COPD and the harm of cigarettes and hookah

What is COPD?

COPD is the name for a group of lung diseases that make breathing difficult. The NHS names two well-known forms: emphysema, in which the air sacs of the lungs are damaged, and chronic bronchitis, in which the airways stay inflamed for a long time. It mostly affects middle-aged and older people, and many do not know they have it.

Common symptoms:

• shortness of breath, especially during activity
• a persistent cough with phlegm
• frequent chest infections
• wheezing

Without treatment, symptoms usually get worse over time. Sometimes symptoms suddenly become more severe, which is called an acute attack or “flare-up” (exacerbation). The ATS writes that in early COPD some patients have no symptoms, which is why people at risk should be checked.

Smoking is the most common cause, and the risk rises with how much and for how long a person smokes. But it is not the only cause. The ATS and NHS also name workplace dust and chemicals, air pollution, wood smoke and inherited factors. The WHO writes that in low- and middle-income countries thirty to forty percent of cases are due to smoking, and that smoke from cooking and heating in the home plays a large part.

Who should be seen?

The NHS says to see a doctor if symptoms keep going, especially if you are over 35 and smoke or have smoked. The NHLBI asks people at risk to ask about their risk even at the age of forty.

GOLD has a short five-question questionnaire: Do you cough several times on most days? Do you bring up phlegm on most days? Do you get short of breath sooner than people your age? Are you over forty? Do you smoke or have you smoked? If you answer yes to three or more questions, ask your doctor about COPD. This questionnaire does not replace an examination.

How is it assessed?

The NHS writes that the doctor asks about symptoms and smoking history, listens to the chest, and usually asks for spirometry. In spirometry, after inhaling a bronchodilator medicine, you blow into a device, and the device measures the volume of air you breathe out and the amount you push out in one second. The WHO and ATS also say the diagnosis is confirmed with spirometry.

Depending on need, other tests may also be required (NHS): a chest X-ray to rule out similar diseases, blood tests, a heart tracing and heart ultrasound, a peak flow meter, oxygen measurement with a finger device, a lung CT scan and a phlegm sample. See the “Lung tests” guide for an explanation of each.

What does treatment look like overall?

The aim of treatment is to reduce symptoms and to reduce the number and severity of attacks. The NHS writes that quitting smoking is the most effective step to stop the disease getting worse. The other treatments, according to the NHS, NHLBI and WHO:

• Bronchodilator inhalers: short-acting ones for when you are short of breath, and long-acting ones for daily use when symptoms are regular. Sometimes a steroid inhaler is added.
• Other medicines: tablets or medicines that thin thick phlegm, and during an attack a short course of oral steroids or an antibiotic may be needed. The NHS says long-term oral steroids are prescribed only by a COPD specialist.
• Pulmonary rehabilitation: a structured programme of exercise and education. The NHS says it runs in group sessions over at least six weeks.
• Oxygen: for people whose blood oxygen is low. The NHS stresses that oxygen does not itself relieve shortness of breath.
• Vaccines: the NHS recommends a flu vaccine every year and a pneumococcal vaccine once.
• Surgery or transplant: the NHS says this is only for a very small number of severe patients after a specialist’s assessment.

Which medicine and which schedule suit you is the doctor’s decision. Using your inhaler correctly matters (see the “Inhalers and spacers” guide).

What can you do yourself?

Quit cigarettes and hookah. Nobody sets out to become ill, and putting nicotine aside is hard for many people. The ATS writes that most people make several attempts before quitting for good, and that combining medicine (such as nicotine replacement) with counselling raises the chance of success. The WHO also says counselling and medicine more than double the chance of quitting. The doctor can help you choose a suitable method, and if one attempt fails, trying again is normal. The ATS says there is not enough evidence to use e-cigarettes as a quitting aid.

Other things you can do:

• Take your medicines as planned and do not stop an inhaler without advice.
• Make a written action plan with your doctor that says what to do in each situation (ATS and ALA).
• Exercise to the point of mild breathlessness. The NHS says exercising until you are slightly short of breath is safe, but do not push yourself. If your symptoms are severe or you have not exercised for some time, ask your doctor before starting.
• Avoid dust, smoke, strong chemicals, perfumes and air-freshener sprays in enclosed spaces (NHS).
• If you use oxygen, arrange travel with the travel company in advance (NHS).
• Know the signs of an attack: more shortness of breath than usual in everyday tasks, more or new coughing, a change in the color or amount of phlegm (the ATS says this is often the first sign), more tiredness and fever. Learn the usual color and amount of your phlegm when you are well. In this situation let your doctor know early, because the ATS says “getting help early” is very important.

Do not replace your medicine with any diet, herb or supplement.

When to get urgent help

Call 115 (Iran’s emergency number) right now or go to the emergency department if:

• You are gasping for breath and cannot finish a sentence.
• Your lips or skin have turned blue, grey or very pale (NHS).
• You are confused or excessively sleepy and hard to wake. The ATS says confusion, difficulty waking or a morning headache can be a sign of raised carbon dioxide and needs urgent medical attention.
• You have chest pain or pressure, or pain spreading to the arm, neck or jaw (NHS).
• You are coughing up blood-stained phlegm, more than a few spots or streaks (NHS).

See a doctor the same day if: your symptoms have suddenly got worse, the color or amount of your phlegm has changed, you have a fever, or you need your reliever inhaler more than before. If you cannot reach a doctor, go to the emergency department. The full list is in the “When should I call urgently?” guide.