You can’t diagnose COPD yourself—you need to see your primary care physician, who may consult with a pulmonologist. Along with examining your risk factors (including cigarette history), the doctor may order a chest X-ray, CT scan and pulmonary function test (PFT, which Crothers describes as “the gold standard” of COPD diagnosis). Combined, these tests detect any lung obstruction and measure lung function. COPD’s early signs can be similar to those of pneumonia or asthma, so if you have trouble breathing, check with your doctor to determine the cause.
If you have COPD, the primary goal of treatment will be to relieve symptoms. Short- and long-acting bronchodilators (Atrovent, Combivent, Foradil, Serevent and Spiriva) or steroid inhalers such as Advair might help. (Two warnings: Advair contains fluticasone, which interacts with Norvir/ritonavir-containing antiretroviral regimens such as Kaletra, possibly causing severe side effects. Using a steroid inhaler can also put you at risk for bacterial pneumonia.) Your doctor may also prescribe antibiotics to treat common pulmonary bacterial infections.
“More severely impaired patients,” Crothers says, “may benefit from pulmonary rehabilitation programs that include exercise and breathing techniques.” Advanced COPD may require oxygen therapy or lung surgery (even transplants). Early detection can help render these radical treatments less necessary.
Asked for tips on managing COPD, Crothers emphasizes kicking cigarettes. Even though COPD isn’t completely reversible, she says, “There may be some improvement if people stop smoking—important at any stage of COPD.” Stopping any street-drug use may help as well, she says, because “smoked or injected drugs like cocaine, heroin and methamphetamines can also damage the lungs.” (California recently added marijuana smoke to its list of cancer risks.) And since some occupational or environmental exposures may raise the risk of COPD, Crothers recommends using appropriate respiratory protection at all times.
Two years ago, with determination and the stop-smoking drug Chantix, Lewis finally quit. He regularly discusses lung disease with his doctor and reads about it online, and he has made changes to improve his overall health. “I do cardiovascular exercise at least three times a week,” he says. “I reduced my drinking and modified my nutrition, partly to help lower my cholesterol. As you get older, you can’t just treat HIV. You have to watch other conditions too.”
TIPS FOR LUNG HEALTH
• Butt out
Yes, we’ve made this point countless times: Stop smoking. Help is available, and seeking it out could be the best health investment you ever make.
Aerobic exercise, also called cardiovascular exercise, improves your body’s oxygen consumption and helps your lungs. Pick an activity you enjoy so you’ll stick with it.
• Eat well
Good nutrition (including lots of fresh fruits and veggies high in antioxidants) may improve lung function.
• Get shot
Talk with your doctor about getting regular immunizations, particularly the pneumococcal and influenza vaccines. Common seasonal flu stresses your lungs.
• Plan ahead
If you are at risk for any of the infections that take advantage of damaged immune function (especially for those with low CD4 counts), ask your doctor about preventive treatments.