Asthma and COPD are common, debilitating diseases that are especially prevalent in populations with high smoking rates, such as Kentucky’s. COPD (chronic obstructive pulmonary disease) is one of the five leading causes of death in the U.S. Asthma can restrict a person’s respiratory health from childhood onward and develop into COPD, particularly if a patient is a smoker. Together, the diseases affect about 35 million adults and children.
In this episode of Kentucky Health, host Dr. Wayne Tuckson talks with a Louisville internal medicine physician about how asthma and COPD endanger a person’s overall health, the risk factors for contracting those incurable diseases, and the ways to treat and manage them.
Dr. John Wesley McConnell, MD, specializes in internal medicine and pulmonary diseases. He is a professor of internal medicine at the University of Kentucky and is based at UK’s clinic in Louisville, and is also a member of Kentuckiana Pulmonary Associates.
“Asthma is a contraction of the airways, or an obstruction of air flow, that comes and goes,” he says. “You can be normal, and have an attack, and go to not being able to push the air out. Your lungs sort of fill up with air, and get hyper-inflated, and that’s what asthma is. Now, COPD is a patient who has chronic airway obstruction that doesn’t go away.”
Incurable, but Often Manageable Diseases
McConnell explains that asthma affects air flow by restricting a person’s ability to exhale. Inhaling is active, he notes, but exhaling is passive. When airways are restricted due to a trigger irritant, a person is unable to fully exhale the amount needed to keep respiratory function normal.
Asthma is chronic, but its effects can be managed and people with it can live relatively healthy lives. “If you have a patient who has asthma, they can be normal in between attacks,” McConnell says. “We have Olympic athletes who have asthma, who are treated. And asthma itself can be well-treated, and not cured, but very well controlled. People can have normal lung function and a normal life.”
COPD is more serious because once it develops, a person’s ability to breathe is permanently diminished. With emphysema, for example, air sacs in the lungs are destroyed over time, resulting in enlarged lungs that are unable to push air out. There is one inherited type of COPD, called alpha-1 antitrypsin deficiency, which is a genetic defect that can be tested for. But the overwhelming majority of COPD cases are caused by one very common and destructive habit.
“COPD is most commonly caused by smoking. In this country, 95 percent of all people who have COPD have exposure to tobacco, which is really bad in Kentucky because 28 percent of our adult population smokes,” McConnell says. “It also can occur when you’re living with a smoker. COPD can occur if you have environmental smoke.”
According to McConnell, COPD was more prevalent in men than in women for many decades after smoking increased in the U.S. population during the middle of the 20th century. That is not true anymore, he says. “It’s amazing that the number of new COPD cases is now occurring more in women than men.”
Asthma is often associated with children, but McConnell says that it can be present in patients of all ages. Many things can trigger asthma, including allergies, chemicals, pollution, changes in air temperature, and even exercise and stress. Triggers are unique to each person with asthma, he notes. There is no single cause.
Though symptoms for both diseases can be managed, they can be very alarming when an attack strikes. “Nothing else matters in your life if you can’t take a breath,” he says. “And I think that we, being healthy people, don’t know about that because we don’t have to live with it.”
Treatment Options for Asthma and COPD
Parents should get their children checked for asthma if their kids cough frequently, cough up sputum, if they get short of breath or are constantly wheezing. These same symptoms are warning signs for adults, too.
At the clinic, the pulmonologist will first give the patient a breathing test. The patient must blow into a machine as hard as possible, and the doctor will measure how much air flows out in one second. “And that really tells us if the airways are narrowed, inflamed, or blocked, and that can tell us if you need treatment or not,” McConnell says.
Further testing for asthma may require an exercise test and something called a methacholine challenge. McConnell explains that in this test, the patient breathes in a chemical in increasing doses to measure how they react. If their airwaves restrict due to its presence, this chemical is marked as an irritant, and the patient is diagnosed with asthma.
For patients who may have COPD, similar breathing tests are administered, and a patient’s occupational history is detailed to see whether he or she smoked and, if so, for how long. Chest X-rays are also given to determine the extent of the disease.
McConnell says that COPD is often co-morbid with other grave diseases. “Remember, the biggest culprit for patients with COPD is smoking,” he says. “And smoking causes stroke, it causes lung cancer, it causes heart problems, and so you frequently end up with more than one disease here. As we say, smoking is not anybody’s friend except for the tobacco companies.”
Treatment for asthma patients begins with identifying their unique triggers and removing the triggers from their everyday surroundings. Patients should have an asthma action plan, McConnell says. They can check their air flow at home to set a baseline for normal air flow, and then, at the onset of an attack, measure their flow against the baseline. There are three zones for care: green (nothing required), yellow (take medication), and red (take additional medication and call the doctor).
Asthma patients are also given a bronchodilator (usually aspirated) and an anti-inflammatory medication such as a steroid. If this treatment does not work, then immune therapy may be tried. McConnell briefly discusses a relatively new form of treatment called bronchial thermoplasty, whereby radiofrequency energy is applied to the airways in the lungs to slightly burn off some of the muscle tissue, which will improve air flow. He is skeptical about its effectiveness but notes that some pulmonologists have had success with the treatment.
For COPD patients, the first step in treatment for most of them is to stop smoking. They are also given bronchodilators and anti-inflammatories, as well as a third medication, an anticholinergic, which reduces muscle spasms. Lung transplants are rarely given to COPD patients as they are usually reserved for persons with more serious diseases, such as cystic fibrosis, that are not self-induced.
Patients who have asthma and COPD are also given a rescue inhaler. “If you are out doing something and have an attack, the most important thing is to get that airway open quickly,” McConnell says. “So, we’ll give them a rescue inhaler that they can use, and keep with them, and have a couple of hits, and hopefully make improvements.”
