Why You Should Care About COPD and What to Do About It
This chronic pulmonary disease is the sixth-leading cause of death and disability in the United States
"Twin Peaks," which aired in 1990, was one of my all-time favorite television shows. Sadly, I recently read that co-creator David Lynch, who also earned three Oscar nominations for Best Director, announced that he had emphysema, a type of chronic obstructive pulmonary disease (COPD). Lynch died Jan. 16, 2025.
At the time, Lynch said he was no longer able to work on set, could only walk a short distance before running out of breath, and had chosen to stay essentially homebound because of fears of getting COVID-19, which could severely compromise his lung function even more than it was. A longtime smoker who quit two years ago, he is one of millions of Americans who sustained long-term lung damage even after quitting.
Raising Awareness
COPD is the sixth-leading cause of death and disability in the United States. In fact, 150,000 people in the U.S. die of the disease every year. Barbara Mann, M.D., a pulmonologist at Mount Sinai-National Jewish Health Respiratory Institute and associate professor of medicine, pulmonary, critical care and sleep medicine at Icahn School of Medicine at Mt. Sinai, explains that COPD is the umbrella term encompassing emphysema and chronic bronchitis.
"The easiest way to see what it feels like is to try breathing through a straw."
In healthy lungs, the airways and air sacs, also called alveoli, are elastic and stretchy. When you breathe in, the air sacs fill up with air like a small balloon. When you exhale, the sacs deflate and air flows out. COPD causes a lessened air flow in and out of the airways due to several possible reasons. The airways and alveoli lose their elasticity, the walls between the air sacs are destroyed and those of the airways become thick and inflamed. The airways produce more mucus, which clogs them and decreases the movement of air.
"The easiest way to see what it feels like is to try breathing through a straw," says Lisa Postow, program officer in the Division of Lung Disease at the National Heart, Lung and Blood Institute (NHLBI).
While emphysema and chronic bronchitis share some similarities, such as shortness of breath and wheezing, and often co-exist in the same person, there are differences between the two, Mann says. "Emphysema causes damage and destruction of the alveoli themselves, allowing less air to reach the lungs and causing an impairment in gas exchange," she explains. The walls of the damaged alveoli can weaken or break, causing hypoxia (low oxygen levels) in the bloodstream, and leads to fatigue and shortness of breath.
Among other effects, chronic bronchitis causes dysfunction of the tiny hair-like projections, called cilia, in the bronchial tubes. The cilia's inability to clear disease-causing microbes and debris out of the airways leads to bronchial narrowing and inflammation, resulting in an irritating mucus-producing cough and the accumulation of thick secretions in the lower airways. The damaged airways and copious amounts of sticky sputum make it a good breeding ground for bacterial infections such as pneumonia to occur.
Approximately 16 million American adults are diagnosed with COPD, and millions more have the condition but have not yet been diagnosed.
According to Postow, approximately 16 million American adults are diagnosed with COPD, and millions more have the condition but have not yet been diagnosed. Early diagnosis is most important so treatment can begin and further lung deterioration hopefully slowed or stopped.
Anyone with a chronic cough, shortness of breath or poorly controlled asthma should see their physician for evaluation. You may be asked to take a written test, which you complete yourself and which gives your doctor an idea of how your lung function is impacting your health status. Most people with COPD are either smokers or ex-smokers, but about 25% of cases are due to genetic or environmental factors.
The first step in diagnosing COPD is a thorough medical evaluation. A number of tests may be done to evaluate your breathing, including spirometry and pulmonary function tests, a CT scan of the chest, determination of oxygen levels and exercise and blood tests.
COPD Research Findings
The 2024 Global Initiative for Chronic Obstructive Lung Disease (GOLD Report) updated and outlined the best practices for disease management, with some modification from 2023 of COPD definition, risk factors and treatment guidelines. Mann explains that the 2024 GOLD Report is more symptom driven than the previous report. This year's goals for treatment of stable COPD include relieving symptoms, improving exercise tolerance and health status, preventing disease progression and reducing mortality. Some other changes include:
- Updating vaccination recommendations and adding RSV (respiratory syncytial virus) vaccine for people over 60 or those with chronic heart or lung disease
- A new section on pharmacotherapies for smoking cessation was added
- E-cigarettes are no longer recommended as a bridge for people trying to quit smoking because there is no valid data on long-term effects
- Pending confirmation, the study showed clear positive effects for the use of biologics such as dupilumab
- Further clarification about spirometry (one type of breathing test) and when it is recommended
- A new section has been added on screening for COPD for targeted populations and leveraging lung cancer imaging for screening for COPD. The GOLD report stated that, in one study, 57% of 986 individuals screened for lung cancer had COPD as well, and, importantly, 67% of those people had been undiagnosed and untreated for their COPD.
- The management of inhaled therapy has been updated, including choice of inhaler device and assessing a patient’s ability to use the delivery system correctly.
Living With COPD
"It is heartbreaking when people have stopped smoking years ago and still have damage 20 years later," Mann says. "The most important way to prevent COPD is to avoid smoking and the exposure to second-hand smoke and environmental toxins."
While lung damage cannot be completely reversed, treatment can help to slow disease progression, reduce symptoms and may improve the body's response to treatment.
Depending on many factors, treatment is individualized and may be modified over time depending on your response. Medications are generally given orally, by inhaler, via nebulizer or by an injection. Long-acting bronchodilators that help to open breathing passages, inhaled corticosteroids, oral glucocorticoids, PDE4 inhibitors, anticholinergics, and mucolytic agents (which thins mucus to make it easier to cough up) are some of the commonly used drugs. In the later stage of the disease, some people need to use supplemental oxygen. In very severe cases of COPD, a lung transplant or lung volume reduction surgery may be recommended.
"The most important way to prevent COPD is to avoid smoking and the exposure to second-hand smoke and environmental toxins."
Once diagnosed, it is important to manage your disease as well as seeing your health care provider(s) on a regular basis. Physical activity, even if some shortness of breath is present, is crucial, Mann says.
Pulmonary rehabilitation is one of the mainstays of COPD treatment, reducing dyspnea, improving health status and exercise tolerance, lessening anxiety and depression and reducing hospitalization in patients with a recent exacerbation.
Getting all vaccinations that are recommended for adults, which include shingles, pertussis, RSV, flu, pneumococcus and COVID-19 shots is essential, and having your pertussis (whooping cough) vaccination updated is especially important for grandparents who are around young children, since there has been a recent uptick of pertussis cases in children. If your COPD has resulted from, or been complicated by smoking, even if you have stopped, an annual low-dose CT scan is recommended for lung cancer screening, since chest x-rays do not always pick up a problem.
Because many people with COPD have comorbidities such as cardiovascular disease, skeletal muscle dysfunction, osteoporosis, metabolic syndrome and depression or anxiety, a healthy lifestyle and addressing your other health issues is important. Managing fatigue, having a healthy diet and mind-body activities such as yoga and tai chi can be helpful.
Our bodies often give us ample warning when something is wrong. We need to honor that and, if you have concerns, take a deep breath, bite the bullet and see your health care provider pronto. Your health, and perhaps even your life, may be at stake.
