COPD: Symptoms, Causes, Treatments, and Natural Approaches

Many live with undiagnosed COPD, as over 50 percent of those with poor lung function are unaware they have it.

Chronic obstructive pulmonary disorder (COPD) often goes undetected in its early stages. Illustration by The Epoch Times, Shutterstock

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease affecting at least 16 million adults in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), COPD was historically thought of as a man’s disease, but trends have changed over the past decades, with more than half of patients diagnosed being women. Many live with undiagnosed COPD, as over 50 percent of those with poor lung function are unaware they have it. It is a major source of disability and the fourth leading cause of death among Americans.

Part of the challenge of diagnosing COPD is that it is often misdiagnosed until the disease is further advanced. Although COPD is incurable, treatment can slow progression and improve quality of life.

What Are the Types of COPD?

Having COPD means you have one or more progressive lung conditions. The two most common conditions under this umbrella are bronchitis and emphysema. Some argue that severe asthma should be classified as COPD, depending on its symptoms and severity. The conditions are characterized as follows:

• Chronic bronchitis: The bronchi, the lungs’ main airways, become inflamed, resulting in more mucus in the lungs. This may cause breathing problems, infection, and chronic cough for some people.
• Pulmonary emphysema: The lungs have nearly 500 million alveoli, tiny sacs at the ends of the bronchioles (smaller tubes branching from the bronchi) that transfer oxygen to the bloodstream when you breathe. This chronic lung condition results in the alveoli being destroyed, narrowed, collapsed, stretched, or too inflated. This can lead to irreversible impairment in respiratory functions.
• Asthma: Chronic asthma can present with recurrent breathing problems in which the lining of the lungs’ airways becomes swollen, the muscles surrounding the airways become tighter, and/or mucus plugs due to the overproduction of mucus.

What Are the Symptoms and Early Signs of COPD?

COPD may not present with symptoms in its earlier stages, making it difficult to detect. As the condition worsens, symptoms begin to develop.

As COPD progresses, the following symptoms are common:

• An ongoing cough that often produces a lot of mucus.
• Shortness of breath, especially with physical activity. Breathing may also feel like more effort.
• Wheezing, resulting in a squeaking or whistling sound while breathing.
• Tightness or heaviness in the chest.
• Recurrent respiratory infections.
• Weight loss (later stages).
• Swollen feet, ankles, or legs.

It is also possible for symptoms to get worse suddenly if the individual is experiencing a flare-up. Symptoms of a flare-up include:

• Sore throat.
• Cold or flu-like symptoms.
• Fatigue.
• A change in mucus color (which may be yellow, green, or brown).
• Thicker or stickier mucus.

Because a wide range of medical conditions can cause many of these symptoms, it is important to consult a doctor if you begin to experience symptoms to rule out other causes.

What Causes COPD?

The leading cause of COPD is tobacco smoking. To function appropriately, the lungs need elasticity in the bronchial tubes and alveoli to allow air to go in and out of the body. Smoking damages the lungs, reducing their elasticity and causing inflammation. Similarly, exposure to secondhand smoke, air pollution, and dust or fumes may also exacerbate inflammation in the lining of the lungs and contribute to the development of COPD.

About 1 percent of people with COPD have a genetic disorder called alpha-1-antitrypsin deficiency. Though rare and not considered a primary cause of COPD, about 100,000 people in the United States are born with it. Alpha-1-antitrypsin deficiency affects the liver’s ability to make a protein known as alpha-1-antitrypsin (AAt). AAt is a protein that, when functioning normally, is secreted into the bloodstream to help protect the lungs. Some people with COPD caused by AAt deficiency can receive weekly infusions to replace the missing AAt protein.

Furthermore, 1 in 6 people with COPD don’t smoke, according to the National Institutes of Health. This appears to coincide with sex, as one study showed that 70 percent of nonsmokers with COPD were women. Researchers theorize this is mainly due to women being more susceptible to secondhand smoke and proximity to biomass fuel sources used for cooking or heating.

Chronic bronchitis and emphysema are two of the main conditions belonging to COPD. Illustration by The Epoch Times, Shutterstock

What Are the Stages of COPD?

There are four stages of COPD that can be classified based on lung capacity. These stages include:

• Stage 1 (Early): Considered mild, this stage may not present any noticeable symptoms. This stage is diagnosed if force expiratory volume in one second (FEV1) is between 80 percent and 100 percent of what is predicted. 
• Stage 2 (Moderate): FEV1 drops between 50 percent to 79 percent of the predicted value. During this stage, people often recognize that something is wrong due to the symptoms they experience. 
• Stage 3 (Severe): This stage is diagnosed when FEV1 drops between 30 percent and 50 percent of the predicted value. In this stage, flare-ups may be frequent, and symptoms are disruptive.
• Stage 4 (Very Severe): FEV1 drops below 30 percent of normal value. This stage can be fatal.

Who Is at Risk of COPD?

There are both unmodifiable and modifiable risk factors involved in whether you develop COPD. The following factors may put you more at risk:

• Smoking.
• Sex: Women who smoke are 50 percent more likely to develop COPD than their male counterparts.
• Age: COPD is more common among people aged 40 or older.
• Childhood history of respiratory infection.
• Excess exposure to smoke, either secondhand or via coal or wood.
• Air pollution exposure.
• Asthma (especially severe).
• Tuberculosis: People who have had tuberculosis are thrice as likely to develop COPD.
• Underdeveloped lungs.
• Alpha-1-antitrypsin deficiency.
• Poor ventilation in the home.

How Is COPD Diagnosed?

COPD may be diagnosed via the following tests after a medical history and physical exam:

• Spirometry: This is the main test to diagnose COPD; it can detect it before symptoms present. A lung function test, spirometry measures how much air you can blow out and the speed of the air exiting your lungs. During this test, while connected to a small machine, you will take a deep breath and exhale as hard as possible. As you do, the device measures the amount of air exhaled.
• Alpha-1 antitrypsin enzyme blood test: The World Health Organization (WHO) recommends testing for genetic deficiency of this enzyme for all COPD patients.
• Peak expiratory flow (PEF) test: This test measures how fast you can blow out air.
• Fractional exhaled nitric oxide (FeNO) test: This test measures how much nitric oxide is in your breath. Higher nitric oxide levels may point toward lung inflammation, making breathing more difficult and potentially indicating signs of COPD. To conduct this test, you will breathe into a tube at a steady rate.
• Arterial blood gas test: This test measures the amount of oxygen and carbon dioxide in the blood.
• Computed tomography (CT) scan: CT scans of the chest may be taken to help rule out other causes of symptoms associated with COPD.
• Chest X-ray: This may be completed to examine structures around the chest and can also rule out other conditions that may be causing symptoms, like pneumonia or tuberculosis.

If a diagnosis of COPD is confirmed, your doctors will provide you with a treatment plan and guidance for optimizing health outcomes.

What Are the Complications of COPD?

COPD can result in several complications. Some of the most common acute complications include:

• Inflammation: People with COPD can have systemic inflammation, especially during flare-ups. This can be measured through blood markers like cytokines or leukocytes.
• Lung cancer: COPD increases one’s chances of developing lung cancer.
• Impaired functional movement: COPD can affect how the body performs basic physiological functions. In addition, if systemic inflammation affects the cardiac system, this may affect a person’s ability to complete aerobic movement and exercise. Individuals may notice this in their day-to-day lives, like feeling out of breath with less exertion or feeling out of breath sooner when they exert themselves aerobically.
• High blood pressure in lung arteries: COPD may lead to pulmonary hypertension, leading to strain on the heart. This may present as swollen feet and legs.
• Muscle weakness: Skeletal muscle weakness can be a complication of COPD due to loss of fat-free mass. Muscle wasting and weakness are possible if an individual cannot meet nutritional needs.
• Cardiovascular disease: As mentioned above, systemic inflammation can affect the heart, increasing one’s risk of developing heart disease. Airflow limitation that affects people with COPD often affects the heart’s ability to function fully. People with COPD are also more susceptible to heart attacks.
• Anemia: While COPD doesn’t necessarily cause anemia, anemia is often a comorbidity of the disease. Patients with COPD and anemia typically have worse outcomes, so health care professionals need to look for anemia to mitigate this.
• Depression: Because people living with COPD are often limited in their overall functioning, this can take a toll on mental health.

One’s life expectancy varies depending on several factors, including age, symptoms, health status, and other comorbidities or lifestyle habits.

What Are the Treatments for COPD?

The COPD treatments are centered around managing lifestyle and mitigating symptoms. Treatments typically involve medications, supplemental oxygen, and rehabilitation exercises.

• Medications: A comprehensive medication regimen is essential for managing COPD. Various types of drugs, including bronchodilators, steroids, antibiotics, anticholinergics (to relax muscles lining the airways), leukotriene modifiers (to manage leukotrienes, which cause tightening of the airway muscles), expectorants (to thin mucus in the airways), antihistamines, and antivirals may all be prescribed to help manage COPD. The appropriate combination of medications will be individualized and managed by a team of health care providers to fit a person’s unique needs.
• Oxygen: Some people may need to also supplement with oxygen if they begin to have hypoxemia, or low blood oxygen.
• Rehabilitation: Rehab exercises can aid people in managing COPD by helping an individual learn movements to reduce shortness of breath and maximize lung capacity.

How Does Mindset Affect COPD?

A diagnosis of COPD and managing its physical challenges can understandably take a toll on a person’s mental health. Feelings of sadness and anxiety are common among people living with COPD.

Research indicates that emotional distress in individuals with COPD is a common and significant type of psychosocial impairment. In addition, how a diagnosis affects one’s relationships is substantial and plays into one’s emotional stress levels. Due to the disease’s physical repercussions, individuals may find their ability to continue working impacted, negatively affecting their mental health status.

If you or someone you know is living with COPD and experiencing troubles with mental health, seeking comprehensive and appropriate care is paramount. Working with health care providers to develop a treatment plan to manage these feelings is possible and essential for optimizing both acute and long-term health outcomes.

Some research shows that people with COPD who engage in stress-reducing measures, like meditation or tai chi, may also have better health outcomes. Engaging in these practices helps people with COPD increase awareness and understanding of themselves and their condition, practice coping behaviors to promote calmness, improve brain chemistry, and improve overall psychological and sociological well-being. This is likely because taking extra measures to care for one’s mental health will help a person better care for their physical health, creating a positive feedback loop.

What Are the Natural Approaches to COPD?

While Western medicine and medications are a central part of the appropriate management of COPD, there are some natural approaches that individuals can consider to aid in symptom management. As always, if you are considering adding new supplements to your routine, it is essential to clear them with your health care provider first.

Breathing Exercises

A Cochrane systematic review found that four to 15 weeks of breathing exercises improved exercise capacity in over 1,200 study participants with COPD, suggesting that breathing exercises could help COPD patients who have difficulty working out, thus potentially improving health outcomes. The breathing exercises used included pursed-lip breathing (inhaling through the nose, exhaling through pursed lips), diaphragm breathing, and a breathing exercise practiced in yoga.

Essential Oils

Several essential oils have demonstrated promise in both human and animal studies, including:

• Eucalyptus: Eucalyptus contains a compound called 1,8-cineole. A 2020 review suggested the compound be used orally with standardized capsules in adjunctive therapy in early-stage COPD patients to control symptom exacerbation and slow the progression of smoke-induced lung inflammation.
• Myrtol standardized: A 2009 study examining the effects of several essential oils on laboratory cell cultures from COPD patients found that Myrtol standardized, an essential oil blend derived from eucalyptus, pine, and lime, exhibited potent anti-inflammatory properties and antioxidative properties comparable to NAC. The study also mentions previous studies that determined that Myrtol standardized could help reduce COPD flare-ups.
• Orange and bergamot: One 2015 article in Evidence-Based Complementary and Alternative Medicine determined that the flavonoids in orange and bergamot juices could prevent oxidative damage in lung cell cultures, a precursor to respiratory conditions like COPD.

Supplements

A nutraceutical diet including both creatine and coenzyme Q10 was found to aid in building lean muscle mass, increasing exercise tolerance, reducing shortness of breath, reducing flare-ups, and improving quality of life after two months in a study of 55 COPD patients with chronic respiratory failure.

Several studies have also examined the effect of various Chinese herbal medicines on people with COPD. The following botanicals have shown promise:

• Bu-fei granules.
• Xuan Bai Cheng Qi.
• Bu-fei Yishen.
• Shufei Tie.
• Yiqi Bu Shen Huo Xue.
• Bu-Fei Jian-Pi.

In addition, other herbal supplements, including Echinacea purpurea, selenium, vitamin C, Cineole (eucalyptus), and Chinese yam, have shown promise in reducing some of the systemic inflammation that occurs in COPD. Many of these studies conclude that including some of these herbs can aid in reducing exacerbation of COPD, reducing cytokine levels (through anti-inflammatory effects), improving psychological functioning, and improving overall perceived quality of life. While further research is needed within populations of people living with COPD and these kinds of supplements, these preliminary studies are encouraging.

How Can I Prevent COPD?

The good news is that individuals can take measures to reduce the risk of developing COPD since the major risk factors are lifestyle-related.

Some of the best ways to reduce your risk include:

• Not smoking: Smoking is the No. 1 risk factor for developing COPD.
• Limiting exposure to smoke and air pollution: Reducing exposure to toxins in your living and working environment is optimal for preventing COPD. Living in an area with better air quality, using advantageous cooking methods, and improving ventilation are all helpful measures.
• Exercising: Getting regular exercise helps ward off COPD and promote overall well-being. Staying active bolsters your immune system and aids in protection against other medical conditions known to exacerbate COPD.
• Eating a nutritious diet: A healthy, anti-inflammatory diet can help keep the body and lungs in a more optimal state.