I don't understand COPD, and my mom has it. Can someone explain?

Sorry this is so long, but you sound like you could use it. I hope it's helpful...

Staging COPD requires formal pulmonary function testing. There are four stages and those stages are based on the FEV1 from a spirometry test. Without formal testing it's not possible to stage it.

COPD is chronic obstructive pulmonary disease. It's a catch-all term for both chronic bronchitis and emphysema when they are found together. It has a highly variable life expectancy and it depends upon the severity at the time of diagnosis as well as the primary cause (e.g., smoking related illness vs congenital a1AT deficiency). It is a chronic, progressive disease with no cure, but it can be treated.

COPD is classified into four stages of severity based on lung function. A high-quality spirometry test is necessary to properly stage COPD. You cannot be said to have "chronic obstructive pulmonary disease" until it is chronic and has demonstrated obstruction on spirometry. There are a lot of people walking around with the diagnosis of COPD who do not have COPD at all.

For people over age 50 with lung function indicating GOLD Stage 0 COPD at the time of diagnosis, the life expectancy is above 90% at five years and above 75% at ten years. The study comparing life expectancies only followed individuals for twelve years so there is no data beyond the twelve year mark.

For those with GOLD stage I COPD, the life expectancy declines to about 80% at five years and 60% at ten years. What that means: Of the people diagnosed with COPD in Stage I at the time of diagnosis, 80% of them were still alive five years later and 60% of them were still alive ten years later.

For those with Stage II the life expectancy is about 70% at five years and 45% at ten years.

For those with Stage III or IV the life expectancy is about 50% at five years and 25% at ten years. Again, that means of the people in Stage III or IV at the time of diagnosis, half of them were still alive five years later and 25% of them were still alive ten years later.

There is significant variability owing in part to the fact that COPD is a highly variable disease in it's presentation, severity, and progression. More severe disease progresses faster and thus has worse expectancy than less severe disease -- even given the same time frame. Additionally, COPD is frequently found with other medical problems that have their own impact on life expectancy. That's why it's so hard to give someone a solid answer. There are just too many variables. The best we can do is get long-term data on groups of people with COPD and compare someone to them statistically.

In any case, the problems with COPD are a few things in combination:

For one, the airways are irritated and inflamed. That's the bronchitis component. Just like when you get a cut and it gets itchy and red, your airways can get itchy and red too. That's inflammation. That inflammation causes coughing, increased mucus production, and it makes the smooth muscles of the airway irritable so they constrict. All of that narrows the airway making it harder to exhale.

The airways also become soft and floppy. The walls between the alveoli break down and they merge into large bubbles called blebs or bullae. That decreases the surface area available for gas exchange -- so getting oxygen in is harder and getting CO2 out is much harder. Those soft airways dilate a little bit during inhalation from the normal pressure changes of breathing but when you exhale they flop closed again which means it takes longer to exhale. That's the emphysema component.

Normally, it takes about twice as long to exhale as it does to inhale. For people with COPD it can take MUCH longer -- I've seen people on a test exhale for more than 20 seconds and still have air left over. If you can't get the air out then there is less room to get the next breath in. So when someone with COPD needs to breathe faster, then can very quickly run out of room to breathe. The breaths "stack" and that trapped gas prevents being able to take the next breath; so they have to stop whatever they're doing and catch their breath. That can take a while.

That air trapping means CO2 can't get out as efficiently. Your normal drive to breathe is based on the amount of CO2 in your blood. People with severe COPD can eventually develop a chronically elevated level of CO2. That blunts that normal drive to breathe and they breathe on the back-up system -- the amount of oxygen in the blood. A high level of CO2 in the blood can make you sleepy (called CO2 narcosis). Add to that the fact that it just takes a lot more work to take each and every breath and yes, people with COPD are typically tired all the time.

Because they can't do much about the excretion side of the CO2 equation, we have to treat the production side. Diet is often overlooked in COPD treatment but it can make a difference in quality of life. The products of carbohydrate metabolism are CO2 and water. You pee out the water and exhale the CO2 -- unless you can't because you have COPD. I have often said: If you want to make someone with COPD pass out, feed them a box of crackers then chase them up the stairs. That's a blunt way of saying: Cutting down on carbohydrates (especially sugar and refined carbs) can improve the CO2 production side of the equation. That can improve quality of life. It doesn't do anything to treat the lung disease but it makes using what lung you've got a little bit easier.

Unfortunately, all of that is rather moot if she is still smoking. Trying to treat COPD while smoking is like digging a hole while someone else fills it in. Dig all you want, you're not going anywhere. Smoking does continual damage with each cigarette. COPD is progressive and while it is treatable, there is no cure. Continuing to do damage by smoking only accelerates the process.

Last but not least: You have to come to terms with the fact that there is really little to nothing you can do about this. You can offer support and be there for her in whatever ways you can, but this is a chronic, progressive, ultimately fatal disease. The progression can be slowed and treatment can make life more bearable, but at the end of the day there is no cure. So the person you need to keep an eye on is you. You are dealing with this as much as she is. It sounds super cliche, but really, you have to take care of you. It is no different from dealing with a loved one with cancer or another terminal illness. You make the best use of the time you have; you do what you can to improve their quality of life insofar as they will let you; and you make time to take care of yourself as well. You can't fix the problem so focus on making the problem as livable as you can.

Best wishes for you both.

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http://www.research4health.com/#!free/cf5o A very understandable explanation...