It’s breathtaking — but not in a good way.Chronic obstructive pulmonary disease, or COPD, is the fourth leading cause of death in the United States for those age 65 to 84 after heart disease, cancer and stroke and the only major disease with an increasing death rate, according to the Pennsylvania Medical Society.Citing data from the websites of COPD International and the Centers for Disease Control and Prevention, a PMS press release also notes Pennsylvania has the sixth highest death rate for COPD in the United States.For someone with COPD, breathing is like having someone squeeze your midsection tightly while you try breathing only through your mouth through a thin straw, the release says.COPD “is ubiquitous,” said Dr. Frederic Becker, an internist in King of Prussia and president of the Montgomery County Medical Society. “every primary care physician comes across COPD because there are so many smokers out there.”COPD refers to a group of diseases that cause airflow blockage and breathing-related problems, generally emphysema and chronic bronchitis, either combined or alone, with some debate over whether asthma is included, according to COPD International.Chronic bronchitis is marked by the persistent over-production of mucus the lungs make in response to a cold or respiratory irritant, Becker said. Those who have COPD “make much, much more mucus than a nonsmoker.”in describing emphysema, Becker explained the lungs have a certain elasticity so when one exhales, the body need not do anything. The lungs are like a spring, with air going down to the bronchial tubes and alveoli — like millions of balloons — at the end of the airways where the exchange of oxygen and carbon dioxide takes place, he said.“Smoking causes a loss of that elasticity over time because the balloon never deflates … you never get rid of the carbon dioxide,” Becker said. “You don’t get that elasticity back.”The result is a decreased level of oxygen, which causes shortness of breath, and an increased level of carbon dioxide, which sedates the brain causing one to breathe “less aggressively to do the exchange,” Becker said. Eventually, “carbon dioxide builds up to the point where you stop breathing.”in 2005, according to the CDC, COPD caused an estimated 126,005 U.S. deaths in people older than 25, representing an 8 percent increase from 116,494 in 2000.Becker said he rarely sees young people with COPD and estimated 5 percent to 10 percent of his patients over the age of 50 have some form of the disease. And while “some rare genetic problems can cause emphysema-like symptoms,” he said, COPD “is really almost exclusive to prior tobacco use.”It can also be caused by certain chronic chemical exposures, but usually the cause is 30 to 50 years of smoking, he said. there are different levels of COPD, he noted, and many people live long lives with it, but it also causes many deaths per year.The No. 1 treatment is to stop smoking, Becker said. And though lung elasticity cannot be reversed, there are inhaled medications that can improve the efficiency of the lungs, making it easier to breathe.Pulmonary rehabilitation — physical therapy for the lungs, can also make breathing easier, but “it’s not a correction,” he said.For those with end-stage COPD, “there are surgical corrections that can tighten up the inefficient lungs, but it can’t reverse the problem,” Becker said. “If that’s not an option, you have to talk about a lung transplant.”Symptoms may include episodes of increased shortness of breath, a chronic cough that produces yellow sputum and frequent respiratory infections or chest tightness, according to the PMS release. “unfortunately, symptoms often don’t appear until significant damage has occurred,” it notes.Most people don’t know they have it, Becker said. they may get a chest X-ray for some other reason, and it will show a suggestion of emphysemic changes.“You have to lose a fair amount of lung efficiency before you feel the problem,” Becker said.“It is also strange,” he said, “that some people can smoke for 15 to 20 years and see it [have COPD], and some can smoke 50 years and have no problem. It goes back to genetics.”Most primary care doctors’ offices can use in-office spirometry, a test measuring how much and how quickly one can move air out of the lungs, to diagnose COPD, Becker said. there are also other pulmonary function tests that can be done to measure lung efficiency.Becker said he sometimes tests patients who have smoked for a long time “to show them their ‘lung age,’ and almost scare them into stopping smoking. We’ll do whatever it takes to get them to stop.“in the end what’s really important is to stop smoking, and the best way to prevent [COPD] is not to smoke; it can kill you.”Linda Finarelli can be reached at lfinarelli@montgomerynews.com.

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