COPD is a condition that takes decades to show up.
Rates of serious lung conditions like COPD are trickling upward—despite the fact that fewer people are smoking. To be exact, the rate of adults who smoke cigarettes has declined from about 21 percent in 2005 to 14 percent in 2017, according to the Centers for Disease Control and Prevention.
Unfortunately, Americans are still dealing with the consequences of the previously high rates of smoking. Since many people in the late 20th century smoked cigarettes, and COPD takes decades to develop, we're just now seeing COPD symptoms in those long-term smokers.
What Is COPD?
Chronic obstructive pulmonary disease, better known as COPD, is a lung condition that causes shortness of breath. It includes chronic bronchitis and emphysema, but since many patients exhibit symptoms of both, doctors more commonly refer to it all as COPD.
COPD means that the airways (or bronchial tubes) of the lungs are inflamed and thickened. The inflammation in the bronchial tubes narrows the air passages, thus leading to the "obstruction" in the COPD name. Additionally, the tissue in these airways is supposed to exchange oxygen as you breathe, so when it’s damaged from inflammation, the body receives less oxygen, according to American Lung Association (ALA).
To make it worse, the inflamed lung tissue also has a harder time expelling carbon dioxide. The brain recognizes this imbalance between oxygen and carbon dioxide, and it signals to the lungs to work harder. As a result, breathing becomes faster, deeper, and more labored in an attempt to get enough oxygen.
Risk Factors for COPD
The vast majority of COPD cases—about 80 percent—are linked to smoking. However, not all people who get COPD are smokers. Here are all the risk factors of COPD, according to the ALA:
Smoking: Smoke in the lungs inherently invites inflammation, so the immune system has to deploy white blood cells to the area, according to the COPD Foundation. This inflammation destroys lung tissue over time.
Air pollution: Over 40 percent of Americans reside in counties with poor air quality, according to the ALA. “Particle pollution” refers to the tiny particles in the air that you inhale; these particles can get into the lungs and even the bloodstream and have an effect on your health.
Secondhand smoke: Being exposed to secondhand smoke in childhood can harm lung health as you age.
Working with chemicals, dust, and fumes: Workers exposed to particle pollution on a daily basis (such as miners exposed to coal mine dust and farmers exposed to grain dust) count for about 15 percent of COPD cases. These are frequently referred to as “work-related COPD.”
A genetic condition called Alpha-1 deficiency: This hereditary condition is commonly referred to as “genetic COPD.” Not everyone with Alpha-1 deficiency experiences symptoms of a lung disease.
And a history of childhood respiratory infection: A 2015 study in Respiratory Research found that pneumonia during childhood increases the risk of COPD, as well as decreased lung function in general.
The good news is that COPD rates should start falling if smoking rates continue to decline (although current use of e-cigarettes in teens could threaten this). It’s important to remember that people developing COPD now likely started smoking during a time when the health risks of smoking were less known. Keeping tobacco use low (and curbing air pollution) can help bring COPD rates back down for future generations.
Dr. Oks is a pulmonologist at Lenox Hill Hospital and Northwell Health. She is triple board-certified in Internal Medicine, Critical Care Medicine, and Pulmonary Disease.
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COPD is an inflammatory
disease of the lungs,
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where the airways are narrowed, and
it affects the way that a person breathes.
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COPD has two main subtypes and
that's emphysema and chronic bronchitis.
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The main risk factor is actually smoking,
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especially if somebody is older and
has a more extensive smoking history.
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About 80% of people who
smoke will develop COPD.
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There are some other risk factors
a little bit less common,
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significant secondhand exposure.
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There's also a genetic component to this,
some people have a protein deficiency, and
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it's a protein that protects the lungs,
it's called Alpha-1 antitrypsin.
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So that could also cause COPD and
be a risk factor for the disease.
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Environmental risk factors like
pollution is increasing, dust, fumes,
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all of those industrial things that can
affect the way that our lungs function.
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The knowledge about COPD and that this
is an actual disease that could be
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caused by environmental factors
is still significantly lacking.
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People are still being
under-diagnosed with COPD.
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About 12 million Americans have the
disease and don't know that they have it.
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There's a lot of outreach
on behalf of the CDC,
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the National Institutes of Health
to kind of get the word out.
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If you suspect COPD, you should go
to your primary care physician, or
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if you already have a pulmonologist
definitely just talking to your doctor
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about your concerns.
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Current cigarette smoking among adults in the United States. Atlanta, GA; Centers for Disease Control and Prevention. (Accessed on July 26, 2019 at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm.)
Hayden LP, Hobbs BD, Cohen RT, Wise RA, Checkley W, Crapo JD, Hersh CP. Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study. Respir Res. 2015;16(1):115.
Lung disease. Coral Gables, FL: Alpha-1 Foundation. (Accessed on July 26, 2019 at https://www.alpha1.org/Newly-Diagnosed/Learning-about-Alpha-1/Lung-Disease.)
Particle pollution. American Lung Association. (Accessed on July 26, 2019 at https://www.lung.org/our-initiatives/healthy-air/outdoor/air-pollution/particle-pollution.html.)
People at risk. American Lung Association, 2019. (Accessed on July 26, 2019 at https://www.lung.org/our-initiatives/healthy-air/sota/key-findings/people-at-risk.html.)What causes COPD? Miami, FL: COPD Foundation. (Accessed on July 26, 2019 at https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-Causes-COPD.aspx.)