Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a group of diseases and conditions that make it hard for you to breathe.1
Chronic: it doesn’t go away
Obstructive: partially or completely blocks some of the airways making it difficult to move air in and out of your lungs
Pulmonary: in the lungs
The main symptoms of COPD include coughing, shortness of breath, and a decreased ability to exercise or be active.1
COPD is a condition that about 30% of Albertans live with.2 The Alberta health care system spends an additional $43,000 on health care during the first four years of a person’s diagnosis with COPD, and an additional $5,000 per year for the rest of his/her life.2 This cost estimate doesn’t include non-health-care costs such as lost productivity and wages or disability payments. It is anticipated that by 2020 COPD will be the third leading cause of death worldwide and it is the only chronic disease that has an increasing death rate.1
There’s plenty of misinformation out there regarding COPD: What it is or isn’t, can it be cured and how to manage it. Understanding the facts will help people living with COPD and their families better manage the condition and maintain an active lifestyle.
Myth 1: COPD only affects smokers
Fact: Although evidence shows that 80-90% of COPD cases appear to be related to chronic tobacco smoking, several other risk factors have also been identified for the development of COPD. These include:1
Occupational dust and chemical exposure
Exposure to second-hand smoke
Frequent lung infections in childhood
Chronic exposure to smoke from wood or other natural fuels (animal dung, crop residues) used for heat or cooking
Myth 2: Young people do not have COPD
Fact: Each year the number of new cases of COPD in Alberta increases with age; however, the condition is not limited to the elderly. The number of individuals aged 0-65 living with COPD ranges from 4% to 6% of the population.3 After age 65 the number increases dramatically from 8% to 20% for those over 85 years old.3
If you are 35 or older and have a persistent, productive cough, activity-related shortness of breath (SOB) and have a history of frequent colds or lung infections, ask your doctor if you need a breathing test to rule out COPD.3
If COPD is detected early, there are steps that can be taken to prevent or lessen chronic lung damage and to help the individual feel better and stay active.3
Myth 3: Asthma is not COPD
Fact: Asthma, chronic bronchitis and emphysema are all conditions that make it hard to breath and are considered COPD. Each of them affects the ability to move air into or out of the lung, as well as the ability of lung tissue to move oxygen from the air sacs (alveoli) into the blood stream.
Asthma is a common condition that is caused when the lung reacts to some type of trigger or irritant. The reaction causes the airways (bronchioles) in the lung to go into spasm, causing wheezing and shortness of breath.4 The spasms narrow the airways making it very difficult for air to move in and out of the lung. Because asthma is a chronic, lifelong condition it is classified as COPD.
This condition often begins in childhood and may be triggered by a childhood viral infection.4 Although asthma attacks are often thought to be simply inconvenient or uncomfortable, they can be fatal if not managed appropriately.5
Asthma is a chronic inflammatory disease of the airways that is characterized by narrowing of the airways bronchospasm and coughing. Humans lungs and bronchi
Chronic Bronchitis is one of the primary conditions identified as COPD. This condition is characterized by a very productive cough on most days, for at least three months of the year, over a minimum of two consecutive years.4 Excessive production of mucus (phlegm) obstructs the airways in the lung, restricting the movement of air and making exercise or even simple activities like doing stairs difficult. Chronic, repetitive inflammation of the airways in the lungs causes permanent lung damage, and narrowing of the airways.4
Emphysema is a condition that involves damage to the walls of the air sacs of the lung. The air sacs are very fragile, small, thin-walled clusters at the end of the airways deep inside the lungs. As you breathe in air, the air sacs stretch allowing oxygen from the airways in and then moving the oxygen into the blood. When you blow out, the air sacs shrink, forcing harmful carbon dioxide out of the body.4
In emphysema, the tissue that makes up the walls of the air sacs is destroyed resulting in the air sacs becoming less elastic. It becomes harder for the lungs to push the old air out, so some air is trapped in the lungs. This makes it harder for fresh air, carrying oxygen, to move into the air sacs. Over time the entire lung loses elasticity, air stays trapped, and the individual develops a characteristic “barrel chest” silhouette.4
Myth 4: You can cure COPD by quitting smoking
Fact: There is no cure for COPD.1 However, you can decrease your symptoms and improve your quality of life.
Smoking has been identified as the main risk factor for developing most types of COPD; therefore, quitting (or reducing) smoking is a major component of managing COPD.
The Canadian Thoracic Society (CTS) recommends the following strategies to assist individuals living with COPD prevent further damage and manage their conditions:6
Patient and family education to help the person with COPD manage his/her condition
Encouraging appropriate medication use to open the airways when needed
Encouraging participation in regular physical activity
Using inhaled corticosteroids to prevent flare-ups in advanced COPD management
Using supplemental oxygen if needed6
Myth 5: The only treatment for COPD is “clapping” on the chest to encourage coughing and clearing mucus from the lungs
Fact: Physiotherapists are trained in mucus-clearing techniques including percussion or “clapping” firmly on the chest wall and strategies to stimulate coughing. However, research suggests this treatment is of limited benefit, only helpful during an acute flare-up of COPD and has no long-term benefits to reduce or prevent future exacerbations.7
Participation in pulmonary rehabilitation (PR), including physiotherapy, is the standard of care for people with COPD.1
A well-rounded pulmonary rehabilitation program will include education and assistance to encourage smoking cessation, education on the correct and timely use of medications, breathing exercises to enhance lung function, how to recognize when an exacerbation (attack) is beginning, and knowing what to do to reduce the frequency or impact of the exacerbation. Pulmonary rehabilitation includes exercise training to increase endurance and the ability to participate in daily activities.
Encouraging individuals living with COPD to participate in regular physical activity is a key feature of PR programs.
Physiotherapists are well trained in prescribing and designing safe and effective exercise programs. They are well positioned to educate and guide people with COPD in managing their symptoms and condition.
Myth 6: I need to wait until I feel better before I start exercising
Fact: There have been numerous studies that have looked at the benefits and risks of starting PR within one month of an acute exacerbation of COPD. The evidence clearly shows that early involvement in exercise programs resulted in improved exercise tolerance, improved quality of life, and decreased symptoms of shortness of breath.6 The studies also showed that participants had fewer hospital admissions and fewer deaths related to COPD after participating in PR within one month of an acute episode. There was no evidence that early involvement in a PR program increased the risk of an adverse event.
In other words, get up, get moving, get active as soon as possible!
Breathe: the lung association. COPD Fact Sheet. Available at https://sk.lung.ca/about-us/news-room/backgrounders-and-information-sheets/copd-fact-sheet
Alberta Government: Health Trends Alberta: Available at https://open.alberta.ca/dataset/0e5841fe-3d39-441f-a0fb-3afcece2553e/resource/096444bd-534e-45a0-8330-db0167ded17f/download/hta-2015-10-13-copd.pdf
Alberta Government: Interactive Health Data (2016) COPD Age-Sex Specific Prevalence. Available at http://www.ahw.gov.ab.ca/IHDA_Retrieval/redirectToURL.do?cat=6&subCat=239
Physiopedia. COPD (Chronic Obstructive Pulmonary Disease). Available at https://www.physio-pedia.com/COPD_(Chronic_Obstructive_Pulmonary_Disease)
Asthma Canada: About Asthma. Available at https://www.asthma.ca/about-asthma/
Marciniuk DD, Brooks D, Butcher S, Debigare R, Dechman G, Ford G, et al. The Canadian Thoracic Society COPD Committee Expert Working Group. Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease – practical issues: A Canadian Thoracic Society Clinical Practice Guideline. Can Respir J 2010;17(4):159-168.
Osadnik CR, McDonald CF, Jones AP, Holland AE. Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD008328. DOI: 10.1002/14651858.CD008328.pub2.
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Regulating Alberta's physiotherapy profession and acting as an association by providing member services.