Seniors with COPD
Last Updated: April 4, 2013
Although COPD is the fourth leading cause of death in the United
States, many Americans are not familiar with this acronym. Standing
for "Chronic Obstructive Pulmonary Disease," COPD is characterized
by chronic airflow limitation in the lungs. Most often a
combination of two diseases-chronic bronchitis and emphysema-this
umbrella term also includes diseases such as chronic asthma and
Perhaps the reason COPD is not a household term is that it is
under-diagnosed and misdiagnosed. While more than 12 million
American carry the diagnosis of COPD, another 12 million likely
have the disease and aren't aware of it, according to the Centers
for Disease Control. "This is a disease that comes on slowly. A
person is often short of breath and she thinks, 'I'm out of
shape,'" says Gretchen Lawrence, a respiratory therapist and
program associate for the National Lung Health Education Program
(NLHEP). "People think shortness of breath is normal as you get
older, but it is not. People ignore [the symptoms], it's
underappreciated, and doctors and other health care professionals
often do not ask the right questions."
COPD causes progressive damage to a person's lungs. The airways
of the lungs become obstructed, making it hard to breathe. "My
medical director at the hospital described it this way: Dying of
COPD is dying of shortness of breath one breath at a time. The rest
of the body wears out, too," says Lawrence. In other words, COPD
can lead to other comorbid conditions such as heart disease.
Symptoms and Causes
Often seniors with COPD will blame their symptoms on age or the
side effects of smoking. Most often, people are not diagnosed with
COPD until they have lost 50 percent of their lung function. "We
were blessed with having two lungs and also an incredible
compensation mechanism in our bodies," says Lawrence. "A person can
lose up to 50 percent or less of lung function for any reason and
compensate (the symptoms will seem to go away)." For example, if a
loved one becomes winded walking up a hill, he will stop or slow
down; perhaps he'll never walk up that hill again, avoiding the
onset of a COPD symptom.
If your loved one suffers from any of the following symptoms, a
doctor's visit may be warranted:
- Shortness of breath: At first, a person may get tired upon
strenuous exertion, say while walking up a long flight of stairs.
Later, a simple task such as a trip to the mailbox causes
- Inability to physically keep up with people that are the same
- Inability to keep up with the tasks of daily living, such as
bathing and dressing.
- Chronic cough: The patient may begin coughing once in a while,
and progress to coughing all the time.
- Sputum production: Sputum or phlegm may be raised during
- Wheezing and chest tightness: These are common symptoms of more
- Loss of appetite and weight loss: Eating is difficult when a
person is short of breath.
- Fatigue: This can be caused by a person fighting to breathe, or
by a person's body receiving less oxygen due to COPD.
To understand COPD symptoms, it is helpful to picture how both
emphysema and chronic bronchitis affect the lungs. Leading to each
lung is a major airway (bronchus). This airway divides into 22
tubes inside each lung; these tubes are themselves divided into
more than one hundred thousand tiny tubes (bronchioles) that end in
clusters of tiny air sacs (alveoli) resembling bunches of grapes.
These air sacs have membranes filled with tiny blood vessels. When
a person breathes in, oxygen attaches to the red blood cells on the
vessels and is delivered to the rest of the body; carbon dioxide
comes back via these same cells and is expelled when the person
breathe outs. "When you have emphysema, the airways that lead to
these air sacs become kind of limp and lose their elastic recoil.
When you breathe out, it is like air getting trapped in an old
balloon that has been blown up a million times. Air gets in but
carbon dioxide can't get out. When the air sacs trap carbon
dioxide, that gives the feeling of shortness of breath," says
Lawrence. Chronic bronchitis is a disease of the lungs' airways.
The airways become hypersensitive, causing more mucus to be
produced. This mucus plugs the airways, holding air in and making
it difficult to expel air.
This damage to the lungs is usually caused by the number one
risk factor for COPD: cigarette smoking. Only about 10 to 20
percent of COPD sufferers are non-smokers, says Dr. Dennis E.
Doherty, FCCP, a professor of medicine and chief of the pulmonary,
critical care, and sleep medicine division at the University of
Kentucky's College of Medicine, and chairman of the NLHEP. Other
risk factors include:
- Exposure to outdoor air pollution.
- Exposure to indoor air pollution, such as coal and biomass
fuels such as wood, grass, or dung, which are used for cooking and
- Smoking a pipe or cigars.
- Exposure to secondhand smoke.
- Exposure to occupational dusts and chemicals.
- Having the genetic disorder Alpha 1 Antitrypsin (AAt)
- A history of frequent severe respiratory infections during
- Being a woman: More women than men died of COPD in the year
A simple breathing test called spirometry is the most common
diagnostic test for COPD. The NLHEP recommends that anyone older
than 44 years of age who is a current or was a former smoker should
have a spirometry test. Also, anyone of any age with a chronic
cough, excess mucus production, shortness of breath on routine
activity, or wheezing should have spirometry testing. The test uses
a device called a spirometer, which consists of a mouth piece and
breathing tube connected to a computer. The patient takes a deep
breath and then blows out air as fast and hard as he can for at
least six seconds. The computer reading includes the following set
- FEV1: the forced expiratory volume of air blown out in one
- FEV6: the forced expiratory volume of air blown out in six
- FEV1/FEV6: the ratio of the two preceding numbers, expressed in
The FEV1 and FEV6 results are compared to data compiled on
people the same age, height, weight, race, and gender as the
patient, and expressed as percent of predicted for that patient. A
FEV1/FEV6 ratio value of less than 70 percent indicates airflow
obstruction and usually a COPD diagnosis. Other tests may be
administered to determine the extent of COPD. These include
arterial blood gas analysis, pulse oximetry, sputum examination, CT
scans, and chest x-rays. According to the Global Initiative for
Chronic Obstructive Lung Disease (GOLD), the stages of COPD
Stage I, or Mild: Few symptoms and mild airflow limitation, with
a FEV1/FE6 ratio at less than 70 percent but the FEV1 at greater
than 80 percent predicted.
Stage II, or Moderate: This is the stage where patients are
typically compelled to see a doctor, as they have developed
symptoms such as shortness of breath upon exertion. The FEV1 is
between 50 and 80 percent of predicted.
Stage III, or Severe: Symptoms at this stage include worsening
airflow limitation, increased shortness of breath, reduced exercise
capacity, fatigue, and repeated exacerbations. The FEV1 is between
30 and 50 percent of predicted.
Stage IV, or Very Severe: Chronic respiratory failure can occur
at this stage and COPD exacerbations can be life threatening. The
FEV1 is less than 30 percent of predicted.
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Treatment and Practical Management
"There is a stigma that [COPD] is irreversible and it's
self-inflicted," says Doherty. "It's a partially reversible
disease, meaning that with medicines you can improve symptoms and
often lung function. You can [also] slow the progression in some
cases." If a patient smokes, stopping smoking slows the
progression. According to Doherty, those who stop smoking don't
regain lost lung function, but they slow that loss to the normal
rate observed in non-smokers, as well as decrease symptoms and live
longer. To help a loved one quit smoking, contact the American Lung
Association, log onto www.SmokeFree.gov, or call
Although there is no cure for seniors with COPD, treatment and
management of the disease should have the following goals,
according to GOLD:
- Relieve symptoms
- Prevent disease progression
- Improve exercise tolerance
- Improve health status
- Prevent and treat complications
- Prevent and treat exacerbations, which are life-threatening
flare-ups that are usually caused by lung infections and airway
- Reduce mortality
Often a primary care doctor will refer seniors with COPD to a
pulmonologist; they may also work with a respiratory therapist.
COPD treatment is dependent on the stage of disease and the
symptoms that are present, and can involve the following:
Flu shots:People with COPD should receive a flu shot every year.
A bout of the
flu can cause serious (perhaps deadly) exacerbations for
Pneumococcal vaccine:This vaccine should be administered every
five years for patients 65 and older.
Pneumonia can cause serious (perhaps deadly) exacerbations for
Protein therapy:For people with AAt deficiency, AAt protein
infusions may slow lung damage.
Antibiotics:These are used sparingly for treating COPD
Bronchodilators:These work by relaxing the muscles around the
airways, helping to open the airways and make breathing easier.
Short-acting bronchodilators are usually initially prescribed
during Stage I, while long-acting bronchodilators are added to
treatment during Stage II and beyond.
Inhaled glucocorticosteroids:These steroids can reduce
inflammation in the airways. They are typically prescribed for
Stage III patients who are on two different bronchodilators but
remain symptomatic and have frequent exacerbations.
Pulmonary rehabilitation:Usually patients in Stage II and higher
attend pulmonary rehabilitation. This is a whole package of
therapies that are designed to minimize the impact of COPD, making
patients as fit and as healthy as they can be, despite their
limitations, according to Lawrence. Components include exercise,
disease management training, nutrition advice, and counseling to
help patients physically and emotionally participate in daily
Supplemental oxygen:This prescribed treatment is used at any
stage of COPD, but typically not until Stage IV, when a patient has
low oxygen levels in her blood. Depending on when the oxygen in the
blood is low, some patients use oxygen only while exercising; some
only while sleeping; while most use supplemental oxygen a minimum
of 15 hours a day or continuously.
Surgery:A loved one who suffers from Stage IV COPD may benefit
from either lung transplant surgery or lung-volume reduction
surgery (LVRS). Only a handful of patients will benefit from either
surgery, and the type of surgery depends on the patient, the
expertise of the care center, and the distribution of the
emphysema, says Doherty. An LVRS basically trims the areas of the
lungs that aren't functional. With lung transplant surgery, COPD
patients usually only receive one new lung.
For seniors with COPD, self-care is important. Preventive habits
include: good hygiene such as frequent hand washing, getting
scheduled flu and pneumococcal vaccines, staying out of crowds
during winter, good nutrition, and regular exercise. Support groups
such as the American Lung Association's Better Breathers Clubs are
also helpful. It's vital that patients still lead an active social
life. "It's very important psychologically not to take the
diagnosis and say I have to stay home in my easy chair and not do
anything anymore," says Lawrence. "Patients [need] to get involved
and maintain a healthy and normal lifestyle, doing the things that
are important to them."