Many chronic diseases have an age dimension. As we grow older, the body’s ability to repair itself changes, and damage can accumulate in various parts of the body. Cancer, arthritis, cardiovascular disease, Type 2 diabetes, osteoporosis and dementia are all diseases that tend to afflict older adults more frequently than younger adults.
Chronic obstructive pulmonary disease also has an age component. Because this incurable and progressive lung disease usually results from years of damage to the tissues of the lungs, it’s more common in older adults. The Mayo Clinic reports that “most people are at least 40 years old when symptoms begin.” These symptoms include shortness of breath, especially when engaging in physical activity, wheezing or chest tightness, a chronic cough, lack of energy and frequent respiratory infections. These symptoms may be mistaken for simple signs of aging, but over time they will increase to the point of requiring treatment. And if it’s COPD, it’s not just age – the symptoms are being caused by real damage to the lungs that can’t be reversed but can be managed to maintain a better quality of life.
A lengthy history of cigarette smoking is the biggest risk factor for developing COPD, but the National Heart, Blood and Lung Institute reports that about 15 percent of COPD patients have never smoked. These people may have encountered occupational hazards such as coal dust or other airborne particles that damaged the lungs, or had other exposures to inhaled irritants that did permanent damage to the inside of the lungs.
Although COPD can be considered a disease of aging, there are some other factors that can lead to COPD at a younger age in some people.
One factor that can put nonsmokers and younger people at risk for developing COPD is a genetic condition called alpha-1 antitrypsin deficiency. Patients with this hereditary condition have a delivery problem with alpha-1 antitrypsin enzyme. The liver manufactures the enzyme, but it can’t exit the liver properly, so it’s not delivered to the lungs where it does most of its work. This can lead to problems with both the lungs and the liver.
“Alpha-1, for short, is primarily a genetic condition that increases the risk of things injuring the lung and liver that normally wouldn’t injure them,” says Dr. Robert Sandhaus, pulmonologist at National Jewish Health in Denver.
“People with this deficiency are 100 times more sensitive to the effects of cigarette smoke,” he says. However, even in the most severe cases, some people “can have severe alpha-1 deficiency and never have a sick day in their life,” or they can “have a single cigarette” that leads to emphysema.
Dr. Umur Hatipoglu, director of the COPD Center at the Respiratory Institute at Cleveland Clinic, explains that alpha-1’s “main effect is to neutralize a group of enzymes that digest lung tissue, such as neutrophil elastase. So when you have alpha-1 antitrypsin deficiency, these enzymes that digest the lungs are unopposed.” He says patients who don’t smoke, don’t have recurrent lung infections, aren’t exposed to other noxious gases or fumes or otherwise have little inflammation in the lungs are less likely to develop COPD even with the alpha-1 antitrypsin deficiency. However, “if you’re smoking or you’re exposed to other stimuli, you’ll get emphysema very early in life,” with this genetic condition.
In patients with AAT deficiency, treatment may include supplementing the body’s levels of the alpha-1 antitrypsin enzyme. Because this treatment can help slow the progression of the disease in patients with the deficiency, “it’s important that alpha-1 antitrypsin deficiency be screened for among patients with COPD. Everyone with COPD should be checked for alpha-1 antitrypsin deficiency at least once,” Hatipoglu says.
Although most people don’t know they have this deficiency until after COPD has been diagnosed, if a parent has COPD, find out whether he or she has the deficiency. If so, you’re more likely to have this genetic condition as well, so you may want to be tested for it even if you haven’t been diagnosed with COPD yet.
A History of Asthma
Another reason that some patients may develop COPD at an earlier age is having a history of asthma prior to age 40. “In fact, we’re calling patients who have features of asthma and COPD together Asthma-COPD Overlap Syndrome now,” Hatipoglu says. “And it seems that a large majority of these patients had a history of asthma before age 40.”
Although asthma and COPD share some symptoms, they are different diseases. According to the National Center for Health Statistics, asthma affects 8.4 percent of children and 7.6 percent of adults in the United States. The National Heart, Lung and Blood Institute reports that asthma "inflames and narrows the airways," causing "recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing."
Over time, it can lead to a process called airway remodeling – long-term swelling and scarring of the airways.
A 2004 study published in the journal CHEST found that "as compared with non-asthmatics, active asthmatics had a 10-times-higher risk for acquiring symptoms of chronic bronchitis, 17-times-higher risk of receiving a diagnosis of emphysema, and 12.5-times-higher risk of fulfilling COPD criteria, even after adjusting for smoking history and other potential confounders." Chronic bronchitis and emphysema are the two primary diseases that fall under the umbrella diagnosis of COPD.
History of Respiratory Infections and Airway Hyper-Responsiveness
Even if you didn't have asthma as a kid, if you had a lot of respiratory infections, that also puts you at higher risk of developing COPD at a younger age. That’s according to the findings of a 2010 study published in the American Journal of Respiratory and Critical Care Medicine. The study included 4,636 subjects without asthma between the ages of 20 and 44 years of age. “Although about half of the cases [of COPD] had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39 percent of the new cases.” A pack year means having smoked 20 cigarettes (one pack) per day for one year, or 40 cigarettes (two packs) per day for half a year.
The study also found that “airway hyper-responsiveness was the second strongest risk factor (15 to 17 percent of new cases).” Airway hyper-responsiveness is a common feature of asthma and refers to a heightened sensitivity to inhaled irritants. “Other determinants were respiratory infections in childhood and a family history of asthma.” Still, the authors note, “cigarette smoke is the most important risk factor for COPD also among young adults,” and “the association observed between smoking and the incidence of COPD is more likely to reflect an early interaction of the tobacco exposure with some genetic or immunologic host characteristics, rather than the effect of the cumulative exposure to cigarette smoke per se.” In other words, science still isn’t sure why cigarette smoking causes COPD in some people but not others and why it might come on faster in certain patients, but it’s probably because of individual differences in physiology and genetic makeup.
Does Treatment Differ in Young Versus Old?
No matter how old you are at the time of diagnosis, the treatment protocol your doctor prescribes will depend on the stage and severity of your COPD. Treatment typically includes pulmonary rehabilitation – a combination of education, counseling and exercise. You may also be prescribed an inhaler to open the airways and/or bring down inflammation. Some patients will also take anti-inflammatory drugs or oral steroids to help control inflammation in the lungs. In some severe cases, patients may undergo surgery to remove damaged lung tissue.
Lastly, the Lung Institute reports that “good advice for anyone at any age, but especially someone entering middle age with COPD is this: Quit smoking now. The progression of COPD can be slowed in patients who quit smoking.” The Lung Institute also recommends keeping your home dust free, not burning wood in the fireplace, fixing water-damaged areas to prevent mold from developing and avoiding air pollution.