What To Ask About COPD

June 06, 2012

Confronting a new diagnosis can be frightening -- and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.

I’ve never smoked cigarettes (or quit 20 years ago). How could I get C.O.P.D.?

Smoking is far and away the leading cause of C.O.P.D. in the United States and accounts for 85 percent of cases (though only about 20 percent of all smokers develop C.O.P.D. with significant symptoms); the disease can develop in people who quit years ago. Passive exposure to secondhand smoke may also play a role. In developing countries, exposure to indoor smoke from heating or cooking can cause the disease. Job exposures (such as to silica in mines) may also cause C.O.P.D. Air pollution likely accounts for only 1 percent to 2 percent of cases, although it can make the disease worse.

I’ve smoked for 25 years. Will quitting now make a difference?

Quitting smoking is the most effective thing you can do to treat C.O.P.D. Smoking inflames the lungs and airways, and while stopping may not be enough to prevent disease progression completely, it may slow it. Studies show that, overall, quitting smoking brings about a 50 percent sustained reduction in lung function decline.
What’s the best way to quit smoking?

In one study from 2001, nicotine replacements products, such as gums, sprays or a patch, were more effective than the pill buproprion (Zyban) in helping smokers with C.O.P.D. to quit. A newer smoking cessation drug, called Chantix, is also available. Counseling may also help.

Do I need a breathing test (spirometry)?
Spirometry, a relatively simple breathing test that measures how much and how quickly air moves out of the lungs, is the best way to assess lung function in patients with C.O.P.D. It is critical for making a diagnosis and assessing progression of the disease. Unfortunately, harried physicians too often skip the test, which only takes a few minutes. A recent study of 25 primary care practices found that most did not perform the test, even when they had the equipment to do so.

Should I see a lung specialist?

A lung specialist would be most likely to perform spirometry during routine visits and be familiar with medications to treat C.O.P.D. That includes preventive medicines to open the airways and quell inflammation, which should be taken daily and not just in emergencies. It’s also critical that patients know how to use inhalers and other medications properly.

How often do I need to come in for check-ups?

If you have C.O.P.D., doctors generally recommend you get spirometry at least once a year. More frequent visits may be needed to assess your response to therapy. It’s also important to see your doctor if symptoms worsen -- an increase in cough, sputum or shortness of breath beyond normal day-to-day variations.

What will happen if I catch a cold or the flu? Will it make my C.O.P.D. worse?

Respiratory ailments like colds, the flu or acute bronchitis can cause a flare-up of C.O.P.D., and patients may not return to their previous levels of lung function after the illness. That’s why doctors advise patients with C.O.P.D. to stay up-to-date on vaccinations, including an annual flu shot and a pneumonia vaccination every five or six years. It’s also important that respiratory ailments be diagnosed and treated early with antibiotics or other measures.

Can weather affect my symptoms?

Many patients’ symptoms worsen with weather changes, such as fronts coming through, more humidity or impending rain or snow. Doctors used to suggest that patients with C.O.P.D. live in a dry climate but now recognize that dry weather isn’t necessarily better for all patients.

Is diet important?

Aim to maintain a healthy weight. Some people with advanced disease lose so much weight their muscles begin to waste. Obesity, on the other hand, can worsen symptoms like shortness of breath.

What limitations will there be on my activity?

Limitations depend on how advanced C.O.P.D. is when it’s diagnosed. Unfortunately, C.O.P.D. is often diagnosed late, because people are unaware that symptoms such as a smoker’s cough or shortness of breath are problematic. Often the symptoms progress so slowly that people don’t recognize that they require treatment. If C.O.P.D. is caught relatively early, patients have fewer limitations on their activity.

Should I be engaging in special exercises?

Exercise is now one of the most important components of C.O.P.D. treatment. Unfortunately, shortness of breath drives many patients to become inactive. Your doctor or a pulmonary therapist can teach you activities to strengthen the arms or legs, as well as breathing exercises to strengthen the muscles used for breathing.

Would I benefit from pulmonary rehabilitation?

Pulmonary rehabilitation, which involves an exercise program, along with counseling and education, can ease shortness of breath and improve quality of life in patients with C.O.P.D. It’s not available in all parts of the country, however, and insurance coverage varies.

How likely is my disease to become worse?

Some people with C.O.P.D. progress rapidly; doctors aren’t sure why. Early treatment is important because it may slow the worsening of symptoms.

Is surgery an option for my C.O.P.D.?

Some patients with very advanced disease may be candidates for lung volume reduction surgery, which removes areas of lung badly damaged by emphysema. The operation helps some, but not all, patients breathe easier. The surgery is undergoing testing at various medical centers to determine who might benefit most. Some newer, minimally invasive forms of lung surgery for C.O.P.D. are also being examined in clinical trials.

Read the original article on the New York Times website.