COPD Diagnosis is Key

Chronic obstructive pulmonary disease is the No. 4 cause of death in the United States, but it is often misdiagnosed, leading to delayed treatment for patients.

If diagnosed and treated early, however, its progression can be slowed, helping improve quality of life for many patients, an MUSC Health pulmonary and critical care physician says.

“COPD is very common and widely underdiagnosed,” says Dr. Charlie Strange, a professor of pulmonary and critical care medicine. “About 8 percent of the U.S. adult population has COPD, and another 6 to 8 percent are undiagnosed because they never had spirometry, a breathing test,” he says. “Although some of these undiagnosed are people who have been prescribed medications, without a correct diagnosis some are undertreated and some are mistreated people who may have other lung or heart diseases.”

Characterized by cough, wheezing and shortness of breath, COPD obstructs airflow in and out of the lungs.

“Our airways are tubes in our lungs that help get air in and out. When they become diseased, the airways get narrowed or collapse and air can’t get out of the lungs very well,” Strange says.

Smoking is responsible for 75 percent of cases, but a growing number -- 25 percent -- will be caused by viruses and environmental factors such as wildfires, particulates, and fumes as contributors. 

“The 25 percent are often dismissed by physicians and others who ask the smoking question first and don’t probe further if the patient is, or was, a smoker,” he says.

Strange recommends doing a breathing test first and then asking more questions.

“It’s the only way to establish a diagnosis of COPD,” he says.

More women than men are diagnosed with COPD, which Strange attributes to an uptick in smoking by women beginning in the 1980s and because women have smaller lungs.

If you’re experiencing shortness of breath or other breathing problems, Strange recommends asking your doctor for a spirometry test. Shortness of breath is not part of normative aging.

Lots of people have shortness of breath and get an inhaler, but not a real diagnosis,” he says. “Getting a pulmonary diagnosis is a journey because there are 500 lung diseases, and it’s important to catch any of them early.

MUSC Health treats patients in several ways, including research studies in airway nerve ablation and airway liquid nitrogen to control mucus associated with chronic bronchitis.

MUSC Health is also the first in the state to offer a novel therapy using valve insertion in the lungs. Known as endobronchial valve placement, the procedure is appropriate for a subgroup of COPD patients who have large lungs caused by emphysema. Emphysema causes holes in the lungs, which trap air when someone exhales. To improve breathing, a physician inserts a one-way valve, called an endobronchial valve, into the lungs to make them smaller by collapsing one of the lung’s lobes.

“The patient’s lungs get dramatically smaller and the diaphragm can regain its normal curvature, allowing the patient to take a big breath again,” Strange says.

Only about 10 percent of patients are candidates for the procedure because of specific anatomic requirements, including a competent fissure between lung lobes, he says.

The targeted airway denervation procedure uses radiofrequency ablation (electrical energy) to kill nerves that cause air tubes to spasm and constrict. These same nerves also supply the mucus glands. The procedure heats up and kills the nerves that produce mucus while protecting the central part of the airways with ice water.

In another research study, physicians are also spraying liquid nitrogen in the airways to kill mucus-producing cells. The cells that line the lungs grow back; the mucus cells die.

Other therapies include inhalers and nebulizers.

Often the first line of treatment, inhalers are a combination of medicines and the inhaling device. The medication is breathed into the lungs to open the airways.

“To receive FDA approval, companies making the newer inhalers have to formulate the medicine and the device as a combination,” Strange says. “A variety of inhalers are available, so it can become confusing. A few generics are available.”

A nebulizer is a machine for home use. It is filled with liquid medicines for a patient to inhale.

Regardless of the therapy used, Strange says, exercise is an essential element of COPD treatment.

“An aggressive exercise regimen is a very important part of pulmonary care. In fact, it’s front and center in all our COPD care,” Strange says. “Walking around isn’t enough for a COPD patient. Exercise improves muscle strength so the body can use less oxygen and produce less carbon dioxide. You can exercise your leg muscles to improve; you can’t exercise your lung function to improve. We get patients doing exercise before they progress to other high-end care.”

And what else can patients do to take care of themselves?

Maintain a normal weight, Strange says.

“Extreme underweight and overweight are not good. Both cause inefficient breathing and make the lungs work harder,” he says.

To learn more lung care and treatment options, please visit MUSC Health’s Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine program or call us at 843-792-5864.