By Dr. Lazaro O. Bravo –
As an Intern when I first started training for my medical specialty, I noticed that we, as healthcare professionals, use a lot of acronyms: CAD (Coronary Artery Disease), HTN (High Blood Pressure), ACS (Acute Coronary Syndrome), DVT (Deep Vein Thrombosis), the list goes on and on. I always assumed that this was a culture that has been fostered by convenience. After all, it’s easier to spell out the alphabet than to go through a long-winded diagnosis. Then, a very interesting phenomenon occurred. I was watching TV recently and they were talking about a new medication for COPD. It seems that every other sentence the letters COPD was thrown out there. I did not pay much attention to it at the time. It was not until I saw two other commercials with the same letters being thrown out there: COPD. As a Pulmonary physician I recognize what COPD is and it’s many forms, but I wonder if the public truly understands what COPD is. My patients know because I spend a great deal of time educating them into what COPD involves. I wonder if we are sending the wrong message by trivializing a severe disease with a cute alphabet name (COPD) by placing too much emphasis on the medications instead of what the disease is, and more importantly how to effectively prevent it’s dangerous decline.
The name Chronic Obstructive Pulmonary Disease tells a better story than the four letters, COPD. Just as the name implies, it is a Chronic disease. By some estimates almost 14 million Americans have COPD. 65-70% of patients with COPD are under the age of 65 years. The disease manifests itself over several years and typically goes undiagnosed for years. It is subtle, slow and progressive. So much so that it is estimated anywhere from 7-10 million people are undiagnosed. It is associated with significant mortality being the overall 3rd cause of death in the US.
Though traditionally this was a disease affecting mostly men, there has been a significant increase in the diagnosis among women. By 2010 data, nearly 8.6 million women had been diagnosed with COPD in comparisons to 5.7 million men. Almost as important, we are beginning to diagnose it earlier in it’s progression. Even though COPD is considered a smoker’s disease, there is a genetic disorder that increases the risk of acquiring COPD at a much earlier age. It has also been determined that there are environmental factors which can cause patients to develop COPD without being primary smokers (e.g. dust from the World Trade Center’s collapse, certain industrial exposures and even second hand smoking).
It’s main symptomatology occurs from the fact that it COPD has an Obstructive component. This is manifested by what we call “air flow limitation.” In smokers, the irritation of smoking on the airways causes damage to the airways. The natural repair process from the airways on this irritation is an increase in sputum production (almost like trying to put out a fire), and decreasing the size of the diameter of the airway due to the sputum in the airways as well as to facilitate the movement of the sputum. Unfortunately, when this process is present for years, the diameter of the airway becomes nearly permanent. The symptoms are subtle at first and usually present as shortness of breath. Initially it is with significant exertion (like walking or stair climbing). As the airways become more narrow and the limitation on airflow worsens, the shortness of breath becomes more prominent with minimal exertion (like walking to the mailbox or even around the house). Ultimately, if left untreated, the shortness of breath will become present even while at rest.
Due to the increased sputum production patients often present with a productive cough that is generally worse in the mornings and clear within an hour or two, but in some cases it may last for most of the day. Patients sometime report with what has been termed Acute Exacerbation of COPD or “COPD attacks.” These are episodes where the sputum may become infected, either from a virus or bacteria, causing a sudden increase in the sputum production along with discolored sputum (usually tan, yellow or green) and worsening of the baseline shortness of breath. These attacks are sometimes mistaken for episodes of “Acute Bronchitis” and can lead to further deterioration of the underlying and already fragile lung function. Recovery of this lung function is usually measured in weeks not days.
As lung function worsens it can lead to emphysema, a component of the Pulmonary Disease. This is the terminal process of COPD. Complications from emphysema include low oxygen levels that usually require the patient to need oxygen on a permanent basis. High levels CO2, a by-product of body function that may require the patient to be hospitalized and sometimes requiring artificial life support.
Believe it or not, Chronic Obstructive Pulmonary Disease (COPD) is even more complicated than I have just explained. Regardless of how we choose to identify it, it is a lethal disorder that deserves a lot more focus on what the disease is instead of how “attractive” we make it’s name sound.