Rita de Cássia Ferraz, 46, discovered by chance that she had chronic obstructive pulmonary disease (known by the acronym COPD) when she was admitted to an emergency room after a respiratory crisis that she suspected was the result of tuberculosis.
The truth is that the security guard had already been diagnosed with the bacteria infection. Mycobacterium tuberculosis, but as he abandoned treatment, he imagined that he was experiencing a new respiratory condition associated with the disease. That was when, through a lung tomography exam, she discovered that she had lost part of her lung tissue due to the chronic, not infectious, disease.
Because of the damage, she needed to have a pneumonectomy, which is the removal of one of her lungs — in this case, the right one. “In the first hour after the surgery, I was just crying in despair. But then I was recovering at home and doing physiotherapy and respiratory rehabilitation, and I got better”, she explains.
Ferraz is one of the 6 million people in the country who live with COPD, an incidence of around 2% to 3% of the population over 40 years of age. Despite this, around 12% only have the diagnosis — the rest live without knowing that their lung tissue is already compromised.
COPD differs from other lung diseases because it is chronic and is characterized by airway obstruction due to loss of lung tissue. “Imagine that we have the pipes or branches of the tree, which would be the bronchi, and then you have the leaves, which are the alveoli, where gas exchange takes place. In COPD, the ‘pipes’ become thinner, obstructing the passage That’s why it’s called obstructive. And chronic because the symptoms will continue for the rest of your life”, explains André Nathan Costa, pulmonologist at the Center for Pulmonary and Thoracic Diseases at Hospital Sírio-Libanês.
According to the doctor, there are two poles or manifestations of COPD: chronic bronchitis, characterized by obstruction due to thickening of the airways, causing a lot of secretion, and pulmonary emphysema, which is the destruction of lung tissue (parenchyma).
The diagnosis is given by clinical history —in this case, being a smoker is the main cause—, combined with simple tests, such as spirometry (also known as lung function test), which measures the volumetric capacity of the lung, and can be complemented with imaging exams. “Spirometry is a simple, cheap and available test. You blow into a tube to measure lung capacity. Imagine it as if it were a bladder, you have air that comes in and fills the bladder, and then when the air comes out you can , by this volume, measure the capacity of the bladder. It’s the same thing with the lungs”, he said.
But even though it is a simple test, the rate of people living with COPD and not knowing it is still very high, says Alberto Cukier, coordinator of the Chronic Obstructive Pulmonary Diseases treatment group at Incor (Instituto do Coração), at USP.
The disease also appears after the age of 40, which worsens the condition since the time of exposure to environmental factors — such as cigarettes, but it can also be due to smoke inhalation from wood stoves and other domestic uses that generate pollutants — can worsen the condition.
“By definition, when someone has COPD there is a limitation of the air flow that the person can inhale, they fill their chest and when they release that air flow it is slower, either because the bronchi have been compromised over the years, or because the alveoli were destroyed,” says Cukier.
According to Costa, the longer you smoke, the more damage it will cause to a COPD patient, and stopping smoking can help stabilize the disease, but not make it disappear. “There is no cure, what there is is treatment, both with bronchodilators [que diminuem a obstrução dos vasos], as well as removing that environmental factor, in this case cigarettes, or exposure to other smoke. In more serious cases, the patient may also need a lung transplant.”
As in Ferraz’s case, exposure to other respiratory agents, such as tuberculosis, can worsen the condition. For this reason, vaccination is also a protective factor. “Antiviral, anti-Covid and anti-pneumonia vaccinations are fully indicated in these individuals and somewhat prevent the changes that induce exacerbation”, says Cukier.
Like other chronic diseases, patients with COPD are also at greater risk of developing other comorbidities. “People say it’s cool, that I’m sedentary, they say ‘go go to the gym’. But it’s not like that, it’s difficult, we can’t climb a staircase, 16 steps, which already takes our breath away”, says Ferraz.
The disability caused by COPD is one of the factors cited as having the most impact on the patient’s life, along with prejudice and lack of knowledge about the disease. “It’s that saying, you don’t see it, but I feel it. I met another person who also told me that he has an invisible disease. I have 35% lung function, I still don’t use oxygen, so no one knows that I have this condition “, said the guard.
Maintaining your health can be an ally in preventing COPD from worsening, says Cukier, from InCor. “Therefore, just like us, COPD patients must maintain regular physical activity.” According to a study carried out at the InCor outpatient clinic, coordinated by him, around half of patients with COPD are also hypertensive, and the proportion of diabetics reaches 11%.
There is also an association between the disease and a greater risk of developing osteoporosis.
Despite all this, there is no cure for COPD, which can cause problems with people’s physical and mental health and even when carrying out daily activities.
“Over the years, it is expected that respiratory capacity will decrease, reaching the point that even minor efforts, such as taking a shower, cause patients to become short of breath, so people start to need oxygen to maintain adequate oxygenation” , said the doctor.
For this reason, reducing smoking is the main public health measure that will help reduce the incidence of COPD and other lung diseases.
“If you already have the disease and stop smoking, it will stay at the current level of how it was during the time you were using cigarettes. If you stopped smoking and don’t have COPD, you won’t get it later. So prevention by Smoking is the main way to avoid the disease”, concludes Costa.