A Guide to COPD: What To Expect Based on Your Age

Chronic obstructive pulmonary disease (COPD) is a common long-term lung condition caused by smoking and other factors. It is usually diagnosed after age 40, but some people have it for years without realizing it.

No matter how old you are when you're diagnosed, knowing what to expect from COPD throughout your life can help you manage it. Lifestyle changes and treatments can slow the disease's course and make it easier to live with.

What Is COPD?

COPD is an umbrella term that refers to a group of conditions, mainly emphysema, and chronic bronchitis, that make breathing more difficult. Emphysema involves damage to the air sacs in the lungs, and chronic bronchitis involves inflammation of the airways.

Both are commonly caused by smoking and share other risk factors, symptoms, and treatments, and many people have both. Healthcare providers are now using the term COPD to refer to them together.

More than 15 million adults in the United States have been affected by COPD—with most not knowing that they have it. The condition is also the fourth leading cause of death in America.

COPD affects everyone differently. Women are more likely than men to have COPD and are more likely to die as a result. Additionally, everyone with COPD may not have the main symptoms of COPD. The primary symptoms of COPD include:

• Coughing or wheezing
• Excess phlegm
• Shortness of breath
• Trouble taking a deep breath

The symptoms are usually mild in the beginning but can get worse over time. And some COPD symptoms can look similar to symptoms of other health conditions and illnesses.

Risk Factors and Age of Onset

Smoking is the biggest risk factor—about 85 to 90% of cases of COPD are caused by cigarette smoking. But some people who develop COPD have never smoked.

Specialists like Neil Schachter, MD, a professor of pulmonary medicine and the medical director of the respiratory care department at Mount Sinai Medical Center in New York City, pointed to exposure to pollution, dust, poor air quality, and secondhand smoke as other significant risk factors.

Other risk factors for COPD include:

• Changes to lung growth and development (during pregnancy or childhood)
• Infections
• Alpha-1 antitrypsin (AAT) deficiency (a genetic condition that can lead to lung damage and COPD)
• Asthma
  

COPD is most commonly diagnosed after the age of 40, but it can happen at any time. Learn what to expect regarding COPD risk at different stages in your life and get advice on prevention and management.

COPD in Your 20s or 30s

A diagnosis of COPD is rare in those under 40, but certain people have a higher risk of developing it now or later.

If you had asthma as a child, your chances of developing COPD as an adult may be higher. Even though COPD itself isn't seen in children, healthcare providers realize that children who have asthma may be at risk of COPD later in life as a result of the lung changes it causes, Dr. Schachter said.

The rare genetic disorder known as AAT deficiency can make people vulnerable to COPD as early as their 20s or 30s, and many people don't know they have it until COPD has been diagnosed. AAT is a protein that your liver makes to protect your lungs, and the deficiency makes a person's lungs very sensitive to damage.

If you have family members with COPD, you are at greater risk of being a gene carrier. Bartolome Celli, MD, a leading COPD expert, and professor of medicine at Harvard Medical School, said that people with COPD should get tested for ATT deficiency if they have children. If they turn out to have it, their children should then get tested.

Adults in their 20s and 30s can take several steps to minimize their risk of COPD, particularly if they're in a higher-risk category.

• Avoid smoking: Experts agree that this is the best way to prevent COPD.
• Make other healthy lifestyle choices: Avoid environmental dust and smoke, eat a healthy diet, and get recommended vaccines to help protect against respiratory illness, said Dr. Celli.

When You're in Your 40s or 50s

At this age, patients often begin showing COPD symptoms such as chronic cough, wheezing, and excess phlegm. The symptoms are similar to those of asthma, and there is a lot of overlap between the two conditions. One-third of people with COPD also have asthma symptoms.

This is the age range when many people are first diagnosed, which is an important step for getting the best treatment. If you are diagnosed with COPD, there are things you can do to slow the progression and ease your symptoms.

• Quit smoking: This is the most crucial thing you can do to keep COPD from getting worse.
• Eat a healthy diet rich in antioxidants: This can also play a role in delaying the condition's progression, Dr. Schacter added.
• Explore treatment options: According to Dr. Celli, options at this stage include pulmonary rehabilitation, which includes exercise training and breathing education. Medication can help too.

To reduce dust and pollutants in your home—which is another way to ease symptoms—Dr. Schachter also recommended the following:

• Use HEPA air filters.
• Remove wall-to-wall carpeting, which collects dust. Ditto for dust ruffles.
• Stop using your fireplace.
• Fix areas with water damage that can breed mold.
• Limit contact with pets.

"All of these things add up over time and can cause significant disease," said Dr. Schachter.

When You’re in Your 60s or Older

If you're in your 60s or older, COPD can hit the hardest and cause the most disability. For example, some older adults might experience "lung function, more comorbidities, and poorer interoception [a sense of knowing what's going on in your body]."

COPD symptoms may increase in frequency and severity: coughing, wheezing, shortness of breath, and weight loss are common complaints. In some severe cases, you might also experience headaches, bloating, swelling in the legs, and confusion.

Additionally, infections such as pneumonia can cause a sudden worsening of symptoms, known as a COPD exacerbation, which can be life-threatening. (In addition to the standard COPD symptoms, exacerbations also may be accompanied by fever and increased heart rate.)

Therefore, it becomes increasingly important to ease the burden of symptoms at this stage.

• Protect yourself against colds and other respiratory tract infections. Dr. Schachter recommended getting an annual flu shot and vaccinations that can protect against certain kinds of pneumonia.
• Exercise gently. Dr. Schacter also suggested less than 30 minutes of daily exercise to boost your immune system so you are less likely to develop colds and infections.

In addition to lifestyle changes and specific COPD medications, oxygen therapy and lung surgery are sometimes recommended for more serious cases.

But Dr. Celli said that the best medicine is to maintain a healthy lifestyle and not smoke. "If you catch [COPD] early enough, you can prevent or delay it from progression," said Dr. Celli.

A Quick Review

COPD is a lung condition that can affect adults, with most getting diagnosed after age 40. There are ways to lessen your risk of COPD before diagnosis. You can also reduce the effects of COPD symptoms after you’ve been diagnosed with the condition.

Some primary lifestyle factors that may help, regardless of age, are quitting or avoiding smoking and reducing your exposure to dust, smoke, and pollutants.