Ask any singer what they detest the most and they will say, “People who cough at concerts.” So, how do you tell if your annoying cough is due to getting older or being a little out of shape? Is it a common cold? Or could it be a life-threating condition, such as chronic obstructive pulmonary disease (COPD)? It’s estimated that one in four people globally over the age of 35 will develop COPD. Worldwide, it’s the third leading cause of death. It’s worrying that the National Heart, Lung, and Blood Institute reports that over 15 million Americans have been diagnosed with COPD and another 12 million don’t know they have the disease.

What causes COPD? It’s almost entirely due to smoking. Older women may experience more serious symptoms, even if smoking less than men. Other risk factors include exposure to secondhand smoke and airborne lung irritants such as toxic fumes and heavy dust.

People at a concert who can’t stop coughing may be suffering from emphysema or long-standing bronchitis, and often they will have both conditions. However, the underlying pathology is quite different. In emphysema, the air sacks that transfer oxygenated air to and from the lungs have lost their elasticity, leading to chronic shortness of breath and lack of oxygen. Those suffering from chronic bronchitis have inflamed lungs clogged with mucus. This limits the intake of oxygen and builds up carbon-dioxide in the blood. What is the answer to self-inflicted COPD? Shakespeare aptly wrote, “The fault, dear Brutus, is not in our stars, but in ourselves.” Some people, despite medical evidence that smoking causes COPD and most lung cancer, still play Russian roulette. They do not need a hardworking family doctor. They need a psychiatrist!

Don’t think the solution is to quit at the first sign of trouble. These diseases are sneaky without major symptoms at first. By the time you notice you’re short of breath going up an easy flight of stairs, you may be too late in getting the message. There are some things your doctor can do to help to reduce further damage to the lungs. Get a flu shot, the pneumonia vaccine, avoid fireplace smoke and other pollutants, and adhere to drugs prescribed by your doctor. If you have signs such as fever, more difficulty breathing, tightness in the chest and increased mucus, see your doctor. Inhaled bronchodilators use drugs to relax the airway muscles making it easier to breath. Inhaled corticosteroids can be added to reduce inflammation in the lungs. Getting oxygen with a mask may be necessary. There’s new evidence that long-term use of antibiotics such as azithromycin may decrease the number of recurrent COPD flare-ups after one year.

What about surgery? This is a last resort and only feasible for some cases. Diagnostic X-rays and CT scans may reveal a part of the lungs that is severely affected. Removing the most diseased lung tissue might enable the remaining healthier parts to work better. This may improve breathing ability, but it can also make the problem worse. A lung transplant is another possibility, but new organs are a rare gift. We hope in the years ahead there will be other ways to treat this debilitating disease. But let’s end with one last warning message. For now, COPD has no cure and will progress when smoking continues. COPD is a terrible price to pay when it means prematurely leaving loved ones needlessly. Doctors see this over and over. What about doctors? Years ago, cocktail parties in the homes of doctors would be full of tobacco smoke. Not today. Most have heard the message.

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-W. Gifford-Jones, MD