Chronic obstructive pulmonary disease (COPD) is a common disease in the elderly and a major cause of respiratory failure and other serious conditions. Continue reading to learn more about COPD, the risk factors you should be aware of, and currently available treatments.
What is COPD?
Chronic obstructive pulmonary disease (COPD) is a long-term illness where airflow out of the lungs becomes obstructed, causing difficulty breathing. COPD is a progressive disease, which means that symptoms gradually get worse over time.
Older adults, and women in particular, are at increased risk for COPD. According to the National Heart, Lung, and Blood Institute, an estimated 10% of American adults age 75 and older suffer from COPD.
The Most Common Types of COPD
COPD is an umbrella term for two different diseases: emphysema and chronic bronchitis. Many older adults are diagnosed with both of these conditions simultaneously.
Emphysema
Emphysema occurs when air gets trapped in the lungs, making it hard to breathe out. This type of COPD is due to the damage to the air sacs in the lungs called alveoli. The principal symptom of emphysema is shortness of breath that gets worse with time, medically known as dyspnea.
Chronic bronchitis
Chronic bronchitis is long-term inflammation of the airways that carry oxygen into the lungs and carbon dioxide back out. When the airways become irritated, they produce extra mucus build-up that makes the airways narrower and blocks the flow of air. The main symptom of chronic bronchitis is a mucus-producing cough that lasts for more than three months.
What causes COPD?
All forms of tobacco smoke, including cigarettes, cigars, and pipes, as well as secondhand smoke, are among the main causes of the development and progression of COPD. Around 80% of people with COPD are current or former smokers. The more and longer you smoke, the more likely you are to develop COPD.
Other factors that contribute to developing COPD include:
- Asthma
- Respiratory infections
- Exposure to air pollution, chemical fumes, and industrial dust
- Frequent use of cooking gas or fires without proper ventilation
- A genetic disorder that causes a deficiency in Alpha-1-antitrypsin (AAT), the protein that protects the lungs from damage and disease.
Symptoms of COPD
Many people with COPD don’t experience any serious symptoms until their lungs have been irreversibly damaged. What’s more, many signs of COPD are easy to dismiss and are often attributed to lack of physical activity and aging.
The common signs of COPD you should be aware of include:
- Difficulty breathing during strenuous exercise. As the disease progresses, shortness of breath is present even without any physical activity.
- Chronic cough that occurs in the morning and eventually starts taking place throughout the day.
- Productive coughing with excessive mucus.
Other COPD symptoms may include:
- Wheezing
- Chest tightness
- General tiredness and lack of energy
- Weight gain due to lack of physical activity
- Weight loss that results from shortness of breath while eating.
Complications of COPD
COPD can cause a number of health issues in the elderly. Below, we list the most common ones.
Worsening of symptoms (flare-ups)
While COPD symptoms often remain stable for long periods, the condition may occasionally get worse. These fare-ups can be triggered by a bacterial or viral infection, as well as exposure to smoke or air pollution. They may cause more frequent shortness of breath and lead to producing excessive amounts of mucus. Getting the appropriate treatment for flare-ups is essential in order to prevent serious illnesses, including lung failure.
Frequent respiratory infections
The chances of getting frequent colds, the flu, or pneumonia are much higher in people who have COPD. These infections may worsen COPD symptoms, causing further damage to the lungs.
Other complications
- Depression
- Fatigue
- Weight loss
- Heart disease
- Heart attack
- Pulmonary hypertension
- Lung cancer.
Diagnosing COPD
Although COPD is quite common, it’s not always easy to diagnose. However, identifying it as early as possible is essential in order to avoid irreversible lung damage. Here’s how this condition is typically diagnosed.
Physical examination
The doctor will start by performing a physical exam and asking your loved one about their symptoms, risk factors such as smoking, and other medical conditions.
Pulmonary function tests (PFTs)
The doctor may prescribe a pulmonary function test to check how well your loved one’s lungs are working. The most common PFT is called spirometry, where the patient is asked to blow air into a tube to measure how much air their lungs can hold and how fast they can breathe it out. The spirometry results will indicate the degree to which the airflow is obstructed.
Other less common tests
- A chest X-ray can show emphysema, as well as some other lung and heart problems.
- A CT scan allows examining the lungs and airways in more detail.
- An arterial blood gas test consists in taking a blood sample from an artery to measure the levels of oxygen and carbon dioxide.
- An exercise test will show how the lungs and heart behave during physical activity.
- A blood test for genetic causes of COPD is used in individuals with a family history of Alpha-1-antitrypsin deficiency.
Treatment for COPD
Although there is no cure for COPD, there are several treatments that can help relieve symptoms, reduce flare-ups, and improve life quality.
Quitting smoking
The most important step in treating COPD and preventing the worsening of symptoms is to quit smoking. Your loved one’s healthcare provider will help them find the best and the most effective approach, like support groups, nicotine replacement products, and medication.
Medications
Prescription medications called bronchodilators can relieve symptoms and complications of COPD. These medications work by relaxing the muscles around the airways to let more air through and make breathing easier.
Short-acting bronchodilators
Short-acting bronchodilators, also called rescue inhalers, start working immediately but they wear off quickly. They are used to quickly relieve wheezing, cough, and shortness of breath.
Short-acting bronchodilators include:
- Albuterol
- Levalbuterol
- Ipratropium
Long-acting bronchodilators
Unlike short-acting bronchodilators, long-acting ones work more slowly but their effect lasts longer. They can be used on a daily basis to relieve the symptoms of COPD.
Long-acting bronchodilators include:
- Salmeterol
- Formoterol
- Indacaterol
- Tiotropium
- Umeclidinium
Some people may need to use both short-term and long-term bronchodilators.
Steroids
Steroids help reduce inflammation in the airways and prevent COPD flare-ups. They are available in two forms: inhaled formulations and pills.
Inhaled corticosteroids
Inhaled corticosteroids are effective long-term usage medications for treating COPD. The most common ones include:
- Fluticasone
- Budesonide
- Mometasone
- Beclomethasone
Steroid pills
If your loved one has flare-ups or worsening COPD symptoms, the healthcare provider may prescribe a short course of steroid pills, such as:
- Prednisone
- Prednisolone
- Hydrocortisone
- Methylprednisolone
Long-term use of steroid pills is not recommended due to the serious side effects of these medications, including infections, osteoporosis, cataracts, and diabetes.
Oxygen therapy
Some people suffering from COPD need to take supplemental oxygen through nasal tubes or a mask. Certain patients require oxygen only during certain activities, such as walking or exercising, while others need it all the time. Long-term oxygen therapy has been shown to extend the life expectancy of people with COPD.
Pulmonary (respiratory) rehabilitation
Pulmonary or respiratory rehabilitation combines exercise, education, and counseling to ensure better life quality in patients with COPD. This treatment is recommended for the elderly who regularly experience shortness of breath and are unable to perform daily activities despite the daily use of medications.
The program can be done either at home or in a group setting in rehabilitation centers and clinics. In people who get flare-ups, pulmonary rehabilitation can significantly reduce the risk of being hospitalized.
Lung surgery
In the later stages of COPD, it may be necessary to surgically remove damaged parts of the lung tissue. Surgical options include a bullectomy and lung volume reduction. Both procedures allow the healthy portions of the lungs to function better, as they can expand and replace the parts that have been removed.
A lung transplant may be required for individuals with advanced COPD. However, this is a complex surgery that entails serious risks, such as infections and rejection of the transplanted lung, and is usually not recommended for patients aged 75 or older.
Read on to learn how you can help your loved one who has been diagnosed with COPD.
Tips for managing and preventing COPD
- Avoid smoking, exposure to second-hand smoke, and air pollution
- Drink plenty of water to keep the mucus in the airways thinner and easier to cough up
- Consider using a humidifier at home
- Eat a healthy diet with plenty of fruits, vegetables, whole grains, legumes, and nuts
- Avoid very salty and highly-processed foods
- Exercise regularly to strengthen the breathing muscles and improve endurance
- Make sure to wash your hands frequently
- Avoid coming in contact with people who are sick to prevent infections
- Get a yearly flu shot and the pneumococcal vaccine, if needed
- Take care of your mental health. Depression and anxiety are common conditions in people with COPD.
- Have regular medical check-ups. Ongoing medical care is crucial for people suffering from COPD.