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COPD: When You Learn More, You'll Breathe Better

A man taking a breathing test

Photo courtesy of NIH/NHLBI

Keith Ferrell is a freelance medical writer.

In January, the NIH's National Heart, Lung, and Blood Institute launched a major public awareness program to increase everyone's knowledge about COPD (chronic obstructive pulmonary disease). Are you at risk for COPD?

You would think that the nation's fourth leading cause of death would be better known. Yet, COPD (chronic obstructive pulmonary disease) has remained off the public radar, despite recognizable symptoms and treatments that can control symptoms and prolong life.

"COPD is not well understood by the general public," says James Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI). "Learn More, Breath Better," a new educational program from NHLBI and more than 20 other organizations, is intended to remedy that. The campaign's goal is to raise public awareness of COPD so that people at risk will talk to their doctors and get a simple breathing test.

COPD most often occurs in people over age 45 and with a history of cigarette smoking (either current or former smokers), although as many as 1 out of 6 people with COPD never smoked. Smoking is the most common cause of COPD—it accounts for as many as 8 out of 10 COPD related deaths.

"COPD is more than just the sum of its parts," Dr. Kiley says. "COPD [as a whole] is a disease of declining lung function caused by persistent airflow obstructions. It is not fully reversible, although there are treatments that do help people breathe easier."

A Simple Breathing Test

Everyone at risk for COPD—especially those over age 45 with a history of smoking or those experiencing shortness of breath—should be tested for COPD with a simple breathing test. Spirometry is one of the best and most common lung function tests. The test is done with a spirometer, a machine that measures how well your lungs function, records the results and displays them on a graph for your doctor. You will be asked to take a deep breath, then blow out as hard and as fast as you can using a mouthpiece connected to the machine with tubing. The spirometer then measures the total amount of air exhaled, called the forced vital capacity or FVC, and how much you exhaled in the first second, called the forced expiratory volume in 1 second or FEV1. Your doctor will use the results to assess how well your lungs are working and whether or not you have COPD.

In COPD, the airways (the tubes that make it possible for air to enter and leave your lungs) become blocked, making it difficult to breathe. COPD is sometimes known as emphysema or chronic bronchitis. It claims more than 120,000 lives per year, and causes millions of others to restrict their physical activities, be unable to work, and confine themselves to their homes. People realize too late that quality of life is directly related to quality of breathing.

"This is a serious and life-threatening condition," says Dr. Kiley. And unlike many diseases that are showing declining death rates as new therapies and treatments are introduced, COPD's death rate continues to climb. Current estimates are that more than 12 million Americans have COPD. An additional 12 million more may have the disease but haven't been correctly diagnosed.

Early detection is crucial. "Coughing, shortness of breath, excess sputum or phlegm production, and other signs of respiratory difficulty are good indications that a physician should be consulted," Dr. Kiley says. Testing for COPD is simple and non-invasive. The test itself is called spirometry, and involves taking a deep breath and then exhaling into a tube connected to a machine, which then provides a reading of lung function.

Once diagnosed with COPD, a patient has several options, depending upon the severity of the obstruction. "There are treatments that can control symptoms," Dr. Kiley says, "and that can slow the decline in lung function, improving the patient's quality of life." Those treatments include medications, such as bronchodilators, inhaled steroids, oxygen, pulmonary rehabilitation and, in a fraction of the most severe instances, surgery.

Lifestyle management and adaptation should accompany medical treatment. COPD patients can coordinate or alter their physical activities to match their pulmonary capabilities and take part in programs of lung rehabilitation and exercise.

"The benefits of early detection are undeniable," he says. "The sooner COPD is diagnosed and treatment begins, the better the chance of slowing the decline in lung function."

It's important to note that former smokers are also at risk. Tobacco smoke damages the lungs at the cellular level—damage that not always can be reversed. Also, COPD's more severe effects may not appear until later in life, accompanying the natural decline in lung function that occurs as we age. Consequently, former smokers may face declining lung function and COPD years or decades after they quit.

Although COPD is at the moment incurable, large strides are being made in its treatment, and in our understanding of it. Learn More, Breathe Better is meant to help make those strides even larger.

 What's New: Large Clinical Trial to Look at Home Oxygen Therapy for COPD

The National Heart, Lung, and Blood Institute (NHLBI) and the Centers for Medicare & Medicaid Services (CMS) are launching the largest randomized clinical trial of the effectiveness and safety of long-term, home oxygen therapy for COPD. The six-year, $28 million project will study patients with moderate disease.

In the Long-term Oxygen Treatment Trial, researchers across the United States will study approximately 3,500 patients with moderate COPD to determine whether supplemental oxygen will help them lead longer, more active, and better quality lives. The results will help Medicare decide whether to extend coverage for home oxygen treatment to patients with moderate disease. Currently, Medicare limits coverage of home oxygen therapy to beneficiaries with severe COPD (very low blood oxygen levels while resting). Medicare is extending coverage of home oxygen treatment to Medicareeligible patients enrolled in the study, however.

Although oxygen therapy has been shown to improve survival in patients with severe COPD, the effects of treatment have not been adequately studied in patients with less severe disease. Patient recruitment for the Long-term Oxygen Treatment Trial is expected to begin in late 2007.

You can learn more about COPD at and at (type COPD into the search box).

Winter 2007 Issue: Volume 2 Number 1 Page 24 - 25