The incidence of chronic obstructive pulmonary disease (COPD) is increasing in women, with the disease occurring more frequently in people living in rural areas. We spoke with pulmonologist Raymond Wade, MD, assistant professor of pulmonary, allergy and critical care medicine at the University of Alabama at Birmingham, about the importance of rapid diagnosis, good symptom management and reducing flare-ups.
Wade told us that earlier diagnosis and treatment reduces the severity of flare-ups, making them not only less frequent but also less fatal. “Outbreaks pose a major risk to people’s lives,” Wade said. “Every outbreak is a roll of the dice.”
What is uncontrolled COPD?
COPD is a chronic disease that causes swelling and inflammation of the airways. Symptoms include shortness of breath, cough and wheezing. If a flare-up occurs, these symptoms can lead to hospitalization or even death. Uncontrolled COPD leads to more frequent and more severe attacks.
Why is it so important to control your COPD?
A spirometry test, which measures how well air flows in the lungs, can be used to determine whether COPD is mild, moderate or severe. COPD is progressive, but slowing this progression with treatment will improve your quality of life and help you live longer. If your symptoms are kept at a mild level, you are less likely to have flare-ups and the flare-ups will not be as severe.
Why is it important to prevent or treat COPD flare-ups?
A COPD flare-up, also called an exacerbation, doesn’t get the same media attention as, say, a heart attack, but its effects are just as serious. Someone who has had a COPD flare-up has exactly the same five-year mortality as someone who has had a heart attack. We have data to support this. Flare-ups pose a great danger to people’s lives.
What treatment options are available for moderate to severe COPD?
Treatments are tailored to the severity of symptoms. In the past, we weren’t able to offer much more medication than an inhaler. Now we are using better treatments. We have airway openers and steroids repurposed from asthma treatments that target the inflammation that triggers the disease. These drugs are an important factor in pulmonary rehabilitation.
Biologics are relatively new to our COPD arsenal. We currently recommend it to patients who have had flare-ups in the past and who have a certain indicator of inflammation in their blood. These tools hold promise for some people with COPD. Vaccinations can also help, as respiratory viruses are the most common cause of worsening COPD. We have vaccines against more severe respiratory viruses such as influenza, RSV and Covid. We can also immunize ourselves against a bacteria called pneumococcus, which causes pneumonia.
How do factors such as lifestyle, living conditions and occupational hazards increase the risk of COPD?
Cigarettes are a major risk factor. U.S. smoking rates have declined and COPD rates in men have decreased, but COPD rates in women are increasing and we’re still trying to figure out why. We know that, in addition to cigarettes, the main causes of respiratory disease are exposure to air pollution, smoke from forest fires or burning garbage, industrial manufacturing and any particulate matter. Severe respiratory illnesses have been particularly common among veterans since the Gulf War due to exposure to burn pits and chemicals.
Why is COPD more common and often more severe in rural areas?
My state, Alabama, is 80% rural. Data shows that smoking is more common in rural areas and there are more jobs that pose a higher risk of respiratory diseases. In rural areas, you are more likely to be exposed to smoke from burning garbage or burning fields after farmers have harvested their crops. Additionally, access to healthcare is more difficult in rural areas.
Why can it be difficult for people living in rural areas to make early and correct diagnoses?
I see patients from up to four or five hours away. There is no pulmonologist near them and their primary care doctor may not have the equipment or experience to diagnose COPD. If you find yourself in a situation where there is no proper healthcare, you are more likely to attribute your symptoms to a respiratory virus and simply head to the emergency room to get medication to treat it. The problem is that by the time you finally get the diagnosis, COPD has already progressed to a more serious state.
How can we improve access to early and correct diagnosis, treatment and pulmonary rehabilitation for people living in rural areas?
The pandemic has taught us that telemedicine works. It’s a good option for people who can’t easily drive to a clinic in a populated area. Our patients go for pulmonary rehabilitation, but online pulmonary rehabilitation is a scalable option that can be used widely. Another good tool is to educate patients and primary care physicians in rural areas about the risk of COPD flare-ups and the risk factors for COPD.
This educational resource was created with support from Sanofi and Regeneron.
From your website articles
Related articles on the Internet