Why is my COPD getting worse even though I quit smoking?

COPD Getting Worse – What are the Possibilities? Dear Dr. Mahler: Why does my COPD seem to be getting worse?  After my doctor pushed hard, I quit smoking 4 years ago. I have been doing pulmonary rehabilitation at the local hospital. However, my breathing seems to be getting worse and I have 1 – 2 chest colds each year, usually sometime between fall and spring. I take Advair and Spiriva regularly, and use ProAir 2 – 3 times a day when I am active. What do you think? Hank from Appleton, WI Dear Hank: That is great that you quit smoking 4 years ago. As you know, it is important not to smoke or to inhale irritants in the air.
Respiratory system - quitting smoking can prevent COPD getting worse

Diagram of respiratory system

Have you had breathing tests that demonstrate that your numbers are going down? If not, it is important to ask your health care provider to order pulmonary function tests to find out if the results have changed. Here is one possibility for your “COPD getting worse.” It is generally believed that inhaling toxic gases and particles from cigarette smoke causes inflammation in the breathing tubes that seems to persist even if someone quits smoking. However, damage to the lining of the breathing tubes (airways) may allow bacteria to get into the walls of these tubes. The presence of bacteria causes the body to call in white  blood cells (inflammation) in an attempt to kill the bacteria. This may also explain why you have chest infections each year. A recent study published in Nature Communications (doi:10,1038/ncomms11240) in mice supports this concept. As author Dr. Bradley Richmond stated, “This may explain why inflammation persists in COPD even after patients stop smoking.” Of interest, the researchers were able to stop the damage in the mice by using roflumilast, an anti-inflammatory medication approved to reduce the risk of an flare-up (exacerbation) of COPD. Other possible reasons for your “COPD getting worse” are anemia, anxiety, and a heart condition. Low fitness (called deconditioning) is unlikely as you are participating in pulmonary rehabilitation. Make sure to continue your exercise program. Once again, I encourage you to talk to your health care provider about your concerns. Sincerely, Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.