Dr. Roach: Smoking, symptoms biggest factors in COPD prognosis
Dear Dr. Roach: I was diagnosed with COPD a year and a half ago and have several questions. I seem to be unable to get answers from my pulmonary doctor, as he is always busy and doesn’t have a lot of time to spend with me.
How fast does COPD progress? I’m 78 years old, in reasonably good health and exercise regularly. I have chronic bronchitis with a slight amount of emphysema. I had been coughing a little during the day, had mucus in the morning and coughed at night for two to three hours after bedtime — to the extent of having to use a rescue inhaler to settle down and get back to sleep. After he put me on Trelegy, all of those symptoms disappeared, and I feel perfectly normal except for shortness of breath.
My other question is what is the life expectancy of a person diagnosed with COPD? I’ve read about answers to this all over the map, from two or three years after diagnosis to 15 or more years. I would presume that it depends on other factors such as physical condition, exercise, weight, etc. But I would like some kind of guideline for someone in my condition.
Dear T.J.: There are two major types of chronic obstructive pulmonary disease: chronic bronchitis, where the primary problem is productive cough; and emphysema, which is destruction of the small airways. Shortness of breath is a common feature of all types of COPD. The most prevalent cause is smoking.
I can’t answer your questions on rate of progression and overall prognosis without much more information, but it is certainly a good sign that many of your symptoms are well-controlled on treatment. The single biggest factor in rate of progression of COPD is whether you are a smoker, but not being able to exercise, being male and being very underweight are additional risk factors for faster progression. Lung function falls inexorably over time. In people who have no lung disease, the normal decline with aging is never enough to cause symptoms during normal activity. In someone with COPD, the decline over months to years can cause symptoms to occur first with exercise, and then when at rest. Once people have severe symptoms at rest, the prognosis becomes quite poor.
No medication can reverse lung damage. Inhaled steroids reduce inflammation and can slow progression somewhat. Inhaled bronchodilators open airways and make breathing easier. Inhaled anticholinergics reduce secretions. Your medication, Trelegy, contains all of these medicines, and is appropriate for people with severe COPD or those who do not have good symptom control with a less intensive regimen.
An online calculator for prognosis can be found at https://bit.ly/2N1UEoy. It can be used if you know how far you can walk in six minutes and the results of your breathing test (specifically, the FEV1%).
Dear Dr. Roach: My family recommended yoni pearls for cleansing the vagina, and for prevention and treatment of vaginal bacterial infection. Are these necessary?
Dear V.A.M.: A healthy vagina does not need any cleaning, and any kind of herb or douche inserted in the vagina is much more likely to cause problems than prevent them, so I recommend strongly against them.
Bacterial vaginosis is a condition where the normal, healthy bacteria in the vagina are outnumbered by other bacteria, such as Gardnerella and others. This outnumbering changes the vaginal pH and may cause symptoms ranging from none to abnormal discharge to unpleasant odor. Bacterial vaginosis is normally treated with antibiotics (via suppository or sometimes oral) when symptoms are bothersome. Women who suspect bacterial vaginosis should have an examination to make sure of the diagnosis.
Readers may email questions to ToYourGoodHealth@med.cornell.edu