If you find yourself wheezing and coughing frequently and having trouble taking deep breaths, it may be time to have a doctor test you for COPD (chronic obstructive pulmonary disease). COPD refers to a group of diseases that causes airflow blockage and other breathing-related problems, including emphysema and chronic bronchitis.
“Basically, COPD is a disease of the bronchial airways that affects both the large and small airways, and the airways collapse,” says Dr. Diego Maldonado, a pulmonologist with Cleveland Clinic Indian River Hospital who has devoted his 20-year career to treating ailments of the lungs and respiratory systems to help his patients breathe better.
“This chronic inflammatory process is triggered by injury, with the most common being smoking. The inflammation starts like any other inflammation with swelling of the tissue, redness and mucus production. The airways become tight and obstruct the flow that comes out during exhalation so the patient can breathe in but has difficulty breathing out. This chronic inflammation produces irreversible damage.
“The swelling of the tissues affects the small airways. They lose elasticity, become dilated and trap air in the lungs, giving the patient less room to breathe,” he continued.
“It’s a process. The early inflammation in the early stages of smoking leads to chronic bronchitis, and as it becomes more damaged it leads to emphysema, which in turn causes hypoxia and pulmonary hypertension,” Dr. Maldonado said. “Eventually it can lead to right heart failure.”
According to the American Lung Association, COPD was the third-leading cause of death in the United States. More than 16.4 million people have been diagnosed with COPD, but millions more may have the disease without even knowing it. While there is no cure for COPD, if diagnosed early much can be done to treat and help manage the disease.
Cigarette smoking causes about as much as 90 percent of all COPD cases, but nonsmokers can get COPD too. Long-term exposure to air pollution, second-hand smoke and dust, fumes and chemicals are also risk factors. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked, while male smokers are nearly 12 times as likely to die from COPD as men who have never smoked.
Which makes it overwhelmingly clear the best defense against COPD is to stop smoking or never start in the first place. People with COPD who have stopped smoking improve their breathing capacity, health and quality of life.
A simple breathing test can determine if you have COPD and what stage it’s at. You take a deep breath in and blow hard into a tube which is connected to a machine called a spirometer. Then you breathe in a medicine that will help open your airways, and blow into the tube again.
“There are four stages of COPD,” Dr. Maldonado explains. “We measure the percentage of function of the lungs to determine the severity of the illness. Stage 1 (in which 80 percent or more of lung function remains intact) is mild; stage 2 (50 percent to 79 percent function) is moderate; stage 3 (30 percent to 49 percent function) is severe; and stage 4 (less than 30 percent function) is very severe.
“Where the patient is on the percentage of lung function will determine their treatment. The early stages can be treated with medication like bronchodilators and steroids. The destruction continues as the patient reaches stage 3 and 4.
“By this time the lung function is lower than 50 percent and there is a mismatch between oxygen consumption and oxygen production,” he continues. “Their lungs cannot catch up with their needs and we need to supplement with oxygen. If there is not enough lung tissue for the exchange, you start to become hypoxic, so we are always looking at the oxygen levels and may need to supplement with portable oxygen to prevent further organ damage.”
Early diagnosis and treatment is the key to living longer and more comfortably with COPD. You should see a doctor if you are having breathing problems, especially if you are a smoker or former smoker. After 10 years of smoking you may already be experiencing chronic conditions, and after 20 years you may already have emphysema.
Even if you quit smoking 20 years ago, if you are experiencing symptoms like shortness of breath, chronic cough and mucus production, you should be screened. However, even if you are a former smoker, if you are asymptomatic there is no reason to screen for COPD.
COPD is a major risk factor for lung cancer simply because of the smoking connection.
“Lung cancer is the most common death from cancer, more than breast and colon combined,” Dr. Maldonado notes.
“In Indian River County lung cancer is in the top causes of death, as common as heart attacks and strokes. Because of this risk we screen our COPD and emphysema patients with a low-dose CT scan of the chest. Seventy-five percent of lung cancers are diagnosed past stage 3, so we recommend yearly screenings for smokers and prior smokers at age 50 and over.
Lung cancer is called the silent killer because there are no symptoms until stage 3, so we are trying to be more proactive and catch it earlier.”
Vaping and inhaled marijuana are the newest risks for COPD and lung cancer. “We don’t know what the long-term affects from vaping are going to be, but early data suggests that it is as bad or worse in damage to the airway,” Dr. Maldonado warns.
“And since the legalization of marijuana, it is being used more frequently with long-term effects on the airways. While cigarette smoking has gone down, vaping and marijuana use has gone up.”
The bottom line is, if you want to breathe easily and have healthy lungs … don’t smoke!
Dr. Maldonado is originally from Ecuador, where he earned his medical degree at Universidad Central del Ecuador. He moved to Miami to complete his Internal Medicine residency training, followed by a fellowship in Critical Care and Pulmonary Medicine at the University of Miami–Jackson Memorial Hospital.
Dr. Diego Maldonado diagnoses and treats pulmonary conditions such as asthma, emphysema, COPD, pulmonary hypertension, sarcoidosis, sleep apnea and lung cancer. He has been at Cleveland Clinic Indian River Hospital for nine years and can be reached at 772-794-5800.
