Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
Paul Scanlon, M.D., worked as a Mayo Clinic pulmonologist for more than three decades. Below, he answers questions about COPD and describes experts’ evolving understanding of it.
Q: Has the approach to treating COPD changed in the course of your career?
A: Having finished my training in 1984, virtually everything in the treatment of COPD has changed. Back then, there was often overreliance on the use of short-acting bronchodilators and often prolonged use of systemic corticosteroid medications. These were among the few choices we had for medications. In contrast, modern therapy uses a guidelines-based approach to diagnosis, maintenance therapy and therapy for acute exacerbations. We have multiple options for controller medications. Other changes include:
- An organized approach to smoking cessation with nicotine replacement and effective medications.
- An organized approach to treatment of acute exacerbations with regular antibiotic therapy and short use of corticosteroids.
- Organized and effective pulmonary rehabilitation programs with a more positive attitude toward the treatment of advanced-stage COPD.
- Better understanding of the indications for oxygen therapy and much lighter and better oxygen delivery systems.
Q: Could you explain the importance of an accurate diagnosis for COPD?
A: Although COPD is the most common chronic respiratory diagnosis, it is both overdiagnosed and underdiagnosed. Overdiagnosis means people who have respiratory symptoms — shortness of breath, cough, wheezing — and a history of smoking are told they have COPD without going through appropriate diagnostic evaluation. Many of these do not have evidence of airflow obstruction on pulmonary function testing, which is the essential piece of the diagnosis.
In pulmonary medicine, we often are asked to evaluate people who have received a diagnosis of COPD but do not respond well to treatment. Such people often have entirely different lung conditions or even heart disease, cancer, blood disorders or other conditions.
That is why a thorough evaluation should always begin with a careful history, physical examination, spirometry (with or without additional physiological measures) and imaging of the chest.
Underdiagnosis of COPD refers to the millions of people with COPD in the U.S. and around the world who are not diagnosed and do not receive the benefit of appropriate therapy.
Q: What are the main lifestyle changes that can help a person manage COPD?
A: Smoking cessation is obviously important, but it is not easy. Work with your health care provider on a plan to address this first.
Other lifestyle changes have a smaller impact on health, reinforcing the importance of complete and permanent smoking cessation. These include regular exercise and the diagnosis and treatment of sleep disorders. A healthy diet is recommended, but special diets, with manipulations of fats, carbohydrates or proteins, have not been shown to be particularly beneficial. Avoiding poor air quality is advised, but special air purifiers are not recommended.
Q: What do exacerbations mean for people with the disease?
A: People with COPD have symptoms, such as shortness of breath, cough and sputum production, that vary from day to day. An exacerbation is identified by a sustained increase in symptoms beyond the range of the usual day-today variability. They are classified as:
- Mild. Not needing treatment.
- Moderate. Needing a change in medication.
- Severe. Requiring hospitalization for more-aggressive treatment.
- Very severe. Resulting in respiratory failure and requiring assisted ventilation.
The best predictor of an exacerbation is a history of exacerbations in the previous year. The more exacerbations, the greater the risk. Exacerbations also are important predictors of sickness and death from COPD, particularly when combined with low body mass index (BMI), poor lung function, breathing difficulty and low exercise tolerance. The most common cause of death with COPD is respiratory illness, but that is followed closely by cardiovascular events and cancer, particularly lung cancer.
Exacerbations are usually treated with a course of antibiotics or systemic corticosteroids (prednisone) or both. Plus breathing support with oxygen is given, if needed.
Q: Do asthma and COPD overlap?
A: Asthma and COPD have a number of features in common: cough, shortness of breath, wheezing, sputum production and the presence of airflow obstruction.
In the past, asthma and COPD have been thought of as separate conditions. However, studies have shown that although some people appear to have primarily one condition or the other, there are many individuals with features of both conditions. One of the strongest predictors of COPD, other than smoking, is a history of childhood asthma.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
Relevant reading
Mayo Clinic on Alzheimer's Disease and Other Dementias
Are there ways you can lower your risk of dementia? Can it be prevented? Can you live well with dementia? If so, how? Mayo Clinic on Alzheimer’s Disease and Other Dementias provides answers to these important questions and more.
