Im a Respiratory Therapist who’s been in the field a long time, but I was a quite taken aback when my local Pulmonologist blurred out these sobering words… “Your COPD”, while assessing me on the ward last week. Specifically she said, “we need to find a way to better control your obstructive lung disease” so we can maybe prevent some of these hospitalizations.
COPD?, since when did I switch from having asthma to COPD? When does one cross that arbitrary point in time where their asthma changes into something else? Ive always been labeled an asthmatic, so why am I now being labeled a COPDer? Was it just a spur of the moment generalization she was making, or is this the new term she’s gonna be using to classify my disease from now on?
When we hear the words “Chronic Obstructive Pulmonary Disease” or the acronym COPD, we often think of a condition that’s a consequence of cigarette smoking. But the term “COPD” is really just a medical umbrella term that refers to all obstructive pulmonary diseases including asthma, chronic bronchitis and emphysema. As far as what actually causes the COPD to occur, is a totally separate issue. In the strictest terms though, if you were never exposed to a lot cigarette smoke(per the GOLD definitions),then chances are you wouldn’t have COPD as we tend to think of it. Likewise, you may have never smoked, but were born missing a protective enzyme called Alpha 1 antitrysin, which could put you at risk for liver problems and a severe form of COPD at a very early age. So even though I have chronic obstructive pulmonary disease, it’s not the cigarette smoke induced variety, which is the worse kind to have since the decline in lung function is much more dramatic.
As far as my journey from asthmatic to COPDer, the transition probably occurred decades ago at the point where my asthma, for whatever reason, decided to no longer respond to therapy. Frequent exacerbations and on- going inflammation probably led to structural changes in my airways, making them stiff, narrow and less reactive. Essentially, my reversible airways disease became less reversible. As bad as all this might sound , Im actually better off than most. While my lung mechanics are pretty crappy, my ability to oxygenate is still very good. My alveoli are still doing a great job of exchanging gases. My O2 saturations are near normal when Im not actively flaring. I also have no signs of Emphysema.
I guess this blog post is more about semantics than anything else, it’s just that some medical words seem to sting a bit more than others. I know what COPD is, and I obviously know that I have it, but having it pointed out to me as a matter of fact kinda caught me off guard.
The line between asthma and COPD can be somewhat blurry, so for those of you who are trying to find out their own status, here are some considerations, as proposed by the COPDGOLD.org See how many apply to you.
As you can see, there can also be some overlap between the conditions as well, known as “Asthma COPD Overlap Syndrome” or (ACOS), which has opened a whole new field of research. ( Btw, my count for this checklist was 3 and 3, so I guess I fall into the ACOS category.)
The whole asthma vs COPD thing can be very confusing, even to medical people. Many patients are diagnosed with one disease when they actually have the other, or both. Regardless of what name you want to give it, the treatment for most of these obstructive lungs conditions remains pretty much the same.
Here’s an excellent article in RT Magazine with additional information on the subject .