On a bright morning in Sri Lanka, I found myself hiking up Sigiriya Rock, an ancient fortress known for its stunning views and cultural significance. As a doctor, I enjoy taking breaks from the hospital to recharge. But that day, I had an unexpected encounter that reminded me of the importance of respiratory health.
Partway through the climb, I noticed a man seated on a rock, struggling to catch his breath. He looked fatigued, his breathing shallow and labored. Concerned, I approached him.
“Are you okay?” I asked.
He nodded but couldn’t speak immediately, catching his breath before responding. “I’m just out of shape,” he said with a weak smile. His accent gave him away—he was American.
As a doctor, his breathlessness immediately raised red flags for me, especially in Sri Lanka’s warm climate, where dehydration and exertion can sometimes mask more serious issues. I introduced myself, and he told me his name was Arjun, a police officer from the U.S. He was visiting Sri Lanka on vacation and had decided to climb Sigiriya to challenge himself. However, he hadn’t expected the climb to be this difficult.
“I’ve been struggling to breathe more lately,” he admitted. “Especially with any form of exercise.”
That’s when I started suspecting that Arjun might be dealing with something more than just being “out of shape.” His history of smoking, combined with his symptoms, hinted toward something serious: chronic obstructive pulmonary disorder (COPD).
What is Chronic Obstructive Pulmonary Disorder (COPD)?
I explained to Arjun that chronic obstructive pulmonary disorder is a progressive lung disease. It encompasses two primary conditions: emphysema and chronic bronchitis. These conditions often occur together in people with COPD.
In emphysema, the air sacs in the lungs (called alveoli) are slowly destroyed, making it harder for the lungs to exhale air. This results in shortness of breath and difficulty breathing. Chronic bronchitis, on the other hand, causes inflammation in the bronchial tubes, which narrows the airways and leads to excessive mucus production.
Unfortunately, millions of people around the world suffer from chronic obstructive pulmonary disorder—with the American Lung Association estimating that around 30 million people in the U.S. alone have COPD. Even more concerning is that many don’t even know they have it.
Recognizing COPD Symptoms
As Arjun shared more about his experience, it became clear that his symptoms matched those of COPD. He told me he had been noticing the following for some time:
- Occasional shortness of breath, especially after mild exercise.
- A persistent cough that wouldn’t go away.
- Needing to clear his throat, especially in the mornings.
- Feeling unusually tired after physical activities.
These early COPD symptoms are often mistaken for common colds or signs of aging, which is why the disease frequently goes undiagnosed until it progresses. I explained to Arjun that as the disease advances, symptoms become more severe. These may include:
- Increased shortness of breath, even with minimal exertion like walking up a flight of stairs.
- Wheezing when breathing, especially during exhalations.
- Tightness in the chest and a chronic cough that may or may not produce mucus.
- Frequent colds or respiratory infections due to weakened lung function.
- General lack of energy and fatigue.
When left untreated, COPD exacerbation—or sudden worsening of symptoms—can occur, potentially leading to hospitalization.
What Causes Chronic Obstructive Pulmonary Disorder?
The more I spoke to Arjun, the clearer it became that his smoking history was the main culprit. In fact, smoking is the leading cause of chronic obstructive pulmonary disorder. In the U.S., smoking accounts for nearly 85-90% of COPD cases, as per the Centers for Disease Control and Prevention. Arjun had quit smoking a few years ago, but the damage had already been done.
Other common causes of COPD include:
- Exposure to secondhand smoke.
- Long-term exposure to workplace chemicals, dust, or pollutants.
- Repeated exposure to air pollution.
- Genetic predisposition, such as a deficiency in the protein alpha-1-antitrypsin, which affects the lungs and liver.
- A history of childhood respiratory infections.
In Arjun’s case, his years as a smoker combined with his current respiratory issues pointed strongly toward COPD.
Diagnosis: What Tests Help Identify COPD?
I urged Arjun to visit a pulmonologist when he returned to the U.S. to get a proper diagnosis. There are several tests that can confirm chronic obstructive pulmonary disorder:
- Spirometry: This non-invasive test measures how much air you can breathe in and out and how quickly. A reduced airflow suggests the presence of COPD.
- Chest X-ray or CT scan: These imaging tests provide detailed views of the lungs, helping doctors spot any damage, blockages, or structural changes.
- Arterial blood gas test: By analyzing a sample of blood from an artery, this test can assess how well the lungs are oxygenating the blood and removing carbon dioxide.
Once a diagnosis of chronic obstructive pulmonary disorder is confirmed, treatment can begin to slow its progression and manage symptoms.
Treatment for COPD: Medications and Therapies
A few weeks after Arjun returned home, he messaged me on WhatsApp with news. He had been diagnosed with moderate COPD. His doctor prescribed medications to help alleviate his symptoms, including:
- Inhaled bronchodilators: These medications, which are delivered through an inhaler or nebulizer, help relax the muscles around the airways, making it easier to breathe. Arjun was prescribed a combination of long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA).
- Inhaled corticosteroids: These reduce inflammation in the airways, helping Arjun breathe more freely.
- Phosphodiesterase-4 inhibitors: Taken in pill form, these help reduce inflammation and relax the airways for patients with more severe cases.
- Oxygen therapy: Although not necessary for Arjun just yet, some patients with severe COPD require supplemental oxygen to maintain healthy blood oxygen levels.
In addition to medications, Arjun’s doctor emphasized the importance of lifestyle changes to help manage his condition.
Lifestyle Changes for Living with COPD
One of the first things Arjun had to do was quit smoking completely. Smoking is the most critical modifiable factor in COPD treatment. I reminded him that by quitting smoking, he could slow down the disease’s progression and improve his quality of life.
His doctor also recommended:
- Regular exercise: While it may seem counterintuitive for someone with a lung disease to exercise, physical activity can actually strengthen respiratory muscles and improve lung function. Arjun began participating in pulmonary rehabilitation programs that included exercises tailored to his condition.
- A nutritious diet: Arjun was also referred to a dietitian, who helped him create a meal plan rich in fruits, vegetables, lean proteins, and whole grains. Staying hydrated was important, too, as fluids help thin mucus, making it easier to cough out.
The Link Between COPD and Lung Cancer
Another topic we discussed during our WhatsApp exchanges was the connection between COPD and lung cancer. Studies show that people with chronic obstructive pulmonary disorder have a significantly higher risk of developing lung cancer, especially those with a history of smoking. Between 40-70% of people diagnosed with lung cancer also have COPD. This link is likely due to shared risk factors, like smoking and prolonged exposure to environmental toxins.
Living with Chronic Obstructive Pulmonary Disorder
Although chronic obstructive pulmonary disorder has no cure, it can be managed with the right treatment plan, lifestyle changes, and ongoing medical care. Arjun’s case serves as a reminder that early detection and intervention are key to managing this chronic lung disease.
If you or a loved one are experiencing symptoms like frequent shortness of breath, chronic cough, or wheezing, it’s important to seek medical advice. Proper diagnosis and early treatment can make a significant difference in your quality of life. As with Arjun, paying attention to your body’s signals and making healthy lifestyle choices can help you live well with chronic obstructive pulmonary disorder.