Editor’s note: This article was updated at 7:10 pm, Tuesday, April 17. The update includes information on the passing of former first lady Barbara Bush. 

Former first lady Barbara Bush reportedly battled chronic obstructive pulmonary disease, or COPD, and congestive heart failure at the time of her death at 92 years old on Tuesday. Former Tonight Show host Johnny Carson, Dean Martin of the Rat Pack and model Christy Turlington also have been affected by the disease.

According to Lauren Goode, MD, an internal medicine physician affiliated with Henrico Doctors’ Hospital, COPD is a long-term lung disease that creates an airflow problem in the lungs, making breathing very difficult.

The American Lung Association estimates that more than 12 million people have COPD, the third leading cause of death in the United States. However, this number could be up to 24 million, since some people may not know they have the condition, says Dr. Goode.

“Sometimes people can miss the early warning signs of COPD, like shortness of breath,” said Dr. Goode, who practices at Primary Health Group – Forest, an HCA Healthcare Physician Services Group affiliate. “Missing these early warning signs often means that the disease is not found until much later and when it has worsened. With early detection, there are treatments available to help manage the disease.”

Dr. Goode tells us what else we should know about chronic obstructive pulmonary disease below.

How does chronic obstructive pulmonary disease affect the body?

COPD makes the heart work harder, especially the right side, which pumps blood to the lungs. The walls of the heart become thickened from the extra work needed to pump blood into the resistant lungs. Because COPD destroys the normal lung structure, you cannot exhale completely. Air is trapped in the lungs, which become hyper-inflated. This causes the chest to expand, leading to a permanent condition referred to as “barrel chest.” The accumulation of mucus and fluid in the lungs provides an ideal environment for bacteria and viruses to grow. These lung infections may become serious, further compromising breathing ability.

What causes chronic obstructive pulmonary disease?

The condition is most often caused by damage to the lungs from smoking cigarettes.

What are the symptoms of COPD?

  • Cough that produces a lot of mucus
  • A whistling or rustling sound that may be heard when exhaling, which is prolonged
  • Excessive wheezing with a cold or respiratory infection

The symptoms of COPD are mild at first. They become more severe and debilitating as the disease progresses. In the beginning, shortness of breath may only occur with physical exertion. As the disease becomes more advanced, it may occur after very modest activity. When the illness becomes very severe, shortness of breath occurs even at rest. Repeated bouts of coughing with sputum production may become disabling. Nighttime coughing may interfere with sleep. You may feel a choking sensation when lying flat. Difficulty breathing may cause sufferers to breathe through pursed lips, or to lean forward when sitting or standing in order to breathe more comfortably.

Are there different types of chronic obstructive pulmonary disease?

The two common forms of COPD are emphysema and chronic bronchitis, often occurring together. Typically, patients with COPD have chronic shortness of breath and a chronic phlegm-producing cough.

Chronic bronchitis is characterized by inflamed airway tissue and excessive mucus production. This leads to a persistent, productive cough for several months each year. The inflammation causes the large and small airways of the lungs to become narrowed, and the lining of the passageways may become scarred. This makes it hard to move air in and out of the lungs, resulting in shortness of breath.

In emphysema, the walls between the tiny air sacs in the lungs lose their ability to stretch. They eventually become weakened and break. As the lung tissue becomes less elastic, air is trapped inside the air sacs, impairing the exchange of oxygen and carbon dioxide.

What other conditions can arise from someone having COPD?

The normal rhythm of the heart may be disturbed, and lack of oxygen in your blood can produce a bluish tinge to your skin, nails, and lips called cyanosis. The extra strain on the right side of the heart may cause a slowdown of blood circulation. This, in turn, can cause engorgement of the large veins and liver, eventually resulting in edema, which is fluid leakage into the abdomen, legs, and ankles.

What are the risk factors for COPD?

  • Smoking is the most important risk factor for COPD. Almost all COPD cases are caused by cigarette smoking. However, not all smokers develop COPD. This risk increases with age, partially related to the number of years of cigarette smoking.
  • Smoking more “exotic” forms of tobacco, such as Chinese water pipes (hookahs), can be even more harmful. In some cases, these can increase your risk more than traditional cigarettes.
  • Research suggests that people who are chronically exposed to secondhand smoke (in any form) have an increased risk of developing COPD.
  • One form of emphysema has a genetic component that is more common in people of northern European descent. People with this form of COPD have a hereditary deficiency of a blood component. It is known as alpha-1-protease inhibitor (alpha-1-antitrypsin [AAT]). People with this defect can develop COPD by early middle age. If you have close relatives who developed COPD in their thirties or forties, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected by blood tests available at medical laboratories.
  • Chronic exposure to dust, gases, chemicals, and biomass fuels increases your risk of developing or exacerbating COPD. These include smoke from burning wood, charcoal, and crop residue. Exposure to these can also worsen symptoms of the disease.

Are there ways to monitor lung function after being diagnosed with COPD?

Many tests of lung function have been developed. Each provides slightly different information about how well your lungs are working, are painless and noninvasive, and performed using a machine called a spirometer. By breathing into the spirometer, your doctor can measure your lung volume and your ability to move air in and out of your lungs in a certain period of time. Your results are compared with typical findings of a healthy person your age and height. Your doctor can then determine to what extent your lung function is diminished.

How can you help prevent COPD?

Don’t smoke, and take measures to quit if you already do.

Henrico Doctors’ Hospital, located in Richmond, Va., is an affiliate of HCA Healthcare.