Learning the Signs That Lead to COPD

DEAR DR. ROACH: What signs and/or symptoms do you need for a doctor to determine whether you have chronic obstructive pulmonary disease (COPD)? -- R.K.

ANSWER: The diagnosis of COPD is suspected in people who are at risk for the disease and note one of two cardinal symptoms: cough or dyspnea. (A “symptom” is what a patient identifies by history, while a “sign” is noted on a physical exam. A cough can be both a symptom and a sign.) Dyspnea is usually described as shortness of breath, a sensation that a person can’t get enough air, like they have just run very fast. Some people with COPD may have very subtle symptoms.

Smoking is the biggest risk factor for COPD, but there are other causes, including other chemical exposures (industrial exposures and home cooking fires are less common now, but are historically important causes of COPD); scarring lung disease; and a genetic cause, a condition called alpha-1 antitrypsin deficiency.

The diagnosis is confirmed most often by tests of lung function, which are breathing tests to look at the physiology of the lung and its ability to exchange oxygen and carbon dioxide. Sometimes the diagnosis can be supported by an X-ray or CT scan, but pulmonary function testing is the best way to determine the severity of COPD.

We do have ways of slowing down lung decline in COPD, one way being smoking cessation for current smokers, but some of the medications we use also help reduce ongoing damage. ***

DEAR DR. ROACH: Please help! Is it true that Trulicity may cause serious side effects, including thyroid tumors and cancer, as well as pancreatitis? -- J.R.

ANSWER: Dulaglutide (Trulicity), like semaglutide (Ozembic) and liraglutide (Victoza), are in a class of drugs called GLP-1 receptor agonists, which have several actions, such as increasing insulin release by the pancreas in response to meals. Initial studies on laboratory rats did show an increase in an unusual type of thyroid cancer, but studies have not yet shown an increased rate in humans. Still, people at an increased risk for this type of thyroid cancer (having a family history of medullary thyroid cancer or of multiple endocrine neoplasia, type 2A or 2B) are not recommended to take this medication. Similarly, there are reports of pancreatitis in people taking this medication, but it isn’t clear whether the medicine is responsible for the pancreatitis. It’s unwise to use this class of medication in people with a history of pancreatitis.

***

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

DID YOU KNOW?

A prediabetes diagnosis means you have higher than normal blood glucose levels, but not high enough to be considered diabetes. Excessive glucose in the blood can damage the body over time, and those diagnosed with prediabetes are at risk for developing type 2 diabetes, heart disease and stroke. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the majority of people with prediabetes do not have any symptoms. The condition is typically revealed after blood tests indicate blood glucose levels are higher than normal. Being overweight and living an inactive lifestyle are two of the biggest risk factors for prediabetes, and doctors may recommend that men andwomen45andolder,especially those who are overweight, be tested for prediabetes. Those who have been diagnosed with prediabetes will not necessarily develop diabetes down the road. In fact, the NIDDK notes that men and women who lose at least 5 to 10 percent of their starting weight can prevent or delay the onset of diabetes and may even be able to reverse prediabetes.

Inflammation

Inflammation can affect anyone, and those who have battled it likely have nothing positive to say. But while few people may associate inflammation with something good, inflammation is actually a process by which the body’s white blood cells and the substances those cells produce protect the body from infection at the hands of bacteria, viruses and other foreign organisms. While inflammation is protective by nature,sometimesaninflammatory response is triggered by mistake. When that happens, the body’s immune system, which is designed to protect the body, begins to damage its own tissues. The resulting symptoms of this faulty immune system response may include joint pain, joint stiffness, loss of function in the joints, and swelling of the joints. None of those symptoms are comfortable, and people suffering from them may be on the lookout for ways to alleviate their pain and suffering. While anyone battling persistent inflammation should speak with their physicians to explore their treatment options, a preliminary search of how to best treat inflammation will no doubt turn up information about heat therapy and cold therapy.

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