This lung disease can be dangerous for younger people, too

By Katia Hetter, CNN

(CNN) — Chronic obstructive pulmonary disease, or COPD, is the fourth leading cause of death worldwide, responsible for 3.5 million deaths in 2021, according to the World Health Organization.

It’s a common disease in the United States, affecting about 6% of US adults and ranking among the country’s top 10 causes of death, the US Centers for Disease Control and Prevention reports.

As people age, the frequency of these cases increases significantly, with some estimates indicating that COPD may affect 20% to 25% of people over age 70.

Now, researchers are trying to learn how many people have “young COPD,” meaning the condition is diagnosed before 50 years of age. “Young COPD” was present in 4.5% of adults under 50 in the population studied, a new study published in the journal NEJM Evidence​ found. The diagnosis was associated with a significantly elevated risk of hospitalization due to lower respiratory disease and an increased risk of death before 75.

What is COPD, and what are the risk factors for developing this condition? And why might young COPD increase mortality risk? What should people with COPD do to improve their health outcomes?

To answer these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore’s health commissioner.

CNN: What is COPD, and what are the risk factors for developing this condition?

Dr. Leana Wen: COPD is a group of lung diseases that cause airflow limitation, making it difficult to breathe. The two most common types of COPD are emphysema, which occurs when the air sacs in the lungs are damaged and lose their ability to stretch and exchange oxygen, and chronic bronchitis, which is marked by long-term inflammation and narrowing of the airways, often with excess mucus and a persistent cough.

COPD is a chronic, progressive condition, meaning it does not go away and tends to get worse over time. Although there is no cure, treatments including medications and lifestyle changes can help patients control symptoms and reduce flare-ups.

The most significant risk factor for developing COPD is smoking. People who currently smoke or previously smoked have a higher chance of developing COPD. Other risk factors include exposure to secondhand smoke, polluted air or other environmental workplace hazards. In addition, individuals with a history of asthma and a family history of COPD are at higher risk for having COPD.

CNN: How does this new study define young COPD?

Wen: According to the study authors, previous researchers have used varying definitions of “young COPD.” For instance, some have included only those who have had a smoking history. This study used a more expansive definition to account for nonsmokers with COPD.

Specifically, individuals must meet three sets of criteria. The first is having a spirometry measurement showing airflow obstruction. Spirometry is a breathing test that measures how much air a person can exhale and how quickly, which helps determine whether the lungs are blocked or narrowed. The second is having either 10 or more pack years of smoking, or symptoms of cough, phlegm and trouble breathing. The third is age between 18 and 49 years old.

CNN: What did the study show about the prognosis of people with the condition?

Wen: The researchers examined four groups of people who were already participating in other research studies. This is important because they were not selected based on smoking exposure or existence of respiratory illnesses; therefore, their health characteristics broadly reflected the overall US population. Using this definition, they determined that the prevalence of young COPD was 4.5%.

Researchers then tracked outcomes of participants with young COPD compared with those without this condition. They found that premature mortality, defined as death before 75 years of age, was increased more than 1.4 times among those with young COPD. The likelihood of hospitalization or death due to chronic lung disease was more than 2.5 times.

CNN: Why might young COPD increase mortality risk?

Wen: Numerous other studies have shown that even for people with mild COPD, the risk of all-cause mortality is higher than in those with normal lung function. One of the primary reasons is association with smoking: People with substantial smoking history have increased rates of deaths from cancer and cardiovascular disease. Another reason is the association between COPD and respiratory disease such as pneumonia. Having COPD increases the risk of severe illness from bacterial pneumonia, not to mention a whole host of respiratory viruses including Covid-19 and influenza.

CNN: What should people with COPD do to improve their health outcomes?

Wen: There are a variety of treatments that can help patients improve symptoms, slow the progression of disease, reduce the risk of exacerbations and improve overall quality of life.

The first step is to be aware that they carry the diagnosis. Many people who have COPD may not know it. They may attribute a chronic cough to a persistent virus or shortness of breath to aging. Or they may think that because they never smoked, they can’t have COPD. This is not correct. While smoking is a major risk factor for developing COPD, according to the American Lung Association, 1 in 4 people with COPD never smoked. Prompt diagnosis is crucial to early treatment.

There are several symptoms that can serve as early warning signs. These include having recurrent lung infections like acute bronchitis or pneumonia, new or worse shortness of breath, a cough that brings up mucus and phlegm, wheezing, chest tightness and fatigue. People who have these symptoms should bring them up with their primary care provider, who can perform an assessment that could include spirometry testing.

Once someone is diagnosed with COPD, their physician or other primary care provider will recommend a combination of therapies. These include lifestyle changes, most notably quitting smoking. Other important steps may include staying physically active, reducing exposure to air pollution and secondhand smoke, and participating in pulmonary rehabilitation, which is a structured program of exercise, education and support designed to improve ease of breathing and overall quality of life.

Making sure to stay up-to-date with vaccinations is essential, as people with COPD are at greater risk of serious illness if they were to contract respiratory illnesses. They should speak with their providers about whether they are up-to-date with vaccines including streptococcal pneumonia, pertussis, Covid-19, influenza and respiratory syncytial virus, or RSV.

The provider may also recommend one or multiple medications that treat COPD symptoms. These include bronchodilators that relax the airway muscles and anti-inflammatories that reduce inflammation and mucus production. Individuals with COPD should also be alert to early signs of infection. They may receive specific antiviral treatment, and antibiotics are often given if a bacterial infection is suspected since infections can quickly worsen breathing problems.

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