The Quest for Multiple Answers About a Multi-System Disease

What Is COPD?

COPD is a lung disease that over time makes it hard to breathe. COPD (short for chronic obstructive pulmonary disease) includes chronic bronchitis and emphysema. With chronic bronchitis, the lining of the breathing tubes becomes swollen and produces a lot of mucus that gets coughed up. With emphysema, the walls of the air sacs in the lungs are broken down and the air spaces get larger and air gets trapped.

Obstruction in COPD means that the flow of air in and out of the lungs is less than it should be. When that happens, less oxygen gets into the body tissues and it becomes harder to get rid of carbon dioxide.

Getting to know COPD for its true self is a scientific challenge on multiple levels. It has unveiled itself as a multi-system disease and a global menace that has become a fact of life for 210 million people worldwide, as the effects of smoking and other environmental factors collide with individuals’ genetics.

COPD is primarily a lung disease, yet the more researchers learn, the more medical experts understand and treat it as an inflammatory disease that can have implications beyond the lungs. Research suggests that it increases a person’s risk for heart disease and stroke, osteoporosis and lung cancer. It affects muscles and the nervous system, and COPD may be improved by an antioxidant-rich diet. It is closely linked to asthma, with many questions about where asthma ends and where COPD begins in older patients. Researchers are dissecting this spectrum of issues that come into play with these entangled physiologic and genetic mysteries.

Some systemic effects are well documented and fairly well understood within the general progression of COPD, and others are at the early stages of research.

  • The disease diminishes the heart’s ability to pump, even when symptoms are mild. But investigators are working to determine the specific cause of cardiac effects.
  • Musculoskeletal changes are not yet necessarily well understood. COPD increases a person’s risk for osteoporosis, but by what mechanism? Some muscle atrophy is attributed to individuals’ limited mobility, but the role of inflammation in the muscle breakdown is not yet clear.

Nutrition is another area of research. Some preliminary data has shown that a diet rich in antioxidants can improve lung function among people with COPD.

Developing novel treatments is a wide-open field of study—and one of critical need as the population ages. American Lung Association genetic research includes work to identify genes that regulate inflammation, which may lead to targeted therapies that could halt progression of COPD. Studies to define various mechanisms of COPD and its systemic effects will be critical not only for potential treatments, but also in understanding risk factors for COPD other than smoking. In addition to those people who have the inherited form of COPD (alpha 1-antitrypsin deficiency), why do some nonsmokers get COPD? Is it related to exposure to secondhand smoke? How do risk factors such as physical inactivity and HIV lead to the development of COPD?

The research questions seem boundless. Investigators are studying the disease from every angle, from genetics and immunology, to neurology and nutrition and multiple topics in between. Scientific evidence has built the case of COPD as a systemic, inflammatory disease, and today’s focal “mysteries” go to deeper levels. These mysteries are the how and why of COPD’s impact throughout the body’s other organs, as well as the interplay between genetics and environment in people with COPD.

Know the Early Warning Signs

COPD is often not found until the disease is very advanced because people do not know the early warning signs. Sometimes people think they are short of breath or less able to do the things they are used to doing because they are ’just getting old”. But shortness of breath while doing ordinary daily activities is never normal. The good news is that COPD can be found early and there is much that can be done to treat and help manage the disease.

Early warning signs are:

  • Constant coughing, sometimes called “smoker’s cough”
  • Shortness of breath while doing everyday activities
  • Producing a lot of sputum (also called phlegm or mucus)
  • Feeling like you can’t breathe or take a deep breath
  • Wheezing

If you believe you may be at risk for COPD or have symptoms of COPD, contact your doctor so that you can be tested. Early diagnosis is critical in treatment of COPD.