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The incidence of chronic obstructive pulmonary disease (COPD) is increasing in women and this disease is more common in people living in rural areas. We spoke with pulmonologist Raymond Wade, MD, associate professor of pulmonology, allergy and critical care medicine at the University of Alabama at Birmingham, about the importance of timely diagnosis, good symptom control and reducing attacks.
Wade told us that early diagnosis and treatment reduces the severity of seizures, making them not only less frequent but also less deadly. “Crises pose a great risk to people’s lives,” Wade said. “Every crisis carries the potential for serious clinical consequences.”
What is uncontrolled COPD?
COPD is a chronic disease that causes swelling and inflammation of the airways. Symptoms include difficulty breathing, coughing and wheezing. In the event of a crisis, 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?
Spirometry, a test that measures how well air gets into the lungs, can determine whether COPD is mild, moderate, or severe. COPD is progressive, but slowing the progression of treatment improves quality of life and helps you live longer. If your symptoms remain mild, you are less likely to have seizures and they will not be as severe.
Why is it important to prevent or control COPD attacks?
A COPD flare-up, also known as a flare-up, does not receive the same media attention as, for example, a heart attack, but is associated with equally serious effects. Someone who has a COPD attack has exactly the same 5-year mortality rate as someone who has a heart attack. We have data to support this. Crises pose a great threat to people’s lives.
What treatment options are there for moderate or severe COPD?
Treatments are personalized depending on the severity of symptoms. In the past we couldn’t offer much more medication than an inhaler. Now we are using better treatments. We have bronchodilators and corticosteroids, previously only used to treat asthma, to combat the inflammation that causes this condition. These drugs are an important factor in pulmonary rehabilitation.
Biopharmaceuticals are relatively new to our COPD arsenal. We currently recommend them for patients who have a history of seizures and who have signs of inflammation in their blood. These resources hold promise for some people with COPD. Vaccinations can also be useful, as respiratory viruses are the most common cause of worsening COPD. We have vaccines against more serious respiratory viruses such as influenza, RSV and Covid. We can also immunize against bacteria called pneumococci, which cause pneumonia.
How do factors such as lifestyle, socioeconomic status, and occupational risks 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 air pollution, smoke from forest fires, burning garbage, industrial factories or suspended particulate matter are the main causes of respiratory diseases. Severe respiratory illnesses are common among retired military personnel who fought in the Gulf War and subsequent wars 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 where there is a higher risk of respiratory illnesses. In rural areas, you are more likely to be exposed to smoke from burning garbage or burning fields after farmers have harvested their produce. Additionally, access to healthcare is more difficult in rural areas.
Why might it be difficult for people living in rural areas to receive early and correct diagnoses?
I see patients who have to drive four or five hours to my office. There is no pulmonologist near them and their primary care doctor may not have the equipment or experience to diagnose COPD. If you don’t have access to convenient medical care, you’re more likely to attribute your symptoms to a respiratory virus and only go to urgent care centers with mild illness to receive medication for treatment. The problem is that by the time you finally get the diagnosis, COPD has evolved into a more serious condition.
How can we improve access to early and correct diagnosis, treatment and pulmonary rehabilitation for people 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 virtual pulmonary rehabilitation is a scalable option that can be used in a variety of ways. Another good resource is to educate patients and primary care physicians in rural areas about the risk of seizures and the risk factors for COPD.
This educational resource was created with support from Sanofi and Regeneron.
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