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COPD: More of Us Are Out of Breath

The average person takes 12 breaths every minute while at rest. It's a reflex--you don't pay attention unless there's a problem. However, a rising number of us literally can't catch our breath because of chronic obstructive pulmonary disease (COPD). COPD is a group of diseases that cause airflow blockage and breathing-related problems.

The main types of COPD are emphysema and chronic bronchitis. These two conditions account for most cases of COPD, which affects millions of Americans. COPD is the third leading cause of death in America. According to the American Lung Association, in the last eight consecutive years, more women than men died from COPD.

Emphysema and chronic bronchitis often appear at the same time and usually require similar treatment. Because they develop at the same time, your doctor may have difficulty distinguishing one from the other. Asthmatic bronchitis, another form of COPD, develops when a person with asthma develops a chronic cough after exposure to an irritant.

Worsens slowly

COPD develops slowly, causing shortness of breath that worsens over time. Because the onset is gradual, you may not think you have a problem.

In the lungs of a person with COPD, tiny breathing sacs called alveoli become scarred. The breathing tubes--called bronchioles--thicken and narrow, and extra mucus develops in the airways. You find it harder to breathe out because air becomes trapped in the lungs.

Emphysema and bronchitis differ from each other in several ways. In emphysema, the walls of the alveoli become inflamed. As the disease progresses, the damage to the alveoli increases and they lose their elasticity. Pockets of dead air form, making it difficult to exhale.

In chronic bronchitis, the structure of the airways changes so that airflow is diminished. A person with chronic bronchitis has a chronic cough and produces excess mucus.

Smoking and COPD

Smoking is the main cause in nine out of 10 cases of COPD.

Other causes include exposure to secondhand smoke, fumes, dust, and other environmental irritants.

What makes smoking so bad for the lungs? Cigarette smoke contains irritants that cause the airways to become inflamed. The inflammation over the long term damages lung cells, boosting the risk not only for COPD, but also for lung cancer.

Not all smokers develop COPD. Researchers think that those who do have genetic factors that make their lungs more susceptible to damage. One genetic condition that has been identified is a deficiency in the protective enzyme alpha 1-antitrypsin (AAT). People with this deficiency can develop emphysema even if they don't smoke. They develop emphysema at a much younger age than most smokers.

Other irritants that can increase the risk for COPD include toxic chemicals, such as silica or cadmium, industrial smoke, and dust. Occupations that can expose workers to these irritants include miners, grain farmers, and cooks.

Broad symptoms

The broad symptoms of COPD include shortness of breath that worsens over time, a cough that produces phlegm, and wheezing.

Symptoms of emphysema usually appear in heavy smokers by their mid-50s. They become short of breath with even light exertion, but they may only have a minor cough. By the time symptoms appear, people with emphysema have lost a significant portion of their normal lung tissue. People with an enzyme deficiency tend to develop emphysema between ages 30 and 40. Late symptoms include rapid breathing with much difficulty even while at rest.

Symptoms of chronic bronchitis include coughing with excess mucus and frequent bacterial infections. To be diagnosed with chronic bronchitis, you must have a cough that lasts for at least three months of the year and continues over the course of two consecutive years. The other main symptom is shortness of breath, but it is not as severe while at rest as with emphysema. As the disease progresses, symptoms often force a person to sleep sitting up. Females are more than twice as likely to be diagnosed with chronic bronchitis as males.

Treatment can make COPD easier to live with, but the only way to change the course of the disease is to stop smoking and avoid exposure to secondhand smoke and other environmental irritants. 

Doctors see most cases of COPD in people ages 60 and older. The third cause of COPD breathing trouble, asthma, most often occurs in childhood. Affecting 23.3 million Americans in 2008, asthma causes its telltale wheezing when air has trouble passing through swollen, narrow air passages. Medication can open airways and decrease swelling.

Warning signs

Don't take breathing for granted. Talk with your doctor if you notice any of these signs:

  • Coughing that lasts longer than the cough you usually get with a cold. A cough that lasts longer than that also could be acute bronchitis. Coughing with acute bronchitis can last up to a month.

  • Coughing or trouble breathing when you move. You should be able to climb a flight of stairs without coughing or being short of breath.

  • Excess sputum or phlegm. If you're producing the same amount of sputum as you might for a bad cold, but it continues for weeks or a month, see your doctor.

  • Wheezing. This can be a sign of asthma. The classic signs of an asthma attack are coughing, wheezing, and shortness of breath.

  • A feeling of tightness or fullness in the chest.

  • Colds that often spread to the chest. People with COPD and asthma face a greater risk for infection in the bronchial tubes and lungs.

  • Increasing trouble breathing around certain irritants. These include smoke, dust, pollen, and air pollution.