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COPD, or chronic obstructive pulmonary disease, affects an estimated 30 million people every year in the United States. More than 80 percent of the time the cause is cigarette smoking.
COPD is actually an umbrella term used to describe multiple progressive lung diseases, including emphysema, chronic bronchitis, refractory (nonreversible) asthma and some forms of bronchiectasis, almost all of which are smoking-related lung diseases.
The most common characteristics of COPD are increased shortness of breath and cough; however, many people have early stages of COPD long before they notice the symptoms.
Not just smoke
When a person inhales cigarette smoke, more than 4,000 chemicals enter the body, and 43 of those chemicals are known carcinogens, such as formaldehyde, cyanide, DDT and arsenic. All of these are extremely toxic to the lungs.
Those chemicals cause your body to produce excess mucous, which can inhibit airflow in the airways causing the cilia (which is your body’s natural clean-up system) to have reduced function. Within your lungs, those chemicals cause the air sacs to be destroyed, which increases the risk of low oxygen levels, infection and cancer.
When trying to diagnose the diseases of COPD, we rely on noninvasive testing rather than biopsies or other methods of diagnosis. We often order chest X-rays and CT scans to evaluate what your lungs look like. We also do pulmonary function testing where we look for evidence of blockages in your airways. We need to find out if air has a harder time exiting your body as compared to another healthy person. People with COPD often have a harder time getting the air out of their lungs because of the narrowing of the bronchial tubes.
These tests enable us to have an objective view of how well your lungs are working, and it helps us with staging. COPD can range from mild to severe.
The only way to get better once you have been diagnosed with COPD is to quit smoking. But the good news is that even if you smoked for a long time, quitting will help your symptoms and your lung function.
Break the habit
Smoking cessation is hard. A large majority of smokers want to quit. I’d say two-thirds of them want to do it. In any given year, half of those will actually try, but only one out of 30 are successful on their own. Trying to quit smoking without any assistance reduces your chances of success, but there are multiple options developed to help increase your success rate. These include counseling, nicotine replacement therapy, prescription medications, and even alternative approaches such as acupuncture and hypnosis.
Because smoking is so much more than just a chemical addiction, I am a big advocate of counseling. I think it is beneficial to talk through the issues of quitting and the lifestyle changes that have to happen as a result of quitting.
Nicotine replacement therapy, or the “patch,” is another very effective tool in the process of smoking cessation. This therapy helps break the chemical addiction to nicotine. This treatment lasts a couple of months but has shown to be twice as effective as quitting smoking alone.
Two other medicines that have been shown to increase the success rate in smoking cessation are bupropion (Wellbutrin) and varenicline (Chantix). Wellbutrin is actually a depression medication, so people who encounter depression during the cessation process find it especially helpful.
The most effective medicine, however, is Chantix. Although you may have read about mood changes and suicide connected to the use of Chantix, those initial concerns have since been disproven. I prescribe it to my patients who truly want to quit smoking. It has been shown to be three times as effective as doing nothing at all to assist in smoking cessation. If you are serious about quitting, this is the most effective thing you can do. It takes 12 to 24 weeks, but patients tell me it simply makes you not want a cigarette anymore.
One therapy that I don’t generally recommend is e-cigarettes. I don’t love them, but I would choose anything over a conventional cigarette. I will only give my vote of approval on e-cigarettes if a patient has tried other options with no success. I’d rather you be addicted to a nicotine vapor, which is mostly water, than cigarette smoke.
Once a smoker has stopped, there still may be some lung function that is lacking, and there are multiple ways we deal with that — from inhalers to oxygen therapy to antibiotics and steroids. All are effective at varying levels.
Another very successful program for those suffering with COPD is pulmonary rehabilitation. The goal of this therapy isn’t to rehab the lungs, as the damage has been done, but we focus on rehabbing everything else. When your lungs don’t work normally, you tend to breathe short and fast.
We want to train people to breathe more effectively and take deeper breaths. Pulmonary rehabilitation is a safe environment for people with breathing limitations to exercise. With nurses and physical therapists monitoring you, people who are reluctant to exercise can get moving again in a safe, controlled environment. If you can exercise, you lose weight, you get stronger and develop more muscle. All of those things help your breathing improve.
When treating patients with COPD, we use a multipronged approach that consists of quitting smoking, implementing the use of inhalers or oxygen (if needed), administering certain vaccinations to protect the health of the lungs, and starting pulmonary rehabilitation.
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