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Lung Disorders Special Report

COPD: Catching the “Silent Killer”

According to the National Heart, Lung, and Blood Institute about 12 million Americans likely have chronic obstructive pulmonary disease (COPD) but don't know it. Because COPD often produces no symptoms in its early stages, it is often not caught until severe breathing problems develop. That's why COPD is sometimes referred to as "chronic overlooked pulmonary disease." However, by catching the disease early, people with COPD can make lifestyle changes and start on treatments that will slow the loss of lung function, improve their quality of life, and, in some cases, increase survival.

To help identify COPD at its earliest stages before it causes serious lung damage, anyone at risk for COPD should take a simple, painless, noninvasive breathing test called spirometry at the first sign of any breathing difficulties. People at risk for COPD include current and former smokers over age 40, anyone exposed to environmental tobacco smoke or irritants in the workplace, people with a family history of COPD, and anyone with the genetic abnormality alpha1-antitrypsin, or AAT, deficiency.

Anyone of any age, regardless of smoking history, should have a spirometry test if they have these COPD symptoms:

  • constant coughing, sometimes called smoker's cough
  • shortness of breath while doing activities you used to be able to do
  • excess sputum production
  • feeling like you can't breathe
  • difficulty taking a deep breath
  • wheezing

What Is Spirometry?
Spirometry is a lung function test that measures the amount of air you can blow out of your lungs and how fast you can blow it out. The test is performed with a machine called a spirometer. To perform the test, you will be asked to take as deep a breath as you can, and to then blow out as hard and as fast as you can into a disposable mouthpiece that is connected to the spirometer with a flexible tube. The spirometer will then measure how much air you exhaled in the first second, called the forced expiratory volume in one second (FEV1), and the total amount of air exhaled, known as the forced vital capacity (FVC). Some portable office spirometers measure FEV1 and the total amount you exhaled in six seconds (FEV6). On these spirometers, FEV6 is used as a substitute for FVC.

Doctors use the ratio of FEV1 to FVC (or FEV6) to help determine whether your lungs are functioning normally. The ratio is obtained by dividing your FEV1 by your FVC (or FEV6).

A value less than 70% suggests that you may have COPD. FEV1 is used to measure the severity of COPD. It is expressed as a percentage of the average result expected (the percent predicted) for a healthy person of your age, height, gender, and race. For example, a person with an FEV1 of 50% exhales about half the amount that a similar healthy person would be expected to exhale in one second. In general, an FEV1 greater than 80% of predicted is considered normal.

Why Early Diagnosis of COPD Matters
If you're in an at-risk group and spirometry indicates your lungs are healthy, experts recommend getting retested in three to five years. If you do have COPD, the sooner you are diagnosed, the sooner you'll be able to start treatment and make lifestyle changes that can help slow disease progression. If you have mild or moderate COPD, your doctor may recommend some or all of the following:

  • Stop smoking. If you smoke, quitting will prevent further damage to your lungs as well as help preserve remaining lung function.
  • Get vaccinated. The flu can be very harmful to people with COPD, often leading to pneumonia and other serious respiratory problems that require hospitalization. To protect yourself from the influenza virus, get a flu shot yearly. A pneumococcal vaccine every five to 10 years also is important.
  • Take your medications. Proper treatment can help to reduce the frequency of COPD exacerbations. If you occasionally have symptoms, your doctor may prescribe a short-acting bronchodilator, such as ipratropium (Atrovent HFA) or levalbuterol (Xopenex HFA) to be used as needed. When your symptoms become more frequent, a long-acting bronchodilator, such as tiotropium (Spiriva) or salmeterol (Serevent), might be prescribed.
  • Go to pulmonary rehabilitation classes. This program of education and exercise classes for people with all stages of COPD teaches you about how your lungs function, how to exercise and do activities with less shortness of breath, and how to live better with your lung condition.
  • Posted in Lung Disorders on July 16, 2009

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