Lung Health

Nagging Cough or COPD? Breathe Easier with Early Diagnosis

October 24, 2018

Nagging Cough or COPD? Breathe Easier with Early Diagnosis

Maybe you’re short of breath walking up stairs. Or you assume that nagging cough is just a side effect of smoking. You may not realize you’re dealing with something much more serious.

Chronic obstructive pulmonary disease (COPD) quite literally takes your breath away. It affects more than 5 percent of the population and is the third leading cause of death in the United States. It has no cure, yet millions of Americans don’t know they have it.

That’s because symptoms can often sneak up on people – or they simply put off seeking medical attention. What they don’t realize is early diagnosis is essential because once you lose lung function, it’s very hard or even impossible to regain. Each COPD exacerbation – or sudden worsening of symptoms – ultimately damages your lungs.

The lung damage is irreversible and eventually becomes severe. As this chronic lung disease progressively obstructs airflow, it can make breathing feel like sucking through a straw. In more severe cases, activities get limited to a great extent because of breathing difficulty and individuals may need supplemental oxygen with activities and sometimes even at rest.

That’s why my message to anyone experiencing ongoing shortness of breath, cough, mucus production or wheezing: Do not neglect your symptoms. Get checked by your health care provider promptly. Especially if you smoke. According to studies, risk of developing COPD in smokers vary from 10 to 25%. Although smoking is the leading cause of COPD, other factors like exposure to secondhand smoke and biomass fuel are also important risk factors for developing this disease.

Diagnosis

When to get checked? If you have breathlessness, cough, increased sputum production or wheezing that persists for weeks, not related to common cold and recurs on and off throughout the year, see your health care provider. Diagnosis may involve:

  • Chest x-ray, CT scan of chest. These look for emphysema and other lung problems, although imaging studies are not absolutely necessary for the diagnosis.
  • Pulmonary function test. This measures the amount of airflow obstruction, lung volumes and gaseous exchange in lungs.
  • Genetic testing. COPD is sometimes caused by inherited disorder, called alpha-1 antitrypsin (AAT) deficiency, though this is comparatively rare. This is generally suspected in young individuals (< 45 years), who are nonsmokers or with minimal history of smoking, has family history of COPD, has involvement of other organs like liver, skin etc.

In COPD, pathologic changes occur in airways, air sacs and blood vessels of the lungs including chronic inflammation, increased mucus secretion and destruction of wall of air sacs, hampering gas exchange in lungs. Other diseases like chronic bronchitis and bronchiectasis may have a similar clinical presentation.

Treatment

Those diagnosed with COPD are encouraged to make key lifestyle changes and start on medications which can improve breathing, decrease symptoms and help prevent exacerbations. Treatment recommendations may include:

  • Smoking cessation. For those who smoke, this is the most important step you can take.
  • Environmental awareness. Avoid secondhand smoke and other air pollutants.
  • Bronchodilators. Inhalers deliver medications which relax the muscles around airways, making it easier to breath and relieving coughing and shortness of breath.
  • Inhaled steroids. These medications also help reduce airway inflammation.
  • Oral medications. Steroids are given for moderate or severe exacerbations, and antibiotics are used to treat infections such as bronchitis and pneumonia; sometimes antibiotics like Azithromycin are given long term for its anti-inflammatory effects. Other medications that can improve breathing and relax airways are phosphodiesterase-4 inhibitors.
  • Oxygen supplementation. This helps to keep oxygen saturation in the normal range in advanced disease.
  • Non-invasive ventilation. This is used in severe disease to decrease the work of breathing, improve oxygenation and blow out excess carbon dioxide.
  • Flu and pneumonia vaccines. These illnesses can be serious for people with COPD.
  • Nutrition and weight management. Laboring to breath can cause you to burn up more calories than a person without COPD. Individuals with severe COPD may have Protein-Calorie-Malnutrition which will lead to poor outcomes overall. Nutritional support is of great importance to mitigate Pulmonary Cachexia, a condition resulting in increased mortality and loss of peripheral and respiratory muscle function.
  • Pulmonary rehabilitation. A full exercise, education and support program can help people with COPD live more active lives.
  • Surgical options. Appropriate candidates are considered for LVRS (Lung Volume Reduction Surgery), Lung transplant etc.

Stopping smoking is the No. 1 thing you can do for your lungs. The sooner you quit, the healthier you’ll be. The U.S. Preventive Services Task Force now recommends annual lung cancer screening with a low-dose CT scan for those with a 30 pack-year smoking history for adults age 55 to 80 who currently smoke, or who quit in the last 15 years.

Meenakshi Ghosh, MD

Meenakshi Ghosh, MD is a Pulmonologist at CHI Health Good Samaritan.

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