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Understanding A COPD Diagnosis: Key Facts

If you or someone you know has recently been diagnosed with COPD, you may be wondering what exactly that means. COPD stands for Chronic Obstructive Respiratory Disease. COPD is composed of different respiratory diseases that cause troubled breathing.

The term COPD can be used to describe a singular respiratory disorder, or more than one. COPD encompasses chronic bronchitis, emphysema, asthma, and some forms of bronchiectasis, as well as any combination of the four. According to the American Lung Association, over 16 million Americans are diagnosed with COPD as of October 2020, but millions more suffer from it without being diagnosed.

The group of diseases in which COPD refers to cause airflow obstruction and trouble with breathing. COPD is chronic, meaning it is long-lasting and constantly present. Each individual case of COPD is different, and some cases are more severe than others. The most common cases of COPD include symptoms of both chronic bronchitis and emphysema.

COPD Explained

What is Happening in Your Body?

Your particular case of COPD will determine what is happening within your body. Cases that include chronic bronchitis will cause swelling and increased mucus production in the lung airways, or bronchial tubes. This causes breathing to become more difficult since your airways are inflamed and narrowed with mucus blocking them. Cases including emphysema cause destruction of the air sacs, or alveoli. The air sacs are responsible for oxygen exchange within the lungs, and they lose their elasticity by becoming destroyed. This causes breathing difficulty since the loss of elasticity leads to air being trapped inside the air sacs, making it harder to get oxygen in and carbon dioxide out.

Symptoms of COPD

Some of the most common symptoms include:

  • Increased shortness of breath
  • Frequent coughing (with or without mucus)
  • Wheezing
  • Tightness in the chest

Remember, not all cases of COPD will have the same symptoms. Other symptoms include frequent respiratory infections, lack of energy and unintended weight loss.

What Causes COPD?

COPD is mainly caused by inhaling lung irritants, and smoking is the #1 cause. People, however, do not realize that other potential lung irritants that can also cause COPD include exposure to air pollution, fumes, chemicals, secondhand smoke and dust particles. Oftentimes, inhaling these irritants can be work-related. Working in construction, mining or welding are examples of occupations that increase the risk of obtaining COPD due to increased exposure to lung irritants. A rare genetic factor called alpha-1 antitrypsin deficiency is also known to cause COPD and is passed from parents to their children.

Comorbid conditions seem to be more common in people with COPD than in people with other medical problems. These conditions may include:

  • High blood pressure
  • High cholesterol
  • Heart disease
  • Diabetes
  • Osteoporosis
  • Depression
  • Arthritis
  • Sleep Apnea
  • Cancer
  • Other medical problems

One reason for these additional problems may relate to the lung inflammation that occurs in people with COPD.

What is a Flare-Up?

A COPD flare-up, or exacerbation, is when your symptoms are considerably worse than usual. Some can be treated at home, but more severe flare-ups can require a visit to the hospital. Flare-ups are triggered by further lung inflammation. This can be from exposure to smoke, pollution or allergens as well as contracting the flu or pneumonia. Symptoms to look out for include:

  • Shortness of breath without physical activity
  • Increased mucus
  • Excessive coughing or wheezing
  • Lower blood  oxygen saturation level than normal

Those symptoms can usually be treated at home with antibiotics or inhalers, but the following list of symptoms require professional help.

  • Increased heart rate
  • Being unable to catch your breath
  • Lips or fingernails turn blue or gray
  • Treatments are not working

Does COPD Have a Cure?

COPD is a progressive disease, which means that it gets worse over time. Unfortunately, there is no cure, but luckily many treatment options are available to improve the quality of life. Bronchodilator and steroid medications are available through inhalers to relax the lungs, as well as oral anti-inflammatory medications. Oxygen therapy is also a popular treatment option to help patients achieve healthy blood oxygen levels, which is difficult to maintain when you have COPD. Oxygen therapy allows you to still be active and live a normal life while getting the oxygen into your body that you need, especially with the availability of portable oxygen concentrators. Pulmonary rehabilitation is another option for those with COPD. It helps patients adjust to and get educated about their conditions. Pulmonary rehabilitation programs often provide support and exercise training as well as breathing techniques that are personalized based on specific patient needs.

Living with COPD

Activities of daily living, such as completing chores or bathing, can be harder to accomplish due to shortness of breath. You may have to take constant breaks to catch your breath. Activities will take your energy to perform, so you will get physically exhausted more easily. Living with COPD means slowing down in order to control your breathing and to prevent tiring yourself too quickly. Living with COPD has its challenges, but modifying some activities of daily living can improve your quality of life and help you better manage your disease.

Takeaway

Although COPD is a life-long condition, you can still live a fulfilling life with the help of treatment options, although you may have to slow your pace. COPD takes a toll on your body, so taking care of yourself, monitoring your symptoms and following your doctor’s orders are top priorities.

Sources

https://www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffeatures%2Fcopd-awareness-month%2Findex.html

https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx

https://www.hse.gov.uk/copd/causes.htm

https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd#:~:text=With%20COPD%2C%20the%20airways%20in,the%20waste%20gas%20carbon%20dioxide.

https://medlineplus.gov/copd.html

https://www.nhlbi.nih.gov/health-topics/copd

https://www.nps.org.au/consumers/chronic-obstructive-pulmonary-disease-copd-explained

Risk Factors of COPD Among Women

Historically, men have been perceived to have a higher prevalence of chronic obstructive pulmonary disease (COPD) as compared to women, however, studies now show that more women are diagnosed with COPD and their mortality rates are higher. There is evidence of susceptibility among women of the risk factors associated with COPD.

The World Health Organization (WHO) in conjunction with the Global Burden of Disease (GBD), reports a prevalence of 251 million cases of COPD as of 2016. In 2015, it was estimated that 3.17 million deaths, accounting for 5% of global deaths, were caused by COPD. This is something that WHO had not predicted to occur until the year 2030.

As we know, COPD is a progressive respiratory condition that causes various limitations for breathing.

  • Pathophysiological changes involve inflammation in the lungs, narrowing of the airways, and damage to the lung parenchyma
  • The most common risk factors associated with the development of COPD include smoking, exposure to secondhand smoke, air pollution as well as occupational dust and fumes that are inhaled
  • WHO estimates that 25% of deaths attributed to COPD involve low- and middle-income countries and correlate to the increased exposure of household air pollution
  • Women who are exposed to high levels of indoor smoke and are twice as likely to develop COPD as compared to women that use cleaner fuels and technologies

While the diagnosis and treatment of men or women with COPD are the same, the risk factors are not consistent among both sexes. The associated risk factors among women that will be discussed include smoking status, associated comorbidities, occupational exposure, as well as anatomical and biological differences.

Smoking Status

As we know, tobacco smoke is the main cause of COPD in the United States and smoking is the leading cause of preventable death. According to information available from the Centers for Disease Control (CDC) and the U.S. Department of Health and Human Services (HHS) cigarette smoke causes about one of every five deaths annually, or 1,300 deaths every day. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, of which 201,773 deaths are among women.

The use of tobacco among women has steadily increased over the years, with a dramatic increase in use since the 1950s. During this time, it was more socially acceptable for women to smoke, and the tobacco industry targeted women in their marketing campaigns by promoting sex appeal, independence, and style. Decades later, tobacco companies continued their strategies by marketing cigarettes with slogans that included phrases such as “It’s a woman thing” or “You’ve come a long way, baby.” Some companies even suggesting that reaching for a cigarette was better than reaching for food and over-indulging, aligning with their campaigns that smoking made you more appealing and stylish. The effects of advertising are attributed to the rise in smoking among women in that era and their shift in use explains why consumption levels remain higher in places such as France, as compared to other countries.

Associated Comorbidities

COPD is typically associated with accompanying comorbidities and includes more organ systems than just our lungs. A recent publication in the respiratory care journal shares data researchers gathered regarding comorbidities among COPD patients and their associated healthcare use. The study included a total of 70,274 COPD subjects, women made up 58.2% of the total COPD subjects. Fifteen comorbidities were identified and the most prevalent diagnosed were hypertension accounting for 47.6%, high cholesterol at 29%, and allergies accounting for 34.2%. Women were found to have at least one or more comorbidities, 51.2% of the subjects studied, and had three times as many diagnosed comorbidities than their male counterparts.

In a 2016 review, Barnes discusses sex differences in COPD and notes that women with severe COPD have a higher risk of hospitalization and death from respiratory failure and associated comorbidities. For those women that have developed COPD due to smoking, their risk of dying from coronary heart disease as compared to other middle-aged nonsmokers’ women is five times higher.

Often, comorbidities in COPD patients go undiagnosed and therefore lead to failure in treatment for their needs. More standardized protocols should be developed by organizations with a goal to provide useful management of patients with COPD and comorbidities so that those healthcare providers caring for these patients provide the right care.

Occupational Exposure

Occupational and biomass exposure is another common risk factor for COPD. Workplace exposures can include things such as dust, fumes, gases, and secondhand smoke. Presently, some three billion people use biomass or solid fuel as energy sources to heat and light their homes, and to cook. In developing countries, women often are exposed to these risks as they spend most of their time in the home and do most of the cooking leaving them disproportionately exposed to larger amounts of biomass irritants.

It has been studied that a lower a person’s socioeconomic status, the higher their risk of poor health. This statistic includes women and children who live in severely impoverished countries and have the greatest exposure to air pollutants. In a 2006 WHO review on energy and health, women who cook with solid fuels have an equivalence of smoking two packs of cigarettes a day. To put it in perspective, a 1-year old girl can accumulate a two-pack year smoking history without ever having been exposed to tobacco smoke.

Women now work in similar jobs as do men, taking on careers in factories and chemical plants, working as farmers, mechanic shops, and in the hospitality industry. All these job fields along with others risk their health through exposure to harmful toxins that can in time lead to the development of COPD.

Anatomical and Biological Differences

Recent studies have also discussed the anatomical differences among men and women and how that is factored into the development of COPD. Various authors have compared lung sizes via different radiological tests and proven that men’s lungs are bigger. According to Aryal et al.,  women are more susceptible to developing COPD due to the size difference of their airways. Their airways are relatively smaller than those of males in comparison to their respective lung volumes.  Therefore, the level of tobacco smoke may be increasingly concentrated per unit of small airway surface. However, no difference in size has been observed in the number of alveoli per unit area, the number of alveoli per unit area volume, individual lung units, and alveolar dimensions. Collectively, more studies should investigate the specific differences in lung size as it relates to tobacco particle disposition and inhaled irritants.

Tobacco smoke contains more than 4,000 chemicals, the smoke inhaled into the lungs is then absorbed and metabolized throughout the body. The process involves a multistep approach but what is important to note about it is that cytochromes p450 (CYP) are what differentiates COPD between men and women. CYP is important in the clearance and breakdown of various compounds, irritants from inhaled tobacco being one of them. In fact. According to a 2016 publication by Hardin, female smokers have increased lung expression of CYP enzymes compared with male smokers. This evidence explains why estrogen levels in women have also been linked to the development of COPD. Estrogen may regulate CYP expression, specifically the estrogen receptor Era, which is more prevalent in women. This information collectively suggests female hormones may hasten the metabolism of tobacco smoke, via the CYP pathways, and accelerate the metabolism of nicotine.

Closing Thoughts

While the number of COPD-related deaths has fallen over the years, the number of diagnosed cases is rising. In the UK, COPD cases continue to rise as the population ages. The long-term effects of smoking are also likely to increase the present burden of COPD on healthcare systems. This presents challenges for both patients and the healthcare systems, not just in the U.S. and UK, but worldwide. It is imperative that we understand the underlying differences between men and women as it relates to COPD.  We should continue to work towards improving the diagnosis, treatments, and monitoring of COPD in women. Reducing the stigma surrounding COPD, raising awareness about various risk factors, and tailoring smoking cessation programs to women can help flatten the curve of this incurable disease.

 

Resources:

Aryal, S., Diaz-Guzman, E., & Mannino, D. M. (2014). Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. International journal of chronic obstructive pulmonary disease, 9, 1145–1154. https://doi.org/10.2147/COPD.S54476

CDC – Data and Statistics – Chronic Obstructive Pulmonary Disease (COPD). (2018, June 05). Retrieved September 22, 2020, from https://www.cdc.gov/copd/data.html

Barnes PJ. Sex Differences in Chronic Obstructive Pulmonary Disease Mechanisms. Am J Respir Crit Care Med. 2016 Apr 15;193(8):813-4. DOI: 10.1164/rccm.201512-2379ED. PMID: 27082528.

Han, MeiLan. (2020). Chronic Obstructive Pulmonary Disease in Women: A Biologically Focused Review with a Systematic Search Strategy. International Journal of Chronic Obstructive Pulmonary Disease. Volume 15. 711-721. 10.2147/COPD.S237228.

Hardin M, Foreman M, Dransfield MT, et al. Sex-specific features of emphysema among current and former smokers with COPD. Eur Respir J. 2016;47(1):104-112.

Quaderi, S. A., & Hurst, J. R. (2018). The unmet global burden of COPD. Global health, epidemiology, and genomics, 3, e4. https://doi.org/10.1017/gheg.2018.1

Soriano JB, Maier WC, Egger P, et al. Recent trends in physician-diagnosed COPD in women and men in the UKThorax 2000;55:789-794.

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Accessed September 22, 2020.

World Health Organization (WHO). Chronic obstructive pulmonary disease (COPD). http://www.who.int/respiratory/copd/en/. Accessed September 20, 2020

State of the Air – how does your city rank?

The American Lung Association State of the Air 2019 report ranks metropolitan areas based on air quality data. See the list of the cleanest cities (summer vacation time?) and find out which cities are the most polluted: https://www.lung.org/our-initiatives/healthy-air/sota/city-rankings/

 

 

Seasonal Allergies and COPD

Seasonal allergies are very common, but people who have COPD and allergies suffer from worsened respiratory symptoms such as coughing and wheezing. Here are a few tips on avoiding serious complications:

Stay indoors on days with high pollen and mold levels. Many weather sites provide information on the allergen levels in your area. If levels are high, try to stay indoors to reduce symptoms.

Stay indoors during poor air quality days.  Check the air quality index in your area – high amount of air pollution can worsen respiratory symptoms. If you cannot stay indoors, wear a mask to filter out the pollutants and irritants.

Treat your symptoms. If you have runny nose, itchy eyes or other allergy symptoms, talk to your doctor about allergy medications or decongestants to help lessen breathing difficulties.

Get more tips on avoiding COPD complications during allergy season: https://www.healthline.com/health/copd/seasonal-allergies-tips-avoid-complications#1

 

Failure to vaccinate children from measles could lead to chronic lung disease in adulthood

A recent case study report demonstrated the possible future increase in non-Cystic Fibrosis Bronchiectasis (NCFB) cases due to more US adults choosing not to vaccinate their children from measles. Diseases such as pulmonary tuberculosis, measles and whooping cough are strongly associated with NCFB developing in affected people later in life.

NCFB is a chronic condition where the airways are damaged and have become widened with scarred and thickened walls. As mucus builds up, bacteria can grow and the airways can become infected, making it more difficult to clear them. This can ultimately lead to the loss of lung function over time, as well as serious health problems such as respiratory failure, heart failure, and atelectasis.

There is no cure for NCFB. The disease often is treated with medicines, hydration, and chest physical therapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated to a section of lung or you have a lot of bleeding. If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen therapy.

Learn more: http://bit.ly/2vIKvTe and http://bit.ly/2vH6eLq

 

Does working in the Information industry cause COPD?

A recent Centers for Disease Control (CDC) study found that during 2013-2017, an estimated 2.4 million U.S. working adults 18 and older who never smoked had COPD. Research suggests that workplace exposures likely contribute to much of their disease.

According to the CDC report, among workers who never smoked, some of the highest COPD prevalences were in the information industry and administrative support occupations. The study also found that within the group of workers who never smoked, women had higher COPD prevalences than men.

See other statistics reported in the study, including COPD prevalences by sex, race and ethnicity, as well as public health implications, here

 

Oxygen and Wound Healing

Oxygen plays a vital role in our daily lives. We breathe because our bodies need oxygen to produce energy. However, in addition to enabling us to function, oxygen’s ability to produce energy plays an important role in wound healing.

Wounds that are infected and inflamed have poor blood flow. Exposure to high concentrations of oxygen (e.g. topical or hyperbaric oxygen therapy) helps accelerate healing by reducing inflammation, promoting collagen formation and stimulating the growth of new cells and blood vessels.

Although many factors affect the wound healing process, a study published in the Journal of Wound Care found that the use of topical oxygen therapy helped nearly half of the previously non-healing wounds close.

The Benefits of Oxygen Therapy

For people with chronic lung diseases, such as COPD, oxygen therapy is prescribed to increase the oxygen level in their blood. However, many patients do not comply with their prescribed treatment, with reasons ranging from self-consciousness to not understanding the benefits.

If you or your loved one has been prescribed oxygen therapy, here is a closer look at some of the benefits of long-term oxygen therapy:

  • Increased survival – by far, the most important benefit for people with COPD is that it prolongs your life if you have more severe resting hypoxemia (low levels of oxygen in your blood).
  • Reduced complications – supplemental oxygen helps reduce COPD complications by stabilizing pulmonary hypertension, reducing secondary polycythemia, and decreasing arrhythmias (irregular heart rhythms).
  • Lessened symptoms – supplemental oxygen can help relieve dyspnea (shortness of breath) and other symptoms related to COPD, including fatigue, dizziness, and depression.
  • Improved health-related quality of life – not only does supplemental oxygen improve your sleep and mood, it also increases your mental alertness and stamina, allowing you to get more done during the day.

These are just a few of the many benefits of oxygen therapy, so read more.

Belluscura to present at UK Investor Show this Saturday

Visit Belluscura at Booth 65 at the UK Investor Show! See a live demonstration of the X-PLO2R portable oxygen concentrator, learn more about its unique technology and multiple advantages, and meet Belluscura’s CEO Bob Rauker and CFO Tony Dyer.

Investment Notice: Neither Belluscura or Crowdcube is soliciting investors in the United States, Canada or Japan or any other country where it would be unlawful for its pitches to be advertised. Investors must not register or view pitches if they are resident in these countries.

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Over 100 investors are now supporting Belluscura through crowdfunding!

To date, we have brought on more than 100 investors from 12 countries and we are very thankful for all the interest in, and support of the X-PLOR. Our goal is to help patients suffering from chronic lung diseases, such as COPD, to enjoy more active and fulfilling lifestyles. Please join us in helping millions of people in the world breathe easier – invest today!

Investment Notice: Neither Belluscura or Crowdcube is soliciting investors in the United States, Canada or Japan or any other country where it would be unlawful for its pitches to be advertised. Investors must not register or view pitches if they are resident in these countries.

Read more