CAUSES AND SYMPTOMS OF EMPHYSEMA AND COPD

80-90% of COPD (including emphysema) is caused by SMOKING . Other factors include exposure to dust, for example coal miners, environmental pollution (recent surveys suggest that living by a motorway may retard lung development in children), and those developing the disease before mid-40s with a genetic factor(known as Alpha-1 antitrypsin but don't worry about this it only affects 2% of COPD patients). However, for patients with this genetic factor it a very real problem. It generally affects people under 40. If you are in this situation please contact  www.alpha-1.org.uk 

Other general risk factors for COPD may be low birth weight, frequent childhood infections, age, damp housing and a diet deficient in fish, fruit and antioxidants. John says he also met someone on holiday this May (2006) suffering from asbestosis, following exposure to asbestos as a teenager. You might be asked by your consultant if you have been exposed to this substance. People who have and are experiencing breathlessness may find this site useful.

On this web site we are primarily concerned with COPD caused by smoking, with or without risk factors. Everybody's lung functioning declines with increasing age but smokers with COPDdecline at a much faster rate and so it is important that COPD is diagnosed at an early stage. Unfortunately, symptoms only appear when the disease is well advanced and then it is often too late to do anything but slow down the rate of lung decline. There is no cure for this disease but a lot can be done to improve life quality and increase your life expectancy.

How do I know if I've got it?

You may not if you have no symptoms. However there is a simple test using what is  known as a a SPIROMETER - John is shown blowing into one in the photograph shown on the Diagnosius page - next. Most surgeries have one but unfortunately not all, so you may have to find a surgery that has one that not only knows how to use it, but also how to correctly interpret the results. Sadly many make errors and I have even had to correct my own surgery (David)

When you blow into the tube, it measures the amount of air you can blow out in one second (this is known as your FEV1 - forced expiratory (meaning blowing out) volume (of air) in 1 second). The GP then compares the result with the one that you are supposed to have at your age and he can work out if you may, or may not have COPD. Your GP or Nurse will tell you the results, probably as a percentage. At that moment John's was about 20 % meaning 20% of what it should be for his age, meaning there was severe damage to his lungs.

If your results are abnormal then your GP should refer to your local hospital with a respiratory unit for further tests and to visit a consultant, and rule out other diseases such as asthma. Some GPs think that they can manage COPD patients in their own practice. This is possible if the disease is stable but your GP must really understand the disease to know about all the most suitable drugs. One person John knew was given nothing and became more and more breathless.Thankfully the situation is now improving because COPD is recognised as a most important disease.

Now we recommend that ALL SMOKERS over the age of 35 or 40 ask for a spirometer test, especially if they have bronchitis in the winter months or constant colds or feel breathless and tired. John didn't and as a result was diagnosed only when it had become a severe disease.

I haven't asked for or been offered a test and I'm over 50 and I smoke. what are the symptoms to look out for?

Right, well these symptoms come on slowly so you might not notice them at first especially if you are overweight or unfit and then you will probably blame, say breathlessness or one of those. And of course you may be right! However, the following are all common symptoms

• Breathlessness especially on exertion
• Cough with or without phlegm
• Wheezing
• Tight chest
• Feeling run-down and constantly tired

The most important of all of these is breathlessness. You might be saying "I just can't get enough air in". You might be breathless while dressing in the morning, carrying shopping, or even bending forward to pick something up. Ask yourself " Can I talk to my friend while walking swiftly down the street? or do I take the car when I used to walk?"

OFTEN THE REASON COPD/EMPHYSEMA IS NOT DIAGNOSED EARLIER IS THAT PEOPLE DISMISS BREATHLESS ON WALKING UP STAIRS OR RUNNING SHORT DISTANCES AS "BEING UNFIT". IF YOU SMOKE, DON'T MAKE THAT MISTAKE.

HOWEVER BREATHLESSNESS ON ITS OWN MIGHT ALSO BE BROUGHT ON BY AN ASTHMA ATTACK OR BE A SIGN OF A HEART PROBLEM OR JUST BECAUSE YOU ARE OVERWEIGHT OR TERRIBLY UNFIT. YOU MUST VISIT YOUR GP TO RULE OUT THESE OR OTHER DISEASES.

You could add swollen ankles and losing weight to these symptoms, but if you have these you must see your GP anyway.

A cough with phlegm could either precede or appear at the same time as the onset of breathlessness - this happens in about 75% of C OPD patients . Sometimes people may call this a "smoker's cough".

IF YOU ARE COUGHING UP BLOOD (AND THAT MIGHT BE BROWN NOT RED) YOU SHOULD CONSULT YOUR GP IMMEDIATELY OR GO TO YOUR NEAREST ACCIDENT & EMERGENCY HOSPITAL. This may or may not be related to COPD but it is an EMERGENCY. In any case an X-ray, breathing, and blood test will sort things out.

Wheezing may happen when you walk into the wind or go out in the cold weather but not necessarily at rest or in sleep.

How do I know if it's ASTHMA and not COPD?

You probably don't, unless you've been diagnosed early on in your life. Unfortunately I've known a few older people who smoked and yet their GPs have diagnosed asthma. As a consequence, they did not receive the correct medication and died earlier than they should have done. Also after many, many years of chronic asthma, this can develop into COPD.

What is the difference?

Well basically with asthma you may or may not be a smoker. Your breathing problem will vary from day to day, even hour to hour but with COPD there is very little variation. You may have had it since childhood or have a family history of asthma. BUT IF you are over 40 and smoke and told that you have asthma please ask for a spirometer test.

If you are worried and smoke, try answering the Q uestionnaire   page before or after reading DIAGNOSIS

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