Q: What is COPD?

A: COPD means chronic obstructive pulmonary disease and is a disease of airflow limitation.

Q: What happens in chronic obstructive pulmonary disease?

A: It is a condition in which the airways and the lungs become narrowed and inflamed and often times the air sacs of the lungs also become damaged. It becomes increasingly difficult to breathe. The subtypes of COPD include emphysema, chronic bronchitis and chronic obstructive asthma.

Chronic bronchitis refers to a chronic inflammation of the bronchial tubes where there is increased mucus production on a regular basis.

Emphysema refers to a destruction of the air sacs of the lungs where there is a loss of elasticity of the lungs. It is important to recognize COPD affects greater than 5 percent of the population and is the third leading cause of death in this country.

Q: What causes it?

A: Basically it is related to the passage of irritating gases and particles that are inhaled while smoking or breathing smoke-filled air or other fumes or particles. These gases and particles injure the airways and the lungs, can cause swelling and inflammation and over a period of time damage the lungs themselves. The major risk factors are clearly smoking and occupational and environmental exposures like dust and fumes. Also secondhand smoke plays a role. There are some patients who have a genetic predisposition to developing chronic obstructive pulmonary disease. Approximately 20 percent of patients who developed chronic obstructive pulmonary disease have never been smokers.

Q: What are the symptoms?

A: The major symptoms of COPD would include shortness of breath, cough and sputum production. This may also be associated with wheezing and chest tightness.The major manifestation, however, is shortness of breath. Initially the shortness of breath may be with exertion but as the disease becomes more severe, the shortness of breath may be with just minimal exertion such as walking.

Q: What are the risk factors for chronic obstructive lung disease?

A: These include smoking and secondhand smoke, occupational and environmental exposures. Certainly genetics play a role and there is an enzyme deficiency called alpha-1 antitrypsin deficiency which is an enzyme that actually protects the lungs.

Q: How does COPD affect the quality of life for the individual?

A: It limits their activity. The patient has increased shortness of breath with exertion, but sometimes at rest in severe cases. This leads to feelings of isolation and depression and often times the patient does not want to go out, particularly if they are wearing oxygen.

Q: How is it diagnosed?

A: It is always important to do a complete history and physical examination on the patient. Chest X-rays and other radiographic studies are reviewed, but the basis for the diagnosis really is breathing tests which are called pulmonary function tests. A pulmonary function test means the patient takes a deep breath in and blows the air out as hard and as fast as the patient can into a machine and the machines measure how fast and how much air the patient can blow out of their lungs. Based on those measurements, we determine the severity of the lung disease.

Q: What treatments are available?

A: The most important thing is smoking cessation if the patient continues to smoke. There are other medications which include long-acting bronchodilators, inhaled steroids which reduce inflammation of the tracheal bronchial tree, and occasionally oral steroids and antibiotics if there is any clear-cut evidence of infection. Oxygen may be necessary in some patients. This is determined by measuring the patient's oxygen level. This can be done with what is called a pulse oximeter which is measuring the level of oxygen with a non-invasive finger clip or it can be measured with an arterial blood gas. Patients with chronic obstructive pulmonary disease are strongly advised to be vaccinated against flu and pneumonia. It is also important for the patient to exercise, to maintain proper weight, receive proper nutrition and get adequate rest.

A pulmonary rehabilitation program is an organized and supervised exercise program and is often very helpful for patients with COPD. St. Luke's has a comprehensive pulmonary therapy program for patients who are hospitalized, as well as an outpatient therapy program. A board-certified pulmonologist and respiratory therapist will work together to develop a personal exercise plan for each patient. The plan is intended to establish reasonable and achievable goals, whether to simply resume the normal activity of daily living or to achieve more strenuous activities.

Dr. Kintzer is the medical director of the pulmonary rehabilitation program at St. Luke's University Hospital – Bethlehem.

To make an appointment with a pulmonologist or for more information about pulmonary rehabilitation, call St. Luke's InfoLink at 1-866-STLUKES (1-866-785-8537).