Is COPD Life Threatening?

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease caused by damage to the lungs, which makes it hard to breathe.  Often, COPD is a result of many years of smoking, which irritates the airways and destroys the fibers within the lungs.  Typically, it takes years of lung damage until symptoms to arise, with most patients diagnosed in their sixties.  Some risk factors include smoking, breathing chemicals, dust, air pollution, and secondhand smoking.  There have been no major progress in treatment or prevention for decades.  To achieve better outcomes and ultimately prevent at least some forms of COPD, a complete rethinking is needed.

                Tobacco exposure is still an important risk factor for COPD.  New Zealand aims to be the first country to eliminate tobacco use by introducing legislation for a so-called smoke-free generation, gradually increasing the age at which cigarettes can be legally bought.  Anyone born on or after Jan 1, 2009, will be forbidden from buying cigarettes.  The New Zealand parliament voted on July 26, 2022, on drastically reduce the nicotine content in cigarettes and allow them to be sold only in dedicated stores.  Other countries, such as Denmark and Malaysia, are considering similar rules.  However, vaping will continue to be allowed in New Zealand and tobacco companies are already shifting their marketing efforts to electronic nicotine delivery systems (ENDS), under the guise of aiding smoking cessation.  However, ENDS often contain more nicotine than cigarettes, and many target adolescents and young adults by using appealing designs and flavors.  They contain chemicals that are harmful to the lungs and long-term effects are likely to be contributing to the burden of COPD.  The best outcome for lung health is for both tobacco and vaping to be eliminated worldwide.

                Indoor and outdoor air pollution are increasingly important risk for COPD that need urgent attention.  Indoor air pollution has a disproportionate effect on women in low-income and middle-income countries through indoor stoves that use wood, biomass, or coal.  So far, attempts to introduce cleaner cook stoves have not been successful despite clear evidence of improved health effects because of costs, cultural habits, and a lack of knowledge about the consequence of traditional indoor cooking.  Outdoor air pollution and wildfires are also affecting many people globally with cumulative chronic injury to the lungs.

                Early-life events are not routinely considered in the context of COPD.  A consequence of better survival of babies born prematurely is that more will reach adulthood with small lungs or injured lungs through chronic lung disease of prematurity.  Yet lung function is not routinely tested in young people who were born prematurely and those presenting with obstructive lung disease are not asked about birth history.  Monitoring patients after such early-life events could lead to new disease-modifying treatments, as well as form the basis of screening policies and risk prediction.  Lung health should be monitored in the same way as heart health is by blood pressure testing and blood lipid screening before organ damage is apparent and irreversible.  Prevention of further lung injury in this group is particularly important.              

                The lung is an incredible organ.  It has 1500 miles of airways and 300-500 million alveoli.  Yet, traditionally, the lung does not receive attention until a disease is diagnosed.  The two most common lung diseases, asthma and COPD, have no clear definition beyond a physiological description.  Currently, a diagnosis of COPD is often accompanied by a sense of futility and a degree of stigma.  By highlighting the risk factors across the life course and recommending far-reaching measures for prevention, early diagnosis, and changes in treatment, the World Health Organization of U.N. aims for nothing less than to transform the way COPD is thought of.  Lifelong lung health for all is the goal to aspire to.  Every health-care worker needs to advocate for the right to clean air.