Chronic Obstructive Pulmonary Disease (COPD) Center

Diagnosis of COPD

None of the current methods used to diagnose COPD can detect the disease before irreversible lung damage has occurred. However, the earlier it is detected, the sooner steps can be taken to modify further damage. When you first see your doctor, he or she will ask about your symptoms and medical history and will perform a physical exam. The history and physical exam provide the most important information that is used for the diagnosis of COPD. If your doctor suspects you might have COPD, you may undergo one or more of the following tests:

Pulmonary (Lung) Function Tests

Many tests of lung function have been developed, and each provides slightly different information about how well your lungs are working. Pulmonary function tests are painless, noninvasive tests that are performed using a machine called a spirometer. By breathing into the spirometer under certain conditions, the doctor can measure your lung volume and your ability to move air in and out of your lungs in a certain period of time. Your results are compared with typical findings of a healthy person your age and height, and the doctor can then determine to what extent your lung function is diminished. Sometimes, tests are repeated after you have been given a bronchodilator medication, to see if your results improve with this type of treatment.

Pulmonary function tests include:

• Forced Vital Capacity (FVC) - This is the maximum volume of air that can be forcibly exhaled after inhaling as deeply as possible.
• Residual Volume (RV) - This is the amount of air that remains in the lungs when measuring vital capacity. In persons with COPD, RV is usually dramatically higher than normal because air is trapped in the damaged lung and cannot be exhaled normally.
• Total Lung Capacity (TLC) - This is the total amount of air the lungs are capable of holding and is the combination of FVC and RV.
• Forced Expiratory Volume in 1 Second (FEV1) - This measures the volume of air that can be forcibly exhaled in one second and represents the rate of air movement out of the lungs. FEV1 typically declines a very small amount per year in normal persons, but the decline can be several times over the expected in people with COPD. A greater than expected annual fall in FEV1 is the most sensitive test for COPD and a reasonably good predictor of disability and early death.
• Carbon Monoxide Diffusing Capacity - This test provides an estimate of how efficiently the lungs can exchange gases with the blood. You take a breath of a known mixture of gases and see what percent is left over at exhalation.
• Oximetry - A sensor on your finger is used to acquire quick, basic information about the amount of oxygen in your blood. More detailed measurements are provided by the blood test called an arterial blood gas.
• Arterial Blood Gases - Arterial blood gases determine the amount of oxygen and carbon dioxide in your bloodstream. This test requires that a blood sample be removed from one of your arteries, usually in the wrist.
• Sputum Test - Collecting a sputum specimen (a sample of coughed-up mucus) for laboratory testing can reveal the presence of an infection that could be complicating COPD.
• Chest X-Ray - A chest X-ray provides a picture of the heart, lungs, bones, and soft tissues in the chest, as well as the blood vessels associated with them.
• Computed Tomography (CT) Scan - This test provides a detailed X-ray of the lungs and can be useful in assessing the extent of lung damage associated with COPD.
• Levels of Alpha-1-Antitrypsin - This blood test measures levels of alpha-1-antitrypsin, which is an important protein that helps protect the lungs from damage due to inflammation. Persons who develop COPD at an early age or who develop the disease but never smoked may have abnormally low levels of this protein due to a genetic defect. The substance can be replaced artificially by giving a medicine intravenously.

COPD Treatment

Although most cases of COPD are preventable, it cannot be cured. Once lung damage occurs, treatment focuses on preventing additional damage, reducing symptoms of the disease, and enhancing the quality of daily activities. The disability from COPD can cause dramatic changes to your quality of life; treatment of its symptoms, prevention of complications, and progression of the disease require attention to a variety of behaviors. Because of these factors, some people seek out their treatment through a comprehensive pulmonary rehabilitation program. These programs provide guidance and support as you learn to manage your COPD through medications, good nutrition, appropriate exercise, and good lifestyle choices. These programs work well for some people and may help optimize quality of life.

Managing COPD

Preventive Strategies

If you’re a smoker, the first and most important thing you should do is stop smoking. This will slow the progress of the disease and make it easier for you to breathe than if you continued to smoke. Lahey Hospital & Medical Center offers free tobacco cessation counseling to all patients. Please call 781-744-7848 (781-744-QUIT) to schedule an appointment.

Other preventive tips include:

• Losing weight, if necessary, as excess weight requires you to breath more to accomplish the same amount of physical activity.
• Daily physical activity, as this can help to reduce lung function decline and exacerbations to prevention.
• Staying up to date on your vaccinations. The flu vaccine, pneumococcal vaccine and COVID-19 vaccines are recommended for people living with COPD to reduce your risk of contracting these infections.
• Seeking treatment for potential chest infections as early as possible, as COPD impairs your lungs’ defense mechanisms and causes infections to linger.
• Avoiding or limiting exposure to second hand smoke, dust, fumes, and environmental burning (such as smoke from burning wood, charcoal or crop residue), as exposure to these can worsen your symptoms.
• Using respiratory therapy devices (e.g., inhalers, nebulizers and oxygen) as instructed. If you are unsure how to use your device, please ask your healthcare provider for a demonstration.

Medications

As a COPD patient, your doctor may recommend you use any of the following types of medications:

• Short Acting Bronchodilators or Short Acting Muscarinic Antagonist Agents: These medications open your airways by relaxing the surrounding muscles and preventing muscles from constricting. They can be used alone or in combination with other medications to provide relief of intermittent symptoms. They are often called “rescue inhalers.” Examples include Albuterol (i.e. ProAir, Ventolin) and Ipratropium (i.e. Atrovent).
• Long Acting Bronchodilators or Long Acting Muscarinic Antagonist Agents: These medications open your airways by relaxing the surrounding muscles and preventing muscles from constricting. Their effects last at least 12 hours. These medications can be taken every day to maintain control and prevent symptoms of COPD. Examples include Salmeterol (i.e. Serevent) and tiotropium (i.e. Spiriva).
• Inhaled Cortico-Steroids: Inhaled steroids are used to help reduce airway inflammation and are typically administered to patients with moderate or severe COPD in combination with a Long Acting Bronchodilator or Long Acting Muscarinic Antagonist Agent. Examples include Fluticasone/Salmeterol (i.e. Advair) and Budesonide/Formoterol (Symbicort).
  The above medications may be used on a trial basis for six weeks to three months so their effectiveness in alleviating breathing difficulties can be determined. At each clinic visit, your healthcare provider will discuss your medications with you and alter your regimen if necessary.
• Oxygen: Oxygen therapy is recommended to patients with severe COPD who are struggling with shortness of breath. This therapy will help to maintain appropriate oxygen levels in the blood, thereby prolonging your life, protecting your heart and other vital organs from damage, improving your sleep patterns at night and mental alertness during the day, and making it easier to complete activities of daily living.

Pulmonary Rehabilitation

Your physician may recommend that you participate in the Pulmonary Rehabilitation program at Lahey Hospital & Medical Center. This coordinated program typically includes aspects such as education on COPD, disease management training (coping strategies), nutrition advice, exercise and counseling. A number of health care professionals—doctors, nurses, respiratory therapists, physical therapists, exercise physiologists and dietitians—collaborate, as a team, to provide you with the comprehensive care you need.

Understanding COPD Symptoms

The symptoms of COPD are mild at first but become more severe and debilitating as the disease progresses.

Early Symptoms of COPD

• Cough - Daily cough, which is usually first noticed in the winter months, with clear sputum (mucus from the lungs) is the earliest symptom of COPD. Coughing may be worse during a cold or respiratory infection, and the mucus may turn yellow or green.
• Wheezing - A whistling or rustling sound may be heard when exhaling, which is prolonged. Wheezing often worsens with a cold or respiratory infection.
• Shortness of Breath - This symptom develops as COPD becomes progressively worse. At first, shortness of breath may only occur with physical exertion, but as the disease becomes more advanced, it may occur after very modest activity. When the illness becomes very severe, shortness of breath occurs even at rest.

Symptoms of More Advanced COPD

• Severe Shortness of Breath and Chronic, Persistent, Productive Cough - Even very mild activities produce significant shortness of breath. Repeated bouts of coughing with sputum production may become disabling. Nighttime coughing may interfere with sleep, and you may feel a choking sensation when lying flat. Difficulty breathing may cause sufferers to breathe through pursed lips or to lean forward when sitting or standing in order to breathe more comfortably.
• Fatigue and Mental Changes - Repeated bouts of coughing and poor oxygen exchange within the lungs leads to fatigue, headache, and mental changes, such as irritability, anxiety, or difficulty sleeping and concentrating.
• Heart Problems - COPD makes the heart work harder, especially the right side of the heart, which pumps blood to the lungs. The walls of the heart become thickened from the extra work needed to pump blood into the resistant lungs. The normal rhythm of the heart may also be disturbed. Lack of oxygen in your blood can produce a bluish tinge to your skin, nails, and lips, called cyanosis.
• Fluid Accumulation - The extra strain on the right side of the heart may cause a slowdown of blood circulation. This, in turn, can cause engorgement of the large veins and liver, and eventually fluid leakage into the abdomen, legs, and ankles (edema). This right-sided heart failure is called cor pulmonale.
• Increased Chest Size - Because COPD destroys the normal lung structure, you cannot exhale completely. Air is trapped in the lungs, which become hyperinflated, causing the chest to expand, leading to a permanent condition referred to as “barrel chest.”
• Increased Risk of Serious Lung Infections - The accumulation of mucus and fluid in the lungs provides an ideal environment for bacteria and viruses to grow. These lung infections may become quite serious, further compromising breathing ability.

Risk Factors for COPD

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop COPD with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing COPD. If you have a number of risk factors, ask your health care provider what you can do to reduce your risk.

COPD Risk Factors Include:

• Cigarette Smoking - The most important risk factor for COPD is cigarette smoking. Between 80 percent and 90 percent of COPD cases are caused by cigarette smoking. Although most cases of COPD are related to smoking, not all smokers develop COPD. This suggests that other factors in your environment or genetic make-up also contribute to the development of COPD. New research also suggests that people who are chronically exposed to second-hand smoke have an increased risk of developing COPD.
• Genetic Factors - Although COPD usually develops in older persons with a long history of cigarette smoking, one form of emphysema has a genetic component and is more common in persons of northern European descent. Persons with this form of COPD have a hereditary deficiency of a blood component, known as alpha-1-protease inhibitor (alpha-1-antitrypsin, AAT). About 70,000 Americans are thought to have this genetic deficiency, and it accounts for 1 percent to 3 percent of COPD cases. People with this defect can develop COPD by early middle age. If you have close relatives who developed COPD in their thirties or forties, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected by blood tests available at medical laboratories.
• Age - You are more likely to develop COPD as you get older, but this is partly related to the number of years of cigarette smoking.
• Medical Conditions - A history of frequent childhood lung infections increases your risk of developing COPD. Frequent infections can lead to scarring of lung tissues, which reduces their elasticity and can lead to COPD.
• Gender - COPD is much more common in men than in women, but this may be largely related to the higher rate of smoking among men. As the number of women who have significant smoking histories has increased, the number of COPD-related deaths among women has also risen.
• Exposure to Environmental and Occupational Pollutants - Chronic exposure to dust, ozone, and gases or chemicals, such as traffic exhaust fumes and sulfur dioxide, increase your risk of developing COPD and can worsen symptoms of the disease.