NEWS

Shortness of breath may be first sign of deadly COPD

Mike DeDoncker

Harry Brunner says it takes him two days to do things another person can do in one.

Brunner, a two-and-a-half-packs-a-day smoker for 20 years, lays the blame on his chronic obstructive pulmonary disease — chronic bronchitis with emphysema. Brunner said he considers himself a “medium” COPD patient because he doesn’t need oxygen therapy, but said his shortness of breath forces him to pace himself during two of his favorite pastimes — working in his yard and playing golf.

It also is responsible for Brunner’s high blood pressure and one of the worst winters he’s ever spent.

“I’m susceptible mostly to pneumonia,” said Brunner, who is in his 70s but doesn’t admit to a specific age. “I had pneumonia this past February, and I was in the hospital for six days and then I had to go to a nursing home for five weeks. I’m also doing pulmonary rehabilitation, and that’s from the pneumonia also. That’s the worst I’ve ever had it.”

COPD is a progressive disease that develops slowly and makes it hard to breathe because air passages in the lungs become abnormally narrowed and clogged with mucus. It can cause wheezing, shortness of breath, chest tightness and other symptoms.

Although smoking accounts for about 85 percent of COPD cases, long-term exposure to air pollutants, chemical fumes or dust can contribute.

Brunner takes five medications a day for COPD and two for the high blood pressure, one of which is a beta-blocker.

Like most patients, Brunner didn’t suspect bronchitis or emphysema when he went to see his doctor in the late 1990s. He said he doesn’t recall being noticeably short of breath back then, either.

“I went because I was getting sick all of the time,” he said.

Dr. Jon Michel, a pulmonologist, intensivist and sleep doctor in the Heart Hospital at SwedishAmerican, said COPD is the fourth leading cause of death in the United States and is expected to become the third leading cause in the next five to 10 years.

Because it is highly preventable and treatable, Michel said, it is frustrating when patients go undiagnosed or are diagnosed too late.

“I have many patients,” Michel said, “that feel their shortness of breath is due to getting older, getting heavier, being sedentary or being out of shape. The answer is that, oftentimes, if you are short of breath you could have COPD so it’s very important to bring up the concept with your doctor, get tested for it and get treated for it early.”

He said a simple test in which the patient holds the tube of a measuring device called a spirometer in their mouth, inhales as much air as possible, and then exhales forcefully into the spirometer is the first step in diagnosing COPD.

The test measures the amount of air that can be moved in and out of the lungs, and patients with COPD cannot move enough air out of their lungs. “It’s like putting your finger over a garden hose,” Michel said. “The air can’t get out.”

Michel said the most important treatment for COPD “is to stop smoking, and, after that, there is a wide variety of medications, lifestyle changes and exercise programs that help people feel better.”

Brunner said he quit smoking within two years of being diagnosed and said, “If I could tell someone with COPD one other thing, it would be to lose weight. I’ve lost 26 pounds since January and the reason is simple. It’s just easier to breathe.”

COPD patients often develop heart problems that, as with Brunner, may be treated with beta blockers. But doctors also may avoid beta blockers because of concerns about causing bronchospasms in the lungs.

“Sometimes, people with COPD, if they get beta blockers, can have worsening of their wheezing,” Michel said.

A report in the May 24 issue of Archives of Internal Medicine, a part of the Journal of the American Medical Association, suggests that COPD patients may have fewer respiratory flare-ups and longer survival if they take beta blocker medications. The report and an accompanying editorial say more research is needed on the subject, but the editorial adds that the report “provides a rationale for the practicing clinicians to use beta blockers cautiously in their patients with COPD who also have a coexisting cardiovascular condition for which a beta-blocker is required.”

Michel said many patients with COPD die of heart disease that can be attributed to inflammation in the body caused by the COPD.

“It has been recently suspected that beta blockers actually can help with the heart disease that comes from COPD and maybe even the COPD itself, so maybe instead of being scared of beta blockers perhaps we should be more aggressive. The recent JAMA article is encouraging but not conclusive. It needs more study.”

Staff writer Mike DeDoncker can be reached at 815-987-1382 or mdedoncker@rrstar.com.

About chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a complex disorder. There are two major forms of the disease, chronic bronchitis and emphysema. In both, narrowed bronchi make it hard to exhale. Narrowed bronchi also cause asthma — but in asthma, the narrowing is temporary and reversible. In COPD, it’s permanent.

COPD is the fourth leading cause of death in the United States. It’s expected to take about 126,000 lives this year, making it the only one of the 10 leading killers that’s increasing each year.

COPD is also a major cause of disability since some 24 million Americans suffer from the condition; although it has traditionally been a predominantly male disease, COPD is on the rise in American women.

COPD is not curable but it is treatable. Lifestyle changes and medication can help patients cope with chronic lung disease and live longer, fuller lives. And if you understand COPD, you’ll know that most cases can be prevented.

Source: Harvard Men’s Health Watch, Harvard Health Letters