Shortness of Breath and Persistent Cough May Be Signs of COPD

Approximately 16 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), a progressive lung condition that makes it difficult to breathe. Yet, because many people do not realize they have it, the actual number of people suffering with COPD is likely much higher.

It is the third leading cause of death by disease in the U.S., and it is a progressive disease that currently has no cure. Here in the Washington, D.C., region, it’s estimated that the disease affects about six percent of the population.

COPD Symptoms

Healthy lungs receive oxygen from the air and move it into the blood, then expel carbon dioxide back into the air. This exchange occurs within the alveoli, small balloon-shaped air sacs residing in spongy lung tissue. The average adult has at least 500 million alveoli, so tiny that oxygen and CO₂ molecules easily pass through them.

In people with a history of smoking, alveoli can become seriously damaged—malformed and less functional. Inflammation subsequently occurs around the alveoli, narrowing bronchial tubes. The airway can become clogged with mucus, making it difficult for air to move in and out of the lungs.

Warning signs of COPD may include:

• An enduring, persistent cough that produces phlegm or mucus from the lungs
• Chronic shortness of breath, often during simple everyday activities
• Wheezing, gasping for breath, or labored breathing
• Frequent respiratory infections
• Blue lips or fingernail beds
• Fatigue

COPD can increase and decrease in intensity. As more and more alveoli are damaged, most patients have periods of exacerbation, episodes of worsening that can make hospitalization necessary. Each exacerbation can leave the lungs increasingly damaged, accelerating the disease’s progress.

Comorbidities or complications associated with COPD include sleep apnea, infection, and pulmonary hypertension—elevated blood pressure in the vessels that feed the lungs.

COPD Risk Factors

The primary risk factor is smoking—about half of all tobacco smokers eventually develop this disease. However, about one in four COPD patients have never smoked—some of them may have been affected by second-hand smoke or by long-term exposure to other environmental contaminants like dust, gas, or wood smoke.

COPD had a higher prevalence in men in the past; however, COPD is now commonly seen in women, as the prevalence of smoking in females has progressively increased. In many developed countries, COPD is now even more prevalent in women than men, and female smokers are about 50% more likely to develop COPD than males.

Other people at higher risk for COPD are asthma sufferers, as well as those with alpha-1 antitrypsin (AAT) deficiency, an inherited disorder in which AAT—a protein that protects the lungs—cannot effectively reach them.

Diagnosing COPD

When diagnosing COPD, we consider the patient’s complete medical history, particularly any episodes of shortness of breath and sputum production that have persisted for three months or more. With spirometry testing, we can obtain a practical measure of the volume of air that the patient can forcibly exhale.

CT imaging can help us evaluate damage to the air sacs (emphysema). We also monitor blood oxygen, since the lungs have greater difficulty moving oxygen into the blood as COPD progresses.

Co-existing with a patient’s COPD may be respiratory infection, heart failure, or severe asthma. At MedStar Washington Hospital Center, we work collaboratively with specialists across our network to help manage such underlying conditions, especially cardiovascular issues (high blood pressure, heart failure, heart attack, arrhythmias, and vascular disease) that can worsen—or be worsened by—poor lung function. COPD patients may also be at higher risk for lung cancer, and COPD can make that cancer harder to treat in its later stages.

Not surprisingly, COPD can take an emotional toll on patients. It can severely limit activity, particularly for patients who depend on the use of supplemental oxygen. Shortness of breath, especially during an exacerbation, can be uncomfortable, distressing, and frightening; for some, anxiety and depression can result.

Treating COPD

At MedStar Washington, we work closely with our COPD patients to help proactively manage their condition. Treatment must be carefully tailored to the needs of the individual patient—one patient may have adequate airflow yet display other severe symptoms of COPD; another may have a more suppressed airflow but few additional symptoms.

With treatment, we have two main goals: improving airflow for better daily quality of life and preventing dangerous exacerbations. We consider each patient’s unique state of disease, lifestyle needs and limitations, and the frequency and severity of exacerbations. We also track the patient’s response to various activities—for example, how they feel after exercise or after climbing stairs.

This assessment helps us gauge the severity of the disease and its impact on the patient’s day-to-day life. We can then tailor a variety of possible treatments, depending on the patient’s condition and response to medications:

• Patients generally use an inhaler to deliver bronchodilators to the lungs—relaxing the muscles around the airways, improving airflow to make breathing easier, and helping to clear phlegm. A “rescue inhaler” delivers fast-acting agents for speedy relief of symptoms, while a longer-acting bronchodilator can help moderate the disease day to day, over the long term.
• Steroids can play a critical role in controlling the inflammation that comes with COPD. We may prescribe regular use of an inhaled steroid or, if symptoms intensify, temporarily supplement treatment with a steroid tablet.
• For some patients, a nebulizer, allowing the patient to inhale medication using a machine that creates a fine mist, can also aid breathing.
• Antibiotics may be used to both treat and prevent infection, a common complication of COPD.
• If needed, supplemental oxygen can be used to aid lung function and keep blood oxygen at a healthy level. For some patients, we also recommend pulmonary rehabilitation, a strengthening and conditioning program to help the lungs and body process oxygen more efficiently.
• Exacerbations tend to begin with a worsening cough, more severe shortness of breath, and increased sputum production. The patient’s rescue inhaler may lose effectiveness, and blood oxygen may drop dramatically. Because an exacerbation can last a week or more, hospitalization of the patient may be necessary, allowing Hospital Center staff to actively manage medication and other treatment.

It’s also important that COPD patients stay up-to-date on their vaccines—both flu and COVID-19 can cause life-threatening respiratory problems.

At MedStar Washington Hospital Center

Our highly qualified team has extensive experience in treating all respiratory diseases and disorders. We perform comprehensive respiratory function testing in our pulmonary lab, including spirometry and walk testing. We are trained in interventional techniques, using advanced endoscopy to clear the airway when growths or tumors interfere with breathing.

In addition, the Hospital Center’s lung cancer screening clinic provides screening services and smoking cessation support for those with a history of tobacco use.

COPD is a progressive disease that creates permanent damage in the lungs. The longer it is untreated, the more complex it can be to manage. If you are a smoker or are regularly exposed to contaminants, it’s important to watch for warning signs. Consult your healthcare professional if you or someone you care about has a persistent cough with phlegm or is regularly short of breath.

Expert assessment and early treatment can make COPD easier to control and give you or a loved one a much improved quality of life.