COPD Life Expectancy – Global Allergy & Airways Patient Platform

If you have COPD (chronic obstructive pulmonary disease) yourself or if you are caring for someone who does, maybe you are concerned about life expectancy.

COPD is a chronic lung disease that gets worse over time. Unfortunately, there is no cure for COPD. However, there are treatments that can help to slow down the speed at which the symptoms get worse. Thus, these treatments can improve the quality of life of patients. As with other diseases, experts use different methods to predict how long you might live with COPD.

How is COPD life expectancy determined?

The life expectancy of COPD patients varies greatly because many different factors are involved. For example, some factors are your individual symptoms, your age, your health, and how you rank in the GOLD system. Another important factor is whether you have smoked during your life and, if so, for how long.

In order to assess the severity of COPD, doctors use the Global Initiative on Obstructive Lung Disease (GOLD) system. Specifically, this system uses a forced expiratory volume (FEV1) test to see how much air you can forcefully breathe out in one second after blowing into a spirometer.

According to the GOLD system, there are four stages of COPD:

1. Mild COPD = GOLD 1 (More than or equal to 80% FEV1)
2. Moderate COPD = GOLD 2 (50-80% FEV1)
3. Severe COPD = GOLD 3 (20-50% FEV1)
4. Very severe COPD = GOLD 4 (Less than 30% FEV1)

In addition, the GOLD system also considers other factors such as your specific breathing problems and the number of flare-ups you tend to have. Ultimately, the higher your score on the GOLD scale, the lower your COPD life expectancy is likely to be.

What is the COPD BODE scale?

Another scale that’s often used in combination with GOLD is the BODE scale. BODE stands for body mass index, airflow obstruction, dyspnea (breathlessness), and exercise capacity. Specifically, this scale looks at how your COPD affects your life and how you score on different factors, including:

• BMI (body mass index) – as having COPD can cause problems with weight management
• Breathing difficulty level – this shows how much trouble you have with your breathing
• Exercise capacity – a measure of how far you’re able to walk in six minutes, which shows how much physical activity you can manage
• Airflow blockage – the BODE scale also takes into account the results from FEV1 and other lung function tests to assess how much your airflow is blocked.

When all the factors have been considered, you end up with a BODE score of between 0 and 10. People who score 10 have the worst symptoms and are likely to have a shorter life expectancy.

Even though assessment tools for COPD are useful and can help to indicate a likely life expectancy, it’s important to remember that they’re only an estimate.

Is COPD considered a terminal illness?

COPD is not a terminal illness but a chronic disease that gets worse over time . Although there is no cure for COPD, the illness can be successfully managed especially if it’s recognized early.

Studies have shown that the rate at which the lung function of COPD patients decreases can be reduced if a diagnosis is made in the early stages of the disease and if medical treatment starts without delay. Furthermore, lifestyle changes can slow down the speed at which COPD symptoms get worse. For example, one study found that stopping smoking after a COPD diagnosis delayed the worsening of the disease.   Even though this was the case at all stages of COPD, earlier actions had the biggest impact.

Can you live 10 or 20 years with COPD?

The exact length of time you can live with COPD depends on your age, health, and symptoms. Especially if your COPD is diagnosed early, if you have mild stage COPD, and your disease is well managed and controlled, you may be able to live for 10 or even 20 years after diagnosis. For example, one study found that people who were diagnosed with mild stage COPD, or GOLD stage 1, had no shorter life expectancy than healthy people.

This is especially so if you don’t smoke: Other research has found that life expectancy with COPD is reduced further for past and current smokers.

People with severe stage COPD, lose about eight to nine years of life expectancy on average .

What can help improve COPD life expectancy?

Quitting smoking can have a positive effect on your life expectancy if you are a smoker and have COPD. For instance, numerous studies suggest that smokers with GOLD stage 1 or 2 (mild and moderate) COPD lose a few years of life expectancy at the age of 65. In addition, it has been shown by studies that people with stages 3 or 4 (severe and very severe) COPD lose from six to nine years of life expectancy because of smoking. Notably, this loss of life expectancy is in addition to the four years of life lost by anyone who smokes.

If you’ve never smoked, you can help yourself by making sure your symptoms are managed well and that you have regular check-ups. For example, routine blood checks can help control inflammation and may help to pick up on potential issues before they worsen.

Simple lifestyle changes such as losing weight, eating healthily, and exercising safely, when possible, can also help you to maintain a good quality of life.

For prople with severe COPD, treatments such as oxygen therapy, lung volume reduction surgery and lung transplants may also help to increase life expectancy.

How do most COPD patients die?

With COPD, everyone’s situation and health are individual and unique and there is no one way to say how patients may die. However, some research has found that for people with mild COPD, the causes of death are often cardiovascular diseases.

In contrast, in cases of severe COPD, research has shown that major causes of death include heart failure, respiratory failure, lung infection, lung embolism, heart arrhythmia, and lung cancer.

While it’s good to stay positive and not focus on dying, if your condition gets worse and becomes very serious, it’s likely that your doctor or nurse will mention palliative and end-of-life care. Moreover, discussing your situation with your family doctor can help you make decisions and take care of your physical, emotional, social, and spiritual needs. As palliative care is both patient and family-centered, it can help prevent and relieve suffering.

At GAAPP, we want to empower patients because everyone deserves to live freely without their symptoms interfering with their lives. Find out more about our Patient Charter here.

Berry CE, Wise RA. 2010. Mortality in COPD: causes, risk factors, and prevention. COPD. 2010 Oct;7(5):375-82. doi: 10.3109/15412555.2010.510160. PMID: 20854053; PMCID: PMC7273182.

BMJ Best Practice. Chronic obstructive pulmonary disease (COPD). Diagnosis: criteria.

Chen CZ, Shih CY, Hsiue TR et al. 2020. Life expectancy (LE) and loss-of-LE for patients with chronic obstructive pulmonary disease. Respir Med. Oct;172:106132. doi: 10.1016/j.rmed.2020.106132. Epub 2020 Aug 29. PMID: 32905891.

Curtis JR. 2008. Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal. 32: 796-803; DOI: 10.1183/09031936.00126107

Global Initiate for Chronic Obstructive Lung Disease. 2018. Pocket Guide for COPD diagnosis, management and prevention: A guide for health care professionals. 2018 report.

Hadi Khafaji HA, Cheema A. 2019. Heart failure and chronic obstructive airway disease as combined comorbidities. Meta-analysis and Review. Arch Pulmonol Respir Care 5(1): 015-022. DOI: 10.17352/aprc.000037

Hansell AL, Walk JA, Soriano JB. 2003. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis. European Respiratory Journal. 22: 809-814; DOI: 10.1183/09031936.03.00031403

Lung Health Institute. 2016. BODE index and COPD: determining your stage of COPD.

Shavelle RM, Paculdo DR, Kush SJ, et al. 2009. Life expectancy and years of life lost in chronic obstructive pulmonary disease: findings from the NHANES III Follow-up Study. International journal of chronic obstructive pulmonary disease, 4, 137–148.

Vestbo J; TORCH Study Group. 2004. The TORCH (towards a revolution in COPD health) survival study protocol. Eur Respir J. Aug;24(2):206-10. doi: 10.1183/09031936.04.00120603. PMID: 15332386.

Welte T, Vogelmeier C, Papi A. 2015. COPD: early diagnosis and treatment to slow disease progression. Int J Clin Pract. Mar;69(3):336-49.

COPD: What’s My Life Expectancy?

Written by Kathryn Whitbourne

• COPD Severity and Life Expectancy
• Symptoms and Severity
• Smoking Plays a Role
• The BODE Index
• Can Medication Help?
• Early Diagnosis Can Make a Difference
• Make Lifestyle Changes
• More

There’s no one-size-fits-all answer when it comes to predicting someone’s life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward.

“COPD is a disease with a lot of moving parts,” says Albert A. Rizzo, MD, chief medical officer for the American Lung Association. “It’s not a death sentence by any means. Many people will live into their 70s, 80s, or 90s with COPD.”

But that’s more likely, he says, if your case is mild and you don’t have other health problems like heart disease or diabetes. Some people die earlier as a result of complications like pneumonia or respiratory failure.

Doctors use a classification system called the Global Initiative on Obstructive Lung Disease (or GOLD) system to determine how severe your COPD is. It’s based on how much air you can forcefully exhale in 1 second after blowing into a plastic tube called a spirometer. You’ll also hear this called a forced expiratory volume (FEV1) test.

The classifications are based on results for an adult your same age, gender, and ethnic group but without COPD. So if your airflow was 80% of someone’s airflow who doesn’t have COPD, you’d be at GOLD or Stage 1. There four stages:

• GOLD 1: Mild COPD (FEV1 of 80% or more)
• GOLD 2: Moderate COPD (FEV1 50%-79%)
• GOLD 3: Severe emphysema/chronic bronchitis (FEV1 30%-49%)
• GOLD 4: Very severe COPD (FEV1 less than 30%)

In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD.

Do you have trouble breathing? Have you been hospitalized for COPD flare-ups, which doctors call exacerbations? Doctors look at your symptoms and put you in one of four categories, A-D. The most serious would be GOLD D (high symptom severity and high exacerbation risk).

Smoking is the leading cause of COPD. One study found a small drop in life expectancy (about 1 year) for people with COPD who had never smoked. But there was a much larger reduction for current and former smokers. For men age 65 who smoke, the drop in life expectancy is:

• Stage 1: 0. 3 years
• Stage 2: 2.2 years
• Stage 3: 5.8 years
• Stage 4: 5.8 years

This is in addition to the 3.5 years of life all smokers, whether they have COPD or not, lose to the habit.

The same study also found that women who were current smokers and at Stage 2 lost about 5 years of their lives at Stage 3 and 9 years of their lives at Stage 4.

Another system doctors use to measure life expectancy with COPD is the BODE Index, which stands for:

• Body mass: Are you obese or overweight?
• Airflow obstruction: How much air can you forcefully exhale from your lungs in 1 second (the FEV1 test).
• Dyspnea: How hard is it to breathe?
• Exercise capacity: How far can you walk in 6 minutes?

The higher your BODE score, the greater your risk for death from COPD. This test is considered more accurate than just the FEV1 score.

Right now there aren’t any medicines that cure COPD. “We are still looking for drugs that can slow down the disease process itself and reverse inflammation in the airways,” Rizzo says. But there are bronchodilators (medications usually taken through inhalers) that can open your airways and improve shortness of breath.

Corticosteroids can help control flare-ups. That’s important because more COPD hospitalizations are linked to a higher likelihood of death.

If you’re constantly low on oxygen, your doctor might prescribe supplemental oxygen. You’ll get a device you can take with you anywhere to help you breathe.

And you have to have access to care in the first place. Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level.

An early diagnosis can also greatly improve your life expectancy. “Probably half the people with COPD had the disease for a number of years before they were diagnosed,” Rizzo says. “They didn’t bring it to the attention of their physician because they thought the cough and the shortness of breath were related to being overweight, out of shape, and still smoking.”

Also, doctors have to diagnose COPD correctly by ordering the right tests, he says.

Rizzo also points to studies under way figure out why some people are more likely to get COPD than others. A study started this year by the National Institutes of Health and supported by the American Lung Association will look at lung function in 25-35-year-olds (lung function reaches its peak in the mid-20s) and figure out what changes over the course of their lifetime. “We want to notice when an individual develops findings of COPD, what may have led to it, and what we can learn from that to improve survival,” he says.

While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life. You can:

• Quit smoking. It’s the most important thing you can do to improve your life expectancy with COPD.
• Avoid secondhand smoke and other things that might irritate your lungs.
• Exercise.
• Control your weight.
• Stay up to date with vaccines, including COVID-19, seasonal flu, and pneumonia vaccines.

Once you’ve been diagnosed with COPD, follow your doctor’s advice to stop smoking, exercise, and take any medications prescribed. “And most important, stay active,” Rizzo says. “Walking is the best exercise for lungs, so walk on a regular basis.”

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COPD Life Expectancy – Global Platform for Allergy & Respiratory Patients

If you have COPD (Chronic Obstructive Pulmonary Disease) or are caring for someone who cares for them, you may be concerned about life expectancy.

COPD is a chronic lung disease that worsens over time. Unfortunately, there is no cure for COPD. However, there are treatments that can help reduce the rate at which symptoms worsen. Therefore, these therapies can improve the quality of life of patients. As with other diseases, experts use different methods to predict how long you can live with COPD.

How is life expectancy determined in COPD?

The life expectancy of patients with COPD varies greatly due to many different factors. For example, some factors are up to you. Symptoms, your age, your health and your place in the GOLD system. Another important factor is whether you smoked during your life and if so, for how long.

Doctors use the Global Initiative on Obstructive Lung Disease (GOLD) system to assess the severity of COPD. Specifically, this system uses the Forced Expiratory Volume (FEV1) test to find out how much air you can forcefully exhale in one second after blowing into the spirometer.

GOLD has four stages of COPD:

1. mild COPD = GOLD 1 (greater than or equal to 80% FEV1)
2. Moderate COPD = GOLD 2 (50-80% FEV1)
3. Severe COPD = GOLD 3 (20-50% FEV1)
4. Very severe COPD = GOLD 4 (less than 30% FEV1)

In addition, the GOLD system also takes into account other factors such as your specific breathing problems and the number of flare-ups you typically have. Ultimately, the higher your GOLD score, the lower your COPD life expectancy will be.

What is the COPD BODE scale?

Another scale often used in conjunction with GOLD is the BODE scale. BODE stands for body mass index, airflow obstruction, dyspnea (breathlessness), and exercise tolerance. Specifically, this scale shows how COPD affects your life and how you score on various factors, including:

• BMI (body mass index) – because COPD can cause problems with weight management
• Breathing Difficulty Level – Shows how difficult your breathing is.
• Exercise Ability is a measure of how far you can walk in six minutes, which indicates how much physical activity you can manage.
• Airflow blockage – The BODE scale also takes into account the results of FEV1 and other lung function tests to assess how much your airflow is blocked.

When all factors have been accounted for, you will get a BODE score of 0 to 10. People who score 10 have the worst symptoms and are likely to have a shorter life expectancy.

Although COPD assessment tools are useful and can help determine life expectancy, it is important to remember that this is only a rough estimate.

Is COPD considered an incurable disease?

COPD is not an incurable disease, but a chronic disease that worsens over time. Although there is no cure for COPD, the disease can be successfully treated. managed especially if it is recognized early.

Studies have shown that the rate of decline in lung function in patients with COPD can be reduced if diagnosed early in the disease and treated promptly. In addition, lifestyle changes can slow the worsening of COPD symptoms. For example, one study found that quitting smoking after being diagnosed with COPD slowed the disease’s flare-ups. While this was the case for all stages of COPD, earlier actions had the greatest impact.

Can you live 10 or 20 years with COPD?

The exact life expectancy with COPD depends on your age, health status and symptoms. Especially if your COPD is diagnosed early, if you have mild COPD and your disease is well managed and controlled, you may live 10 or even 20 years after diagnosis. For example, one study found that people who were diagnosed with mild or GOLD stage 1 COPD did not have a shorter life expectancy than healthy people.

This is especially true if you don’t smoke: other studies have shown that life expectancy with COPD is further reduced for former and current smokers.

People with severe COPD lose an average of eight to nine years of life expectancy.

What can help you live longer with COPD?

Quitting smoking can improve your life expectancy if: You smoke and have COPD. For example, multiple studies show that smokers with GOLD stage 1 or 2 (mild to moderate) COPD lose several years of life expectancy at age 65. In addition, studies have shown that people with stage 3 or 4 (severe and very severe) COPD lose six to nine years of life expectancy due to smoking. Remarkably, this loss of life expectancy is added to the four years of life lost by everyone who smokes.

If you have never smoked, you can help yourself by making sure your symptoms are well managed and that you get regular medical checkups. For example, routine blood tests can help control inflammation and identify potential problems before they get worse.

Simple lifestyle changes, such as weight loss, eating healthy, and exercising safely whenever possible, can also help you maintain a good quality of life.

For patients with severe COPD,
treatments such as oxygen therapy, lung volume reduction surgery, and lung transplantation can also help increase life expectancy.

How do most COPD patients die?

In COPD, the condition and health of each person is individual and unique, and it is impossible to say unequivocally how patients can die. However, some studies have shown that for people with mild COPD, the cause of death is often cardiovascular disease.

In contrast, in cases of severe COPD, studies have shown that the leading causes of death include heart failure, respiratory failure, lung infection, pulmonary embolism, cardiac arrhythmia, and lung cancer.

While it’s good to stay positive and not focus on death, if your condition worsens and becomes very serious, it’s likely that your doctor or nurse will talk about palliative care and end-of-life care. What’s more, discussing your situation with your family doctor can help you make a decision and take care of your physical, emotional, social, and spiritual needs. Because palliative care is both patient and family oriented, it can help prevent and alleviate suffering.

At GAAPP, we want to empower patients because everyone deserves to live in freedom and their symptoms don’t get in the way. Learn more about our Patient Charter here.

Berry S.E., Wise R.A. 2010. Mortality in COPD: causes, risk factors and prevention. COPD 2010 October; 7(5): 375-82. DOI: 10. 3109 / 15412555.2010.510160. PMID: 20854053; PMCID: PMC7273182.

BMJ Best Practice. Chronic obstructive pulmonary disease (COPD). Diagnosis: criteria.

Chen CZ, Shih CY, Hsiue TR et al. 2020. Life expectancy (LE) and LE loss for patients with chronic obstructive pulmonary disease. Respir Med. October; 172: 106132. DOI: 10.1016 / j.rmed.2020.106132. Epub 2020 August 29th. PMID: 32905891.

Curtis Jr. 2008. Palliative care and end-of-life care for patients with severe COPD. European respiratory journal. 32:796-803; DOI: 10.1183 / 09031936.00126107

Global initiator of chronic obstructive pulmonary disease. 2018. Pocket Guide to the Diagnosis, Management and Prevention of COPD: A Guide for Health Care Professionals. Report for 2018.

Hadi Khafaji HA, Cheema A. 2019. Heart failure and chronic obstructive airway disease as combined comorbidities. Meta-analysis and review. Arch Pulmonol Respir Care 5(1): 015-022. DOI: 10.17352 / aprc.000037

Hansell A. L., Walk J.A., Soriano J.B. 2003. What causes patients with chronic obstructive pulmonary disease to die? Multiple Cause Coding Analysis. European respiratory journal. 22:809-814; DOI: 10.1183 / 09031936.03.00031403

Institute of Lung Health. 2016. BODE and COPD Index: Finding Your COPD Stage.

Shavelle R.M., Pakuldo D.R., Kush S.J. et al. 2009. Life expectancy and years of life lost due to chronic obstructive pulmonary disease: findings from the follow-up NHANES III study. International Journal of Chronic Obstructive Pulmonary Disease, 4, 137–148.

Westbo J; TORCH Research Group. 2004. TORCH Survival Study Protocol (Toward a Revolution in COPD Health). Eur Respir J. Aug; 24(2):206-10. DOI: 10.1183/09031936.04.00120603. PMID: 15332386.

Welte T, Vogelmeier C, Papi A. 2015. COPD: early diagnosis and treatment to slow disease progression. Int J Clin Pract. Mar; 69(3): 336-49.

Self-care: Self-care: Lenta.ru

In Russia and throughout the world, the death rate from chronic obstructive pulmonary disease (COPD) is steadily increasing year by year. This is also due to the fact that it is extremely insidious: it develops slowly, has no pronounced symptoms, except for a prolonged cough and shortness of breath, often attributed to age and lifestyle, and, as a rule, is difficult to diagnose. Doctors and scientists are increasingly saying that, unlike heart disease and diabetes, for ordinary people and even for the leaders of many countries, COPD is still an unknown disease, the danger of which is clearly underestimated. Who is at risk? When should you sound the alarm? How to protect yourself from an insidious disease? Why is it worth refraining from using mustard plasters, cans and other popular Soviet methods in the treatment of any lung diseases? On the eve of World COPD Day, which is celebrated every third Wednesday of November, Lenta.ru spoke with a doctor of medical sciences, a professor at the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia Zaurbek Aisanov.

Lenta.ru: According to WHO, chronic obstructive pulmonary disease ranks third in mortality among diseases, second only to stroke and coronary heart disease. What is the reason for such a high level of morbidity and mortality?

Aisanov: Indeed, COPD is one of the deadliest diseases in the world, and its incidence and mortality are growing faster than others for at least two reasons. First, the disease depends on risk factors such as smoking and environmental pollution with pathogenic particles and gases, which can affect the pulmonary system, which is their entry gate. Secondly, COPD is a diagnosis that can only be formally made in patients over 40 years of age. Naturally, as overall life expectancy increases, the percentage of people in the older age group increases. Therefore, statistics on diseases that occur mainly in the second half of life will also grow.

Russia is one of the countries with a high prevalence of COPD. What is it connected with?

This is primarily due to the fact that Russia is not the best country in terms of ecology, not the warmest and with a rather high level of industrial pollution. We also have a fairly large percentage of smokers. It is for these reasons that chronic obstructive pulmonary disease is such a common disease in our country.

You mentioned the climate. Does this also have an effect on the incidence rate?

Naturally, it does, because any respiratory infection, including hypothermia, is one of the risk factors for developing COPD. In addition, if the patient already suffers from COPD, hypothermia can cause an exacerbation and an unfavorable course of the disease.

Photo: Shutterstock

Living conditions also play a significant role in the development of this disease. For example, in Northeast or Southeast Asia, factors other than smoking are important. In India, there is a high risk of developing COPD due to the fact that large families often live in the same room and in very poor conditions. They sleep there and cook food on an open fire. The use of so-called biofuels is a powerful risk factor for COPD in developing countries. Russia, fortunately, does not belong to this category. Nevertheless, we have a certain percentage of people who live in similar conditions. For example, in the North there are peoples living in yurts; naturally, living conditions there are not the same as in Moscow or in another large city. It’s just that this phenomenon is not widespread in our country, but in Asian countries it is very common. These countries even have a special program initiated by the World Health Organization: more modern and more environmentally friendly stoves are installed in such dwellings. It is not yet known how effective this program is, but it is being carried out.

How many people die each year from this disease in Russia? Who is at high risk?

The data of the last five years in our country show that more than 20 people per 100 thousand of the population have chronic obstructive pulmonary disease as the official cause of death. I must say that these are quite high numbers, but in reality they should be even higher. The fact is that COPD is a disease that is poorly detected, and often people suffering from it are not diagnosed. We call this underdiagnosis.

Most patients with COPD are elderly and usually have a history of other pathologies. Approximately half of them developed cardiovascular diseases, the rest suffer from other comorbidities. And it turns out that we are dealing with the so-called mutual burden: COPD affects the severity of comorbidities, and comorbidities affect the severity of COPD. And the insidiousness of COPD lies in the fact that it predisposes to the development of other diseases and thus indirectly leads to an increase in mortality from other causes, which is often not reflected in COPD statistics

Zaurbek AisanovDoctor of Medical Sciences, Professor of the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia

Separate risk groups can be distinguished by professional activity. These are people working in hazardous industries, in hot shops, in steel plants, as well as those who work in low temperatures – for example, in the Far North. Prolonged work in extreme cold conditions can also provoke lung damage. The risk group includes those who live in an urban environment with high air pollution, near busy highways.

World Chronic Obstructive Pulmonary Disease (COPD) Day has been celebrated every third Wednesday in November since 2002. Has the situation somehow improved over the past decades in terms of the prevalence of the disease, the reduction in the number of patients and the awareness of people about it in our country and in the world?

At one time, at the initiative of WHO, it was to raise people’s awareness that a global initiative on COPD was adopted, which is called the Global Initiative for Chronic Obstructive Lung Disease (abbreviated as GOLD). This initiative, among other things, had two main goals: to increase public awareness of chronic obstructive pulmonary disease and to reduce the morbidity and mortality associated with it. Have these goals been achieved? I can say that in terms of awareness there is some progress, but, of course, those ambitious plans that the GOLD experts set were not fulfilled. COPD is comparable in prevalence to cardiovascular diseases, diabetes mellitus, hypertension, but for ordinary people who are not connected with medicine, it is not known to the same extent as the diseases I have listed. The low awareness of people about COPD is typical not only for Russia, but this is also the case in the rest of the world.

Photo: Shutterstock

With regard to the prevalence of COPD, prognostic curves were drawn already in the late nineties and early 2000s. Then COPD was the fifth cause of morbidity and mortality in the world. But the expert community agreed that after 2012-2015 this disease will rise to third or even second place. And we see that this unfavorable scenario is coming true. This is due, among other things, to the fact that COPD is still to some extent unknown to the leadership of most countries. And still, insufficient measures are being taken to combat it.

Smoking is perhaps one of the main factors provoking chronic obstructive pulmonary disease. What else can provoke its development?

In addition to the smoking, unfavorable ecology, working environment and poor living conditions that I have already mentioned, poor air quality in ordinary non-residential premises, such as offices, is also a risk factor. Scientists have calculated that in Europe in winter, a person spends 80 to 90 percent of his time indoors. And in Russia, the climate is even colder, and in winter a person can spend more than 9 hours indoors.0 percent of the time. WHO has even developed recommendations on indoor air quality, because it is a risk factor not only for pulmonary, but also for other diseases (primarily cardiovascular).

Do I understand correctly that a non-smoker can also get COPD?

Quite right. Of course, smoking is a major factor: COPD can develop in 30-50 percent of smokers. According to some studies, smoking is the number one cause of COPD in Europe and North America. At the same time, do you know how many smokers were among the people who died from COPD in India, where this disease is the second leading cause of death? 18 percent! In the rest of the dead, the disease was provoked by other factors, primarily living conditions.

I can also cite another large study that was conducted in the UK from 1946 to 2016 as an example. At the end of the experiment, the participants were 70 years old. The most interesting finding was that the COPD symptom of coughing up phlegm was highly dependent on whether these people smoked. Moreover, changes were observed already at a young age, when these symptoms in a smoker developed very quickly. In people without this bad habit, these symptoms were practically not observed until the age of 70. And the most curious thing is that if one of the participants in the study quit smoking, the cough with sputum immediately disappeared even in old age. It’s about the fact that it’s never too late to quit smoking.

The second thing that scientists tracked during these 70 years is the change in lung capacity depending on smoking and living conditions in childhood. Measurements were taken using a routine instrumental study called spirometry. Those who both smoked and had poor living conditions had the worst results. This data is very important, since the rate of decrease in lung volumes is, in fact, the rate of aging of the lungs.

If perhaps everyone knows about the dangers of smoking, then the safety of vapes and electronic cigarettes is still being debated. Can they provoke the development of COPD?

The use of so-called vapes is a very serious problem, the extent of which we have yet to assess in the future. These devices differ in their nicotine delivery technologies, but share some common features. First of all, in addition to nicotine, they contain a lot of components that have the ability to affect the lungs.

During 2019, there was an epidemic of lung damage in the United States, which in the world literature is referred to by different abbreviations: EVALI (“E-cigarette or Vaping product use-associated Lung Injury”), VAPI (Vaping-Associated Pulmonary Injury) or VALI (Vaping -Associated Lung Injury). This syndrome of lung damage on the x-ray pattern is very similar to what we see in patients with severe coronavirus infection. If we look at a CT scan of a COVID-19 patientwith a severe course and a person who smoked a vape, there will be a very similar picture, which means severe lung damage. This pattern was noted in young people who were fond of vaping. After that, many vape manufacturers were banned in the United States. The most common brand of electronic nicotine delivery systems at the time was JuuL, which at the time accounted for 70 percent of the US market. So, this technology was completely banned both in the US and in Russia.

Photo: Shutterstock

Vaping is a very serious problem that is very difficult to assess due to the limited experience with this phenomenon. In addition, vapes are mainly smoked by young people who have compensatory abilities of the body, but how this will affect the future is unknown.

Why did vapes become popular in general? Because the best marketers were engaged in their promotion. What do some young people want today? Use everything high-tech, seem ultramodern and trendy. And by design, these devices are similar to electronic gadgets (for example, USB sticks). Vapes have also been promoted as a way to help people quit smoking. But, as studies show, they practically do not help anyone get rid of this bad habit. Moreover, vapers often become dual smokers, meaning they smoke both vape and regular cigarettes

Zaurbek AisanovDoctor of Medical Sciences, Professor of the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia

Who suffers more from COPD in Russia – men or women? What is it connected with?

Men are more often ill. This is primarily due to the fact that there are more smokers among them. Why does everyone keep smoking? Because they do not notice the clinical manifestations of the disease (cough with sputum, shortness of breath), which develop gradually – and the patient adapts to them. He goes to the doctor only when the symptoms become severe, for example, when he can no longer calmly go up to the second floor. In addition, people usually attribute these symptoms to age-related manifestations. And it often happens that a patient comes to us for the first time, we do him a spirometry study, and his indicators are 30 percent of what should be at his age. However, he never went to the doctor.

Most lung diseases begin with a cough. How, then, to distinguish COPD from, say, chronic bronchitis or tuberculosis? What symptoms of the disease should be paid attention to?

The fact is that cough is generally one of the most common symptoms in medicine. If we are talking about COPD, then it should be alarming when it becomes chronic. The formal time limit for the presence of cough at which COPD can be suspected is considered to be at least three months during the year for two consecutive years.

In addition to coughing, COPD presents with shortness of breath on exertion. Not asthma attacks, but increasing shortness of breath, which is permanent

But in general, there is not a single symptom that would be characteristic only for COPD and did not occur with other diseases. Diagnosis of this disease consists of symptoms, the presence of risk factors in history and the results of a clinical study, primarily spirometry.

By the way, people often do not perceive a prolonged cough as a dangerous symptom and do not pay attention to it. What can its ignoring or self-treatment lead to?

In the case of COPD, this can lead to the disease being diagnosed later. The later the pathology is detected, the more neglected it is and the more difficult and ineffective the treatment can be. COPD in the last stages of development is an extremely serious disease that is difficult to treat. So far, we do not have drugs that can reverse the steady decline in lung function, when it has already gone far, when there are already irreversible changes. For example, emphysema is a pathological change in the lungs, in which small vessels, alveoli, small bronchi are affected, ventilation and gas exchange begin to suffer. In such cases, a person develops respiratory failure. And this is an irreversible process. In especially severe cases, people need oxygen therapy.

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How has the COVID-19 pandemic affected COPD morbidity and mortality?

In the early days of COVID-19, information began to spread that smokers were protected from the coronavirus. But it should be said that they get sick no less often and, moreover, get sick more severely. There is a wealth of data that shows that a severe course of coronavirus with hospitalization, the transition to mechanical ventilation and death in smokers is several times more common.

Patients with a history of COPD were more likely to die due to covid as they already had lung disease. Naturally, such patients have a much smaller physiological reserve, they get sick more severely.

How do exacerbations affect a person’s overall health and quality of life?

Many well-known scientists say that a severe exacerbation of COPD is like a myocardial infarction in coronary heart disease. This is an episode that is very life-changing for the patient, as it accelerates the decline in lung function, accelerates lung aging, and is more likely to be fatal. After a person has suffered an exacerbation, the disease worsens, the body becomes more susceptible to the next exacerbation. And to avoid it is one of the main tasks in the treatment of COPD.

Are there any self-diagnosis methods that will allow you to suspect COPD? How is COPD diagnosed in Russian hospitals today?

Self-diagnosis cannot be here. A person may be suspected of having COPD if he smokes for a long time, if he has a cough with phlegm in the morning, and if the cough is persistent, that is, it has been observed for more than three months during a year or more. But the fact is that we in a medical institution must document the diagnosis when such a patient comes. In addition to these symptoms, in order to make a diagnosis, we must confirm that the patient also has changes in lung function. To do this, we perform a spirometry test, and if during it we get a certain digital marker that shows that a person has a fixed bronchial obstruction, COPD is diagnosed. Of course, we must exclude other diagnoses – primarily asthma.

Self-diagnosis leads to self-treatment, and this cannot be done. The patient may suspect a disease and consult a doctor in time. For any severity of COPD, there is a specific therapy. Knowing what COPD is, the doctor will make the correct diagnosis and prescribe the treatment that is indicated for this particular patient.

How is COPD treated in Russia today? To what extent are modern techniques available in large cities and regions?

It should be noted that our country is far from the worst in terms of diagnostics. I once participated in an international study in which different countries were involved, and it turned out that we have one of the most affordable spirometry in the world. In terms of accessibility, we and the UK ranked first (this was about five years ago), so in terms of diagnostics, we are doing well. The only problem is that there should be awareness and alertness of doctors regarding COPD, especially among primary care physicians, that is, district doctors, general practitioners. We make a lot of educational efforts, give lectures, hold seminars so that general practitioners, local specialists know what this disease is and can effectively detect and treat COPD. We understand how hard their work is, because in addition to COPD, they have a lot of patients with other diseases.

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In terms of therapy, there is now increasing evidence that combined bronchodilatory therapy should be prescribed in the case of COPD. We are dealing with obstructive disease, which is manifested by obstruction – narrowing of the lumen of the bronchi. Our goal is to fight this as much as possible. With COPD, the role of irreversible processes is already very large, therefore it is necessary to improve the human lung function as much as possible with the help of bronchodilatory therapy. And the second goal is anti-inflammatory therapy, because COPD is an inflammatory disease, and in addition to bronchodilator drugs with different mechanisms of action, an anti-inflammatory drug should also be prescribed, the main of which is an inhaled glucocorticosteroid. Today, this combination of drugs is considered the most effective choice for the treatment of COPD. It is important that this should not be an occasional use of drugs, but regular daily therapy. One inhaler contains three substances, and with regular use in humans, pulmonary function and its important component, bronchial conduction, are significantly improved and stably maintained at the highest possible level. The patient feels better, he has less shortness of breath, cough, quality of life improves.

Is it possible to stop the progression of the disease? What can you do to protect yourself from COPD?

It all depends on when the person was diagnosed. The later this happened, the less likely it is that the disease can be paused. But if the diagnosis is made early – before the age of 40, it is possible to prescribe therapy earlier, which, of course, will be more effective.

The most important recommendation in the fight against COPD is to stop smoking, because no other therapy brings such success in treatment as quitting cigarettes. Only then does the decline in lung function stop. We can slow this process down with drugs, but only a combination of smoking cessation and effective therapy can stop it

Zaurbek AisanovDoctor of Medical Sciences, Professor of the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia

Our field of medicine – pulmonology – differs from other areas in that the role of the patient in the treatment process is especially great here. The patient must first of all get rid of the main risk factor – smoking, which is not at all easy. And the process of treatment itself is therapy using an inhaler, a device in which the patient must learn a certain breathing maneuver, which is also not at all easy. The doctor is obliged to teach the patient this maneuver so that he receives a full dose of the drug. Moreover, at each visit, the doctor must check whether the patient uses the inhaler correctly, and if there are any errors, he must correct them.

There is information on the Internet that adding vegetables, grains, nuts, and foods rich in omega-3 fatty acids to your diet can help reduce the risk of COPD and other lung diseases due to the presence of substances in these foods that have anti-inflammatory properties. How true is this advice?

This is absolutely true. One of the factors in the development of COPD is poor nutrition, poor living conditions. The combination of foods you mentioned is exactly the kind of diet that can reduce your chances of developing COPD. There is a lot of scientific evidence that malnutrition, an unbalanced diet increases the likelihood of developing and the severity of COPD. Therefore, in the world COPD affects the poorest and least educated population. In the West, there is even a popular meme that COPD is a disease of the poor, and cardiovascular disease is a disease of the rich.

What other foods might be helpful? And vice versa – what can harm?

COPD is a common disease, so the population of patients is very different: there are people with increased and, conversely, underweight. Accordingly, different dietary recommendations are required for each patient and should be given by the attending physician. Nevertheless, the general principles of healthy eating should be observed and are well known. It is necessary to avoid fast food, monotonous and poor nutrition.

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When it comes to nutrition as a preventive measure, a nutritious diet with enough vegetables and fruits, nuts, vegetable oils, seafood leads to the fact that the likelihood of COPD is reduced.

What pulmonary pathologies, besides COPD, are among the most common in Russia?

Top 3 are COPD, bronchial asthma and pneumonia. COPD and asthma are chronic diseases, while pneumonia is acute. They cannot be compared, since a person can get pneumonia several times a year, while COPD and asthma are ill throughout life.

Statistically, asthma is more common, but this is only because many patients with COPD are not diagnosed due to the fact that people do not see a doctor for a long time. Therefore, many patients with COPD live without a diagnosis. They are already sick, but we do not know about them.

If the lungs are not working at full capacity due to COPD, having COVID-19, or having part of the lung removed, what happens to the body?

If a person’s lungs are affected, it means that the supply of oxygen suffers. Naturally, the lack of oxygen causes respiratory failure. And those inflammatory markers that are produced in COPD have an adverse effect on other body systems, and if there are concomitant diseases, this causes their exacerbation.

Poor oxygen saturation in the body can lead to death in the worst case. Have you seen, probably, people who carry oxygen devices with them? Without them, they cannot exist. In such patients, any respiratory infection, even the flu, can be fatal. Pneumonia with which they fall ill, or any other disease, is especially difficult.

How often should I have a preventive chest x-ray?

In the USSR it was a good practice to undergo fluorography once a year, and in some cases, if the profession required frequent medical examinations, twice a year. This is a completely reasonable mode, since the load that a person experiences during fluorography is minimal and does not pose a threat to the body. This should be done especially regularly for the elderly and patients with COPD, since in this disease, due to the smoking factor, the risk of developing lung cancer sharply increases. Lung cancer, of course, can develop in a non-smoker, but in a smoker and in a COPD patient, this risk increases many times over.

How do contrast showers and Russian baths affect lung health?

Hardening and contrast showers are useful for any person. If you harden and your body tolerates it, then you have a lower risk of developing respiratory viral infections. When it comes to saunas, a balance is needed because the temperatures are very high and can adversely affect the lung system. It is difficult to recommend these measures to everyone, everything is very individual.

Can lung diseases such as bronchitis and pneumonia be treated with folk remedies such as mustard plasters or jars? Are there any hidden dangers of these methods?

In Soviet times, when I was studying, there was such a good term – “distraction therapy”. This therapy may affect symptoms, but if a person has pneumonia, it cannot be cured by these methods.

Antibacterial drugs are needed to treat pneumonia. In acute bronchitis, drugs such as cups or mustard plasters can somehow affect subjective symptoms, but in the case of chronic diseases, which include COPD, this will not help in any way. Such exposure may reduce the severity of subjective symptoms, but not cure the disease itself

Zaurbek AisanovDoctor of Medical Sciences, Professor of the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia

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Russians have two common beliefs: the first is that frequent chlorinated pools are bad for the lungs, and the second is that visiting salt caves, on the contrary, is extremely beneficial for their health. Is this really true, or is it just a myth?

The concentration of chlorine on the surface of the water in the pool is really high, and in certain cases it can be very damaging to the lungs. This is especially dangerous for professional swimmers. Their mouth breathing technique directly above the water surface, where the concentration of chlorine is highest, significantly increases the risk of developing asthma. Due to intense exercise requiring high levels of pulmonary ventilation, they drive through their lungs a very large volume of air containing a large amount of chlorine, which is undoubtedly a pathogenic factor. Professional swimmers get asthma more often – it’s a fact.

The same can be said about skiers. They sometimes run 30-50 kilometers at a temperature of minus 20-30 degrees – imagine what volumes of cold dry air they pump through themselves, and even with such serious physical exertion. Cold air affects the epithelium of the bronchi, it is also a risk factor for asthma. Therefore, I would not say that big sport is what makes a person healthy.

Salt caves are very popular, but there is no scientific evidence that they have any positive effect on the respiratory system. But it cannot be denied that when a person relaxes while visiting the salt caves, this brings certain health benefits

Zaurbek AisanovDoctor of Medical Sciences, Professor of the Department of Pulmonology of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia

Salt itself has an antiseptic effect – perhaps this can somehow have a positive effect on the body. But, unfortunately, I have not come across reputable scientific studies that would show that this leads to sustainable effects in the long term.

How do you keep your lungs healthy?

In my life, I adhere to very simple and well-known recommendations. Do not smoke, try to be outdoors more often, if possible, do not use the elevator in order to walk more. When you are not actively involved in sports, you probably need to look for ways that would compensate for this to some extent: do not get on the bus when you have the opportunity to walk, and not waddling, but at a normal brisk pace.