More to know about COPD: Disputing the myths about an underdiagnosed disease

This condition is often missed or misunderstood. Experts urge more awareness and newer diagnostic tools.

By Kathleen Phalen Tomaselli, AMNews correspondent. Jan. 7, 2008.

It's a slow and surreptitious process within the lung tissue. At first, few patients notice the subtle changes -- the shallow, uneven breathing; the trapped air; the uncomfortable suffocation. Even when they do, they rationalize: "I'm getting older," they say, or "I need to lose some weight."

Without intervention, the devastation continues -- sometimes a result of cigarette smoke or inhaled toxins, sometimes for no known reason. Over time, the alveoli appear almost moth-eaten, unable to do their jobs. The silhouette of the heart shrinks because of hyperinflated lungs, the diaphragm flattens and the bronchi become floppy and narrow. Other symptoms -- the chronic cough, the mucus, the shortness of breath, the difficulty blowing air out, the inability to do physical activities -- become more pronounced.

Often, more than half of lung functioning is lost before a diagnosis of chronic obstructive pulmonary disease is made. Partly because the condition's patient profile has changed -- it's no longer considered a disease of old men -- and partly because it is fraught with other misconceptions, COPD remains overlooked, even though it is the fourth leading U.S. cause of death.

More than 12 million people are diagnosed with COPD, but at least 12 million more unknowingly have it. "It's absolutely not on anybody's front burner," says Barbara Yawn, MD, a family physician who directs research at Olmstead Medical Center in Rochester, Minn. She also co-chairs the U.S. COPD Coalition, a nonprofit network of organizations dedicated to public education and research. "The primary care physician is focusing on two or three other chronic conditions, and they don't get around to questions of COPD."