Living with COPD

This story first appeared in Healthy You - November 2025, The Gazette’s quarterly health publication.

For a potentially serious, life-altering condition, avoiding chronic obstructive pulmonary disease might seem simple enough: don’t smoke.

“The major risk factor for COPD is smoking,” said Dr. Hamad Azam, pulmonary critical care at UnityPoint Clinic.

“Smoking is the most common exposure that leads to COPD in developed countries,” added Dr. Syed Shah, Mercy Medical Center pulmonologist.

But people still smoke, albeit fewer of them — about 11 percent of American adults in 2022, which is about a third of the rate in the 1980s, according to Gallup polls. That means COPD is still a leading cause of morbidity and mortality, resulting in 151,000 hospitalizations and 142,000 deaths a year, according to the American Lung Association. About 14 percent of COPD cases happen through occupational exposures to vapors, gases, dusts and fumes.

COPD emerged as an umbrella term for several respiratory diseases, including emphysema and chronic bronchitis, caused by lung damage. Because its effects are irreversible, early diagnosis and treatment are essential to supporting a patient living with its effects.

“Early diagnosis is critical,” said Shah. “If you have an early diagnosis, we can work up front on improving the patient’s quality of life.”

Perhaps the most typical early COPD symptom is shortness of breath, especially during or after physical activities. Patients may also experience wheezing, a tightness in the chest and a chronic cough that may bring up a lot of mucus.

“The symptoms will overlap with many other conditions like asthma,” Azam said. “Even some patients with underlying heart disease can have the same symptoms.”

Early symptoms will lead to a pulmonary function test to determine the extent of lung damage, often supplemented with imagery via X-ray or CT scan.

“What is the severity?” said Azam. “That is why we want to diagnose early, so we don’t get to the next stage. The symptoms become worse.”

Because it’s so closely related to smoking, many patients who see their doctor regularly have already had “The Talk” with their general practitioner.

“Preventing the disease from developing is more of a primary intervention,” said Azam. “The most effective way is smoking cessation.”

That can mean nicotine patches, gums and lozenges, as well as some pharmaceutical medications.

“There’s behavioral therapy as well,” added Azam.

When early intervention doesn’t happen or doesn’t produce the desired result, early treatments include inhalers, nebulizers or bronchodilators to deliver medications that relax muscles around the airway, helping to relieve coughing and make breathing easier.

“The therapy that we typically start treatment with is inhalers,” said Shah. “We try to make sure the inhalers are maintenance inhalers, not a short-term inhaler for rescue purposes. (Medication from) a maintenance inhaler can stay in the body for 24 hours.”

“The goal of treatment is to address the symptoms and to arrest the disease progression,” said Azam. “Pulmonary rehabilitation is also a very important topic,” addressed through exercise and diet.

Surgery to remove lung damage may happen in advanced COPD cases.

“With some subset of the patients with emphysema, we offer to remove that part of the lung,” Azam said. “More recently, we have valve replacement, we have some surgical options with some success.”

  Buy Photo

“It’s mostly reserved for patients who are still symptomatic despite intervention,” Shah said. “Surgery is not an option for everyone.”

That leaves COPD patients learning to adjust and live with reduced lung function.

“The definition of COPD is permanent restriction of airflow,” said Shah. “The treatment can bring some improvement. The damage can significantly slow down in some cases.”

“If the lung function goes down, it is very hard to bring the same lung function back,” said Azam. “The number one priority is preventive, to keep it from worsening.”

That often includes changes in diet and patient counseling to help them adjust.

“Once you treat everything, even though the lung function doesn’t return, the quality of life does improve,” Azam said.

Counseling helps patients deal with COPD’s ongoing effects. Those may include seasonal flareups due to flu, colds and days with heightened air pollution.

“If we can prevent exacerbations, we are going to help prevent mortality as well,” said Shah. “Get age-appropriate vaccinations, including the flu shot. We also recommend regularly getting the pneumonia shot and being extra cautious around people who are sick.”

“When I tell patients the lung function is unlikely to come back, they don’ like to hear that,” Shah said. “It’s a patient-centered outcome. We want them to be able to exercise more in order to function much better. The numbers are not important for the patient. For you, what’s important is the quality of life.”