Lung Health: Sorting Out COPD, Asthma, and Emphysema

Jonathan Vellinga, MD -

Breathing is automatic, and people expect to breathe - rarely considering what it would be like not to have the next intake of air. The dramatic failure of breath, such as in asthma attacks, is easy to spot. What is harder to notice is the slow progression of some lung conditions, which incrementally reduce the amount of oxygen in the bloodstream over such long periods that it often goes unnoticed until the condition is very advanced. Both dramatic and barely noticeable lung conditions can profoundly affect the human body. This article will cover three common lung conditions, tips for preventing lung diseases, and some specific treatment options.

The Lungs: A Crash Course

Human lungs look like an upside-down tree. The "trunk" is the tube that leads from the mouth and nose to the lungs, called the trachea. The trachea branches off into the two primary bronchi, one going to the left lung and one to the right. In the lungs, the bronchi branch and get smaller, forming bronchioles and, eventually, the alveoli. The alveoli are covered with capillaries, and it is here where oxygen that is breathed in is transferred into the circulatory system and where carbon dioxide is released as waste. These structures are delicate and can be damaged by inhaled chemicals and toxins.

COPD - Umbrella Term and Standalone Disease

Much of the confusion regarding lung diseases stems from the term Chronic Obstructive Pulmonary Disease (COPD), which is both its own disease and a broad term that encompasses other lung diseases. What is common to COPD (and the lung diseases grouped under this term) is the persistent (chronic) blockage of airflow and the adverse effects on breathing (1). The blockage of airflow in the lungs can be caused by (2, 3):

• Bronchial walls (airway tubes) that constrict or collapse

• Collapse or damage of alveoli

• Swelling, growth in thickness, or loss of elasticity of the bronchial walls

• Buildup of mucus in the airways

If a lung disease involves obstructed airflow and shortness of breath, it can be grouped under the umbrella term of COPD. Chronic bronchitis and emphysema can be considered COPD, though they have different causes and can require other treatments. These lung diseases are diseases in their own right but also exist as subcategories of COPD. So, what determines the diagnosis of COPD versus one of the subcategories?

The standalone diagnosis of COPD may be given when there are symptoms of both chronic bronchitis and emphysema, rather than giving the patient two separate diagnoses.

Though people (and doctors) may use these terms interchangeably, it helps to clarify the definitions of the different lung diseases. Note, many words describing lung diseases use the word "pulmonary." The Latin word "Pulmo" means "lung."

COPD - Chronic Pulmonary Obstructive Disease - COPD is an umbrella term for a group of diseases involving chronic blockage of airflow and disrupted breathing. Also, COPD is a standalone diagnosis to indicate the extreme severity or irreversible nature of one of the diseases under the umbrella (emphysema or chronic bronchitis). There are four stages of COPD, with stage 1 being the early stage and stage 4 being very severe (2).

Asthma - Asthma is characterized by a sudden surge in symptoms (attacks) that have some triggering event. During the attack, airways constrict, inflammation may swell the airways, and mucus production in the lungs may increase and block the airways. Asthma is often called an inflammatory condition because inflammation is a crucial component. Asthma may be persistent or intermittent, allergic or non-allergic, and adult-onset or pediatric (4). Exercise-induced asthma is triggered by physical activity, whereas "occupational asthma" indicates that exposure to triggering events comes from irritating chemicals or dust at work. It's estimated that asthma attacks caused 1.6 million Americans to visit the emergency room in 2017 (5).

COPD/Asthma Dual Diagnosis - Although similar in some ways, asthma and COPD are two distinct diseases with separate causes. However, the two diseases can overlap, in which case a person will be diagnosed with both COPD and asthma (13, 14).

Chronic Bronchitis - This lung condition centers around the bronchial tubes, which become swollen and lined with excessive mucus. This process narrows the space where the lungs can take in air. Once the mucus is made, it is not removed quickly because the hair-like structures called cilia are damaged (often from smoking) (2).

Emphysema - This lung condition involves the breakdown of alveoli (air sacs), the structures at the ends of the airways in the lungs. Alveoli take in oxygen upon inhalation and release carbon dioxide as waste upon exhaling. In emphysema, the walls of the alveoli are damaged, reducing the amount of oxygen that comes into the body (2). Additionally, blockages can develop that trap oxygen in the lungs rather than letting it diffuse across the membranes of the alveoli. Trapped oxygen can puff out the chest, resulting in a "barrel-chested" shape (7). Emphysema is often unnoticed until more than 50% of the lung tissue has been damaged because the only symptom before that point is shortness of breath (7). The four stages of emphysema are determined by severity, with the mildest being stage 1 and the most severe being stage 4.

There Are Many Similarities Between COPD, Asthma, & Emphysema

Similar Causes - While the exact cause of asthma is still debated, emphysema and COPD can both be caused by genetics, environmental factors, and smoking. Environmental factors that cause COPD and emphysema are air pollution, smoking, secondhand smoke, fumes from chemicals, or dust (4, 7).

Similar Symptoms - COPD, asthma, and emphysema share many symptoms, although the underlying physical reasons may differ slightly. It's vital to diagnose the issue correctly because if similar symptoms are caused by different underlying physiology, they may need other treatments. Shared symptoms include (2, 4, 7):

• Coughing, with or without mucus

• Shortness of breath

• Wheezing

Similar Risk Factors - A few risk factors are common to COPD, asthma, and emphysema. However, one of them stands out above the others - smoking.

• Smoking - Without judgment, practitioners at Temecula Center for Integrative Medicine (TCIM) warn patients about things that may be harmful. It is an unfortunate fact that smoking courts many disease processes, and the longer the smoking occurs, the worse the damage can be. Smoking anything (e-cigs, tobacco, herbal cigarettes, marijuana) can damage the delicate structures designed to bring oxygen into the lungs. We know these substances can be severely addicting. If you are ready to quit smoking, we are prepared to support you (through medicines, supplements, education, and/or referrals to other resources).

Smoking is so damaging that even exposure to someone else's smoking (secondhand smoke) can trigger asthma or make one more likely to have an asthma attack. Exposure to secondhand smoke is also a risk factor for emphysema and COPD. Imagine how much more severe the risk is if that smoke is inhaled directly into the lungs.

• Environmental Factors - Other airborne irritants can increase asthma, emphysema, and COPD risk. Dust, pollen, pet dander, fumes from chemicals, smoke from fires, and toxins irritate the lungs differently and raise the risk of developing lung diseases (2, 4, 7).

• Genetic Factors - Asthma, COPD, and emphysema can be affected by genes. If there is asthma or a tendency for allergies in the family, there is an increased risk of having asthma. In COPD and emphysema, the genetic risk comes from alpha-1 antitrypsin deficiency (AAT deficiency). AAT is a rare inherited condition. Normally, AAT protects lungs from being damaged by neutralizing an enzyme that is designed to kill germs and consumes damaged or very old cells. However, the genetic condition creates a deficiency of this enzyme, which allows the killer enzymes to turn on healthy tissue and destroy it (2, 4, 7).

Similar Prevention Tactics

Fortunately, a handful of prevention strategies can have a powerful impact on lung health and can prevent a disease from developing or worsening. Some of the prevention strategies listed here for asthma, emphysema, and COPD overlap with lung cancer prevention strategies, which were covered in a previous article.

Prevention Tactic 1 - Get Tested - As stated before, sometimes symptoms only occur once lung damage is very advanced. So, the best way to detect an issue before symptoms appear is through regular testing and screening.

Prevention Tactic 2 - Quit Smoking - If you don't smoke, please don't start. If you are currently smoking and are ready to quit, we can help you find (and stick to) a cessation program. Cigarettes are very high in toxins, including acetone, arsenic, tar, and carbon monoxide (also found in car exhaust) (8). These toxins make direct contact with tissues in the lungs, damaging them. Repeated damage from toxins damages cells that exchange oxygen and can cause mutations that make the cells vulnerable to cancer.

Prevention Tactic 3 - Avoid Inhaling Dust and Irritants (Particulate Matter) - Whether at home or at the work site, avoid inhaling irritants by wearing masks or other appropriate safety gear. For those with asthma, irritants can trigger an asthma attack. Consistent inhalation of car exhaust, pollen, cooking fumes, or industrial pollution can lead to emphysema or COPD (2, 4, 7), and inhaling irritants like these and others such as mold can cause flare-ups if you already have a lung condition. Restaurant workers in front of fry baskets where oil is heated or hot cook tops that give off fumes from oils are vulnerable to lung damage. Occasional exposure is less damaging than consistent, daily exposure for months and years. Larger particles are not as dangerous as smaller particles because the smaller particles can get deeper into the lungs and enter the bloodstream (9).

Spirometry & Other Types of Testing for Lung Diseases

There are many types of testing used to determine a diagnosis of lung disease. The doctor or practitioner will pick the appropriate tests depending on your personal medical history, family history, and type and severity of symptoms. Below are just a few of the many tests that could be used:

Spirometry - When testing pulmonary function, Temecula Center for Integrative Medicine (TCIM) uses "spirometry," the best and most common way to measure lung capacity and strength. A patient blows into a tube connected to a spirometer, a device that measures airflow, the strength of airflow, and an estimate of the amount of air the lungs can hold. A clip is put on the nose to keep air from coming out of the nose, and a tight seal is made while blowing into the device's tube. Depending on what is being measured, there are different ways to blow into the device, and it is usually repeated several times to collect an average.

Two frequently used measurements obtained from spirometry are (10):

• Forced vital capacity (FVC) - the most air you can breathe out after taking a deep breath (helps determine how much air the lungs can hold)

• Forced expiratory volume (FEV1) - the amount of air you can force out of your lungs in one second (helps determine the strength of lungs)

Spirometry can help a practitioner diagnose lung disease correctly or check the severity of a known lung disease. Spirometry can also help determine if medications or treatments are working (10).

Pulse Oximetry - A pulse oximeter measures how saturated the blood is with oxygen. The device is shaped so that it can clip onto a finger. Using a light that shines through the surface of the skin, reflections are used to determine how oxygenated the blood is. Other sensors detect the heartbeat from the finger and calculate the pulse rate and blood pressure. When lung disease is advanced, the oxygen saturation lowers because the lungs are not taking in oxygen efficiently.

X-Ray / CT Scan of Lungs - Sometimes, a picture is worth a thousand words. Lung scans can show areas of damage.

Potential Treatments

Different treatments may be proposed for your care depending on the exact diagnosis. A doctor or practitioner will craft a plan that addresses the type and severity of the issue, pulling from many different kinds of therapies available. Some of the more common treatments are listed below:

1. Bronchodilators - Bronchodilators are medicines that open the airways of the lungs by relaxing the smooth muscles embedded in the walls. They can be oral medications or in the form of a personal inhaler. Inhalers deliver the medications directly to the lung tissues. Bronchodilators are used for all three conditions - asthma, emphysema, and COPD.

2. Steroids - Steroids are a particular class of medications that can significantly reduce inflammation anywhere in the body. Steroids can be loaded into an inhaler or can be taken in the form of oral medication.

3. Supplemental Oxygen - In cases of emphysema and COPD, sometimes more oxygen is needed, so devices can be used to deliver oxygen to the nose or mouth for inhalation. The addition of oxygen in cases of oxygen deprivation is almost always welcome because it helps to increase energy and mental clarity. Please note that other oxygen therapies, such as hyperbaric oxygen therapy or ozone therapy, may not be appropriate, so please consult your doctor if you have a lung condition and are considering those therapies. In some cases, it could be very beneficial, but in other cases, it could be very dangerous.

4. Antibiotics - Those living with emphysema and COPD are very vulnerable to lung infections. In these cases, antibiotics might be more liberally provided than usual to help protect against diseases settling in the lungs.

5. Rehabilitation & Broader Range of Medicines for COPD - Since COPD often involves severe symptoms, it is often treated more aggressively. In addition to antibiotics, a more comprehensive range of medications is available for COPD, including (2):

• Anticholinergics - blocks acetylcholine, which restricts passageways

• Antivirals - to help prevent viral infections from settling in the lungs

• Expectorants - help remove mucus from passageways

• Leukotriene modifiers -block inflammation-inducing leukotrienes

6. Pulmonary Rehabilitation for COPD - Pulmonary rehabilitation is a medically supervised program that aims to improve the breath, reduce COPD symptoms, increase the ability to perform exercise, and enhance emotional well-being (11).

7. Biologic Therapies for Asthma - Drugs made from living organisms are called "biologics." Many biologics are used for asthma treatment, such as Dupilumab and Benzralizumab, which are derived from monoclonal antibodies. Science has been evolving quickly, and biologics from monoclonal antibodies are being used more extensively in the field.

8. Exercise and Breathing Exercises - Conditioning the lungs can help counter the adverse effects of lung disease in many cases. However, you may have to work with a doctor to create a safe plan, especially in cases of exercise-induced asthma. Beyond cardio exercise, there is an "incentive spirometer" similar to the device used in testing, but the purpose of this device is to exercise the lungs. The incentive spirometer is often used in pulmonary rehabilitation.

9. Eliminating Food and Pollen Allergens - Food sensitivities may trigger asthma attacks for some, especially right before exercise (12). Some studies over the years have indicated that pollen allergies can trigger asthma attacks or worsen COPD and emphysema. It makes sense because pollen is a small irritant that can mechanically and chemically irritate tissues and trigger inflammation. Eliminating sources of inflammation in the diet can undoubtedly reduce symptoms of lung diseases.

Breathing Easy

Testing of lung diseases can be done during TCIM's two-part extensive "executive physical" if your medical history, lifestyle habits, or symptoms warrant it. We encourage current or former smokers to test for lung fitness and blood oxygen levels. The slow progression of lung diseases can be deceiving, but catching it early can make the difference between life and death, true health and costly medical bills, oxygen sufficiency and oxygen deprivation. We can help you reduce risk factors. If your last physical was long ago and you have problems breathing, please call and schedule an appointment soon. For some, every day counts.

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Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​

Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.

info@tcimedicine.com

951-383-4333

www.tcimedicine.com

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