The guidelines for Medicare coverage of pulmonary rehabilitation vary from state to state—check with your physician or pulmonary rehabilitation provider to obtain the guidelines in your state.

Originally published in 2016, this post is regularly updated.

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Chronic obstructive pulmonary disease is a debilitating respiratory condition for which there isn’t a cure. It results in chronic coughing and shortness of breath. Treatments ranging from inhalers to medications to surgery may help those with COPD to manage its symptoms.

COPD affects some 16 million people, making it the third-leading cause of death in the U.S., behind only heart disease and stroke. Mrs. Bush, who also struggled with congestive heart failure and Graves’ disease, had been a smoker for decades, but quit in 1968. It may have contributed to her COPD.

What Does COPD Stand For?

It’s easier to remember the COPD definition—and understand it—when you break it down letter by letter:

• Chronic: Usually refers to a disease or medical condition that has lasted for at least three months. In the cases of serious health challenges, such as COPD or lung cancer, the word “chronic” also suggests that the condition is likely to get worse over time.
• Obstructive: In this case, it refers to a blockage in some part of your airways or another problem that makes normal breathing more difficult. If you have COPD, inflammation caused by chronic bronchitis causes an overproduction of mucus, which leads to an obstruction in your airway.
• Pulmonary: Refers to the lungs. Your lungs are filled with tiny air sacs called alveoli at the very ends of the airway known as bronchi. To work properly, alveoli need to stretch like balloons. The sacs should fill up with air when you inhale and then empty with each exhale. COPD causes the alveoli to lose their elasticity, making it more difficult to expel each breath. When you can’t breath out, it’s hard to breath in, and the breathing difficulty associated with COPD can result.
• Disease: A disorder that affects a particular part of the body and produces symptoms. However, COPD can lead to complications elsewhere in the body, too. The arteries that supply blood to the lungs—which remove carbon dioxide from blood cells and replace it with oxygen—can become damaged by COPD. This can then lead to problems such as pulmonary hypertension and heart disease. Difficulty breathing can also take their toll on your emotional and mental health. Your risk of depression is higher if you have COPD.

Under the COPD Umbrella

The COPD definition—characterized by coughing and shortness of breath—actually has a broad meaning. The term is used to describe several lung diseases, but primarily emphysema and chronic bronchitis.

It’s worth noting that chronic bronchitis is different from acute bronchitis, which is a temporary inflammation of the mucus membrane in the bronchial tubes, often caused by a virus. Acute bronchitis can often be treated and resolved within two to three weeks without long-term or chronic problems.

So what does COPD stand for if it’s actually referring to emphysema and chronic bronchitis? Why do health experts group these conditions together under one broad term? Well, according to the National Institutes of Health, most people who have COPD have both emphysema and chronic bronchitis. It makes sense to view these patients as having a single, but complex, respiratory condition.

However, ask your doctor the question “What does COPD stand for?” and you might get a slightly different answer than what we’ve described above. For example, you may have chronic bronchitis without the airway problems associated with emphysema. So your physician may diagnose you as having chronic bronchitis only. Just know that one doctor’s COPD definition may be different than another’s. The key in addressing it is to be proactive.

Is There a Cure for COPD?

COPD is one of the most debilitating conditions in the United States. Although it’s not curable, there are treatments that include medications, inhalers, and, in serious cases, surgery. Don’t hesitate to see your doctor if you have a nagging cough or shortness of breath. The sooner you can quit smoking or start treatment, the better your quality of life will be.

And if you don’t yet have the symptoms of COPD, talk with your healthcare provider about what you can do avoid problems down the road. Obviously, quitting smoking is the best thing, if you’re a smoker. Even if you’ve smoked for years, you can start to restore lung and heart health as soon as you quit.

Originally published in 2016, this post is regularly updated.

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To make a COPD diagnosis, a doctor will perform a physical examination and evaluate the patient with spirometry, which can diagnose COPD by measuring FEV1 even before COPD signs and symptoms become apparent. Spirometry also is used for COPD staging, and to monitor the progression of the disease for a COPD prognosis.

GOLD COPD Stages: What They Mean

People with COPD have a decrease in FEV1 (the amount of air that can be blown out in one second). As the disease gets worse, the FVC (the total amount of air that can be exhaled after inhalation) also deteriorates compared with people of the same age who have normal lung function.

For the GOLD guidelines, COPD is divided into four stages: mild, moderate, severe, and very severe. (See also “COPD Stages: How Chronic Obstructive Pulmonary Disease Advances.”) These classifications are based on increasing severity of airflow restriction and symptoms. The spirometry reading for FEV1 is generally used to determine the severity classification, which can provide information as to your life expectancy with COPD.

• COPD Stage 1: Mild COPD. Spirometry shows mild limitation in airflow (FEV1 greater than 80 percent of predicted). Chronic cough and sputum production may be present. At this stage, the person is often unaware of impaired lung function.
• COPD Stage 2: Moderate COPD. Spirometry shows limitation in airflow that is worse than in mild COPD (FEV1 less than 80 percent but greater than 50 percent of predicted). Shortness of breath typically occurs with exertion. Cough and sputum production are more likely than in mild COPD. At this stage, the person may first become aware of a problem with breathing, and seek medical advice.
• Stage 3 COPD: Severe COPD. Airflow limitation becomes progressively worse (FEV1 less than 50 percent but greater than 30 percent of predicted). Shortness of breath will increase, even with even a small amount of exertion, and the person will likely feel fatigued. Quality of life often diminishes.
• Stage 4 COPD: Very severe COPD. Among COPD stages, this level is the one also known as COPD end stage. Airflow is severely compromised (FEV1 less than 30 percent of predicted or less than 50 percent of predicted, plus the person has chronic respiratory failure). This may lead to heart problems, such as heart failure. Quality of life is markedly impaired. Exacerbations of the disease may be life-threatening.

What Is the Difference Between Asthma and COPD?

COPD signs and symptoms can be similar to asthma, especially in the early stages of COPD. COPD and asthma also can coexist. Therefore, for some patients (especially those who smoke), it may be difficult to make an accurate diagnosis. However, there are some distinguishing characteristics between the two afflictions. The following two lists summarize the difference between asthma and COPD.

COPD

• Usually begins after age 40.
• Symptoms get worse with advancing age.
• Occurs in people with a history of smoking.
• Results in a limitation in airflow that is non-reversible.

Asthma

• Usually begins early in life (often in childhood).
• Symptoms can vary from day to day.
• Symptoms often occur at night or in the early morning.
• Allergy, rhinitis, and/or eczema are usually present.
• Family history of asthma
• Limitation in airflow is largely reversible with medication.

One major difference between asthma and COPD relates to the reversibility of the condition. Is COPD reversible? No—the damage to the airways is permanent, and gets progressively worse. The airway narrowing in asthma, on the other hand, is usually reversible.

In addition an asthma attack generally is sparked by a trigger, such as an allergic reaction, exposure to the cold, or exercise. Doctors can simulate an asthma trigger with an inhaled drug called methacholine. This drug causes the airways to spasm, which will be detected on a test of breathing function (spirometry). A positive result of this test indicates asthma is probably the cause of the patient’s symptoms. However, this is not 100 percent accurate because a person with chronic bronchitis also may have a positive result on this test.

People with asthma (especially those who smoke) can develop a chronic cough, and could develop COPD. In some cases, it may not be possible to make a clear distinction between asthma and COPD. Current medical treatment guidelines state that for patients with both asthma and COPD, treatment should be similar to that for asthma. But each patient is different—therefore, treatment will likely be individualized.

For further reading, see these University Health News posts:

• “What Does COPD Stand For?“
• “Extra Help for COPD Signs and Symptoms“
• “Lifestyle Changes Among the Keys to COPD Treatment“

Originally published in 2016 and updated.

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Statistics afforded by COPD ICD 9 and other ICD 9 codes help governments decide how to budget for preventive health and treatment programs.

The International Classification of Diseases codes used in the United States are based on version 9 of the ICD—so your health records, and any documents you receive from your health insurer, will have a “COPD ICD 9” number. They also will have another code called a CPT.

CPT stands for Current Procedural Terminology, but it doesn’t relate to your diagnosis—it relates to whatever treatment you were given or procedure you had at your medical appointment.

COPD ICD 9 Codes: What They Mean

The United States still uses the ICD 9 codes even though ICD 10 is more up to date, because most healthcare providers have not yet transitioned over to ICD 10. At some point in the future, your COPD ICD 9 code will be circumvented by a COPD ICD 10 code. Until then, the COPD ICD 9 codes include diseases that are characterized by irreversible airflow limitation, and are as follows:

• ICD 9 code 490: bronchitis (not specified as acute or chronic)
• ICD 9 code 491: chronic bronchitis
• ICD-9 code 492: emphysema
• ICD-9 code 494: bronchiectasis
• ICD-9 code 496: chronic airway obstruction

Some authorities also include:

• ICD-9 code 493: asthma
• ICD-9 code 495: hypersensitivity pneumonitis

For further reading on COPD symptoms and treatment, see these University Health News posts:

• • “What Does COPD Stand For?“
  • “Extra Help for COPD Signs and Symptoms“
  • “COPD Exacerbations: These Lung Condition Flare-Ups Can Be Serious“
  • “Lifestyle Changes Among the Keys to COPD Treatment“

Originally published in 2016, this post is regularly updated.

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Nicotine is an addictive substance that acts on regions of the brain that produce pleasurable effects, and it produces these effects very quickly. Many smokers come to depend on smoking to reliably produce these effects. However, because nicotine levels don’t stay elevated in the blood for very long, the effects are short-lived, and more cigarettes are needed to achieve them.

COPD treatment guidelines urge smokers to quit, and with good reason: It can make a big difference when it comes to helping you avoid COPD complications. But many smokers, when they try to quit, report withdrawal symptoms such as depression, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite or weight gain. These are relieved with smoking, making it especially difficult to quit even though it can help ease COPD signs and symptoms.

The physiologic addiction to nicotine is only part of the story: There also is a large psychological and behavioral component. Smoking becomes a habit, and as such, smokers often associate smoking with certain activities or moods. For example, some people smoke a cigarette after a meal or with a drink, when they feel stressed, or to perk themselves up when they feel down.

Smokers also come to associate the pleasurable effects of smoking with the ritual of smoking. They may enjoy just holding a cigarette, the act of lighting it, or the smell and taste of the smoke.

Get Help to Quit and Increase Your Life Expectancy with COPD

Because smoking is associated with physiological, behavioral, and psychological factors, all three must be addressed when attempting to quit.

For people who want to quit in order to increase life expectancy with COPD, studies have shown that some combination of counseling, social support, and pharmacologic therapies usually is necessary. It will probably take more than one try to quit for good, but the benefits are worth it. These strategies may help you succeed, especially if you remember that your life expectancy with COPD may increase if you no longer smoke:

• Set a quit date.
• Remove all cigarettes and ashtrays from your home, car, and place of work.
• Tell your family and friends, and ask for their support.
• Use some form of nicotine replacement (patch, gum, or lozenge).
• Talk to your doctor about medications that may help you.
• Call 1-800-QUIT NOW (784-8669) to find the quit line in your state. You can also access the service online at https://smokefree.gov/talk-to-an-expert.
• Find counseling (individual, group, or telephone) that you are comfortable with.
• If you don’t succeed the first time, try again.

Enlisting the support of family and friends is essential. Some form of counseling—either an individual or group counseling program—is advised, and Internet-based chat rooms can also be a helpful source of support. Some smokers have been helped to quit with acupuncture or hypnosis.

For some people age 65 and older, Medicare Part B will cover smoking cessation counseling. The coverage is limited to those who smoke and have a disease or adverse health effects linked to tobacco use. Two smoking cessation attempts are allowed every year; for each attempt, Medicare will pay for up to four counseling sessions.

Breaking the smoking habit to increase life expectancy with COPD will most likely require coming up with new problem-solving and stress-reducing techniques to replace smoking. For example, it can be helpful to identify situations or activities that increase your risk for smoking, and discuss new types of coping skills with a counselor or fellow smokers who are quitting. Also try to minimize time spent with smokers, to reduce temptation.

Medications That Can Help You Quit

None of the drugs on the COPD medications list will help you quit smoking—but other drugs can relieve withdrawal symptoms. Many of these products are nicotine replacement therapies. These are available in skin patches, gums, lozenges, inhalers, and a nasal spray. The patch, gum, and lozenges can be obtained without a prescription. Nicotine gum is not chewed like regular gum—in order for the nicotine to be absorbed, the gum must be chewed a few times, and then placed and held between the cheek and gum.

Nicotine patches are designed to disrupt the “crave and reward” cycle of smoking cigarettes.

The nicotine patch maintains a steady blood level of nicotine, which avoids the ups and downs of nicotine levels during smoking, and disrupts the “crave and reward” cycle. A step-down program is usually recommended when using the nicotine patch. This program starts with a higher dose (21 mg/day), which is reduced to a moderate dose (14 mg/day), and finally a low dose (7 mg/day).

E-cigarettes contain nicotine, and some smokers switch to these vapor-producing devices to help them quit tobacco cigarettes. While the effectiveness of nicotine replacement therapies such as the gum and patch are established; e-cigarettes are still being studied as an aid to quitting. One recent study found that smokers who used e-cigarettes were actually less likely to quit smoking than those who never used them.

Another drug that is sometimes used for smoking cessation is bupropion (Zyban), which requires a doctor’s prescription. Zyban has been shown to help eliminate withdrawal symptoms, but it appears that the drug works best when used in conjunction with one of the nicotine replacement therapies.

Varenicline (Chantix) is another drug available by prescription only. This drug works by binding to some of the nicotinic receptors, which blocks nicotine from binding to these receptors. This results in a reduction in the craving for nicotine, and decreases the pleasurable effects of smoking.

Studies have shown varenicline to be generally effective at helping people to quit smoking; however, some people who take the drug experience severe changes in mood and behavior. The manufacturer advises stopping the drug and contacting a healthcare provider immediately if agitation, depressed mood, changes in behavior, or suicidal thoughts or behavior occur.

Some people who use varenicline have a decreased tolerance to alcohol, and get drunk more easily—therefore, people who use the drug are advised to decrease the amount of alcohol they consume.

Within two to three months of your last cigarette, your lung function improves and your risk for heart attack decreases.

Health Benefits of Smoking Cessation

You can definitely increase life expectancy with COPD if you quit smoking. But that isn’t all.

Within 20 minutes of your last cigarette, for example, your heart rate drops, while the carbon monoxide level in your blood drops to normal after about 12 hours. By two to three months after your last cigarette, your lung function begins to improve, and your heart attack risk begins to fall.

Within one to two years, the risk for heart disease decreases. The risk for developing cancer also declines with the number of years of smoking cessation.

Originally published in May 2016 and updated.

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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a program created to raise awareness of COPD signs and symptoms and to boost COPD life expectancy. It was launched in collaborative effort between the National Heart, Lung, & Blood Institute, the National Institutes of Health, and the World Health Organization.

GOLD COPD guidelines are used to assess how severe a patient’s COPD is, and to establish his or her COPD prognosis. GOLD COPD also has guidelines for the use of spirometry in assessing COPD signs and symptoms.

Spirometry Testing

A spirometer is a machine that measures how fast air is blown out of the lungs, as well as the total amount of air inhaled and exhaled—you simply take a deep breath in and then exhale as hard and as long as possible into a hose connected to the spirometer.

The spirometer takes several types of measurements. Some common ones used for assessing COPD signs and symptoms are as follows:

• Forced vital capacity (FVC): The total amount of air that can forcibly be blown out after inhalation.
• Forced expiratory volume in 1 second (FEV1): The amount of air that can be blown out in one second.
• The ratio of FEV1 to FVC (FEV1/FVC): In healthy adults, this should be 75 to 80 percent.
• Peak expiratory flow (PEF): The speed of air moving out of the lungs at the beginning of an exhalation.

COPD requires significant medical supervision and rehab. In this instance the patient is using an incentive spirometer to build back lung function depleted by COPD.

GOLD COPD standards recommend that people who are at high risk for COPD should have a spirometry test. Specifically, this includes:

• People who are older than 40 and who have a history of exposure to COPD risk factors, such as tobacco smoke
• People who have had exposure to other kinds of smoke, or dusts and fumes (for example, those who may have worked in a machine factory or grain mill)
• People who have COPD signs and symptoms such as a chronic cough with mucus and/or phlegm

What Does GOLD COPD Mean? COPD Stages Help Explain

To answer the question “What does GOLD COPD mean?” it’s important to consider the the progression of chronic obstructive pulmonary disease. First, consider that people with COPD have a decrease in FEV1 (the amount of air that can be blown out in one second). As the disease gets worse, the FVC (the total amount of air that can be exhaled after inhalation) also deteriorates compared with people of the same age who have normal lung function.

In GOLD guidelines, COPD is divided into four stages: mild, moderate, severe, and very severe. These classifications are based on increasing severity of airflow restriction and symptoms. The spirometry reading for FEV1 is generally used to determine the severity classification, which can provide information as to your life expectancy with COPD.

• Stage 1 COPD: Mild COPD. Spirometry shows mild limitation in airflow. Chronic cough and sputum production may be present. At this stage, the person is often unaware of impaired lung function.
• Stage 2 COPD: Moderate COPD. Spirometry shows limitation in airflow that is worse than in mild COPD. Shortness of breath typically occurs with exertion. Cough and sputum production are more likely than in mild COPD. At this stage, the person may first become aware of a problem with breathing, and seek medical advice.
• Stage 3 COPD: Severe COPD. Airflow limitation becomes progressively worse. Shortness of breath will increase, even with even a small amount of exertion, and the person will likely feel fatigued. Quality of life often diminishes.
• Stage 4 COPD: Very severe COPD. Stage 4 COPD may also be known as end stage COPD. Airflow is severely compromised, and this may lead to heart problems, such as heart failure. Quality of life is markedly impaired. Exacerbations of the disease may be life-threatening.

Originally published in 2016, this post is regularly updated.

The post What Does “GOLD COPD” Mean? appeared first on University Health News.

These classifications are based on increasing severity of airflow restriction and symptoms, and they help doctors determine an individual’s COPD treatment guidelines and life expectancy.

Accessing COPD Stages

A COPD test called spirometry is generally used to determine which of the COPD stages you’re in. A spirometry test involves taking a deep breath in and then exhaling as hard and as long as possible into a hose connected to a machine called a spirometer. The machine measures how fast air is blown out of the lungs, as well as the total amount of air inhaled and exhaled.

The spirometer can be used to take several types of measurements. Some common ones used in the diagnosis and management of obstructive lung diseases are as follows:

• Forced vital capacity (FVC): The total amount of air you can forcibly blow out after inhaling.
• Forced expiratory volume in 1 second (FEV1): The amount of air you can blow out in one second.
• The ratio of FEV1 to FVC (FEV1/FVC): In healthy adults, this should be 75 to 80 percent.
• Peak expiratory flow (PEF): The speed of air moving out of your lungs at the beginning of an exhalation.

COPD Stages: Defining Each Level

Doctors use four COPD stages to gauge patients with the condition.

• COPD Stage 1: Your spirometry test shows mild limitation in airflow (FEV1 greater than 80 percent of predicted for a person of the same age with no lung disease). At this early stage, your COPD signs and symptoms may be barely noticeable. It is likely you are unaware that your lung function is impaired, although you may have a chronic cough, with sputum production.
• COPD Stage 2: Your spirometry test shows limitation in airflow that is worse than in mild COPD (FEV1 less than 80 percent but greater than 50 percent of predicted for a person of the same age with no lung disease). Your COPD signs and symptoms are becoming more obvious—you may notice that you are experiencing shortness of breath when you exert yourself, and a cough and sputum production are more likely than in Stage 1 COPD. Your growing awareness of your breathing problems may lead you to seek medical attention.
• COPD Stage 3: This is severe COPD. Your airflow limitation will have become progressively worse (FEV1 less than 50 percent but greater than 30 percent of predicted for a person of the same age with no lung disease). Your shortness of breath will increase, especially with even a small amount of exertion, and you will likely feel fatigued. Quality of life often diminishes during this stage.
• COPD Stage 4: This is very severe COPD; it means your airflow is severely compromised (FEV1 less than 30 percent predicted or less than 50 percent of predicted for a person of the same age with no lung disease). You also may have chronic respiratory failure that may lead to heart problems, such as heart failure. Your quality of life is markedly impaired, and COPD exacerbations may be life- threatening.

Originally published in 2016 and regularly updated.

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