Unfortunately, Black people in the US are more susceptible to many diseases. One of them is a chronic obstructive pulmonary disease, COPD. Many with African ancestry are at higher risk because of physical characteristics, family history, socioeconomic status, and, if applicable, cigarette smoking. Because the disease has most likely progressed significantly once symptoms are apparent, African Americans should reduce their risk if at all possible and know the most common symptoms to ensure an early diagnosis. This is vital for the most effective disease control measures.
What is COPD, and why are African populations so vulnerable? Keep reading to learn more.
What is Chronic Obstructive Pulmonary Disease?
It is important to note that while asthma is also an obstructive pulmonary disease, COPD is a progressive disease. In contrast, asthma can be controlled and, in some cases, reversed with medication and lifestyle changes.
Chronic Bronchitis
Bronchitis is caused by irritation and swelling of the bronchial tubes inside the lungs. The inflammation leads to mucus buildup, and the narrowed tubes become difficult to breathe through. When chronic, this condition is easily recognized by a “smoker’s cough.” Although it is common for smokers to develop this type of chronic obstructive pulmonary disease, smoking is not the only risk factor.
Emphysema
Emphysema is another chronic obstructive pulmonary disease marked by worsening shortness of breath. Alveoli, or the small air sacs within the lungs, are damaged and then rupture, leading to shortness of breath that worsens as the disease progresses. This is caused by more and more air becoming trapped in the lungs as they lose elasticity.
Symptoms of COPD
According to the Mayo Clinic, most patients don’t present with symptoms of chronic obstructive pulmonary disease until there is significant damage to the lungs, making disease control more difficult. Those who smoke, are exposed to secondhand smoke, or are subjected to chemicals and other workplace hazards should be evaluated often for signs of lung disease.
While chronic bronchitis and emphysema will each present with unique symptoms, you should be familiar with the general list of symptoms below. If you experience most or all of these symptoms or know someone who does, the first step is to quit smoking, and the next is to see your physician.
- Shortness of Breath: This shortness of breath often worsens with physical activity and worsens as the disease progresses.
- Wheezing: At first, wheezing may only be heard with a medical exam, but it slowly becomes louder and more chronic.
- Persistent Cough: A cough that never goes away indicates something is wrong, and you should see a medical provider as soon as possible. Those caused by COPD may be managed in the early stages of the disease.
- Chest Tightness: Tightness is typically caused by the lungs overfilling with air as it becomes more difficult to empty them when exhaling fully. It can become more uncomfortable with physical exercise.
- Frequent Infections: Both chronic bronchitis and emphysema are known to cause recurrent respiratory infections noted by off-color sputum.
- Swelling of the Lower Body: Swollen feet, ankles, or legs could indicate poor circulation caused by overfilled lungs putting pressure on the heart.
- Unintended Weight Loss: Most patients with COPD lose weight in the later stages of the disease.
- Lack of Energy: It’s common for those with COPD to experience low energy levels as their blood oxygen levels decrease.
Racial Disparities in Self-Reported COPD
The American Journal of Managed Care (AJMC) recently reviewed a study initially published by the International Journal of Chronic Diseases. Nearly 130,000 Americans over 50 were asked to self-report on various demographics and health conditions. These included things like age, race, gender, and height but also their socioeconomic factors. All those polled had never smoked, and the study aimed to determine what variables outside of cigarette smoking were most prevalent. The study also provided insight into the racial and gender disparities in COPD diagnoses.
Their initial assumption was that chronic obstructive pulmonary disease would mimic many other medical conditions and affect various ethnic groups and genders disproportionately. The new study proved it correct, with women and Black Americans more likely to develop COPD than white men or African American men.
Risk Factors for COPD and Related Respiratory Disease
The various risk factors put women and the Black population at higher risk of developing COPD. Black people are disproportionally affected by many of these risk factors, and a vast majority may experience more than half.
Physical Characteristics
African Americans, especially women, have a shorter sitting height. A shorter torso may contribute to the disease by affecting how well the lungs are clear of cigarette smoke. If it is challenging to expel much of the nicotine, especially compared to other ethnic groups, this may explain why they are more susceptible to the disease. Lower lung capacity before developing the disease could also make disease control more difficult once the damage starts.
Family History
Because Black people are already more susceptible to chronic bronchitis and emphysema, knowing their family history is essential. Family members, especially children, will be at higher risk for developing chronic obstructive pulmonary disease as they age.
Economic Issues
COPD is a progressive disease that can affect many Black patients simply because of their socioeconomic status, the location of their Black community, or their access to health insurance and adequate COPD treatment options.
Many African American communities have a limited number of healthcare clinics and an increased cost of care. This has become a growing public health concern. Lower middle-class families may live in multi-unit buildings without adequate air filtration, causing indoor air pollution, or even live with many family members who smoke in a single home.
Racial equality in healthcare has improved slightly over recent years, but disparities in access to healthcare have negatively impacted many African Americans in the US. Different ethnic groups, like Hispanics and Native Americans, also suffer from similar disparities in healthcare that can affect their access to a proper diagnosis and treatment for chronic illnesses such as COPD.
Smoking
Black people metabolize cigarette smoke differently. In a clinical investigation performed in 1998, it was determined that nicotine and related substances stay in the body longer for those with African ancestry compared to those with mostly European ancestry. While these substances are present, they are more likely to cause damage associated with COPD and related lung diseases.
The American Lung Association reports that the smoking rate between Black Americans and non-Hispanic whites is fairly similar. However, over three-quarters of Black smokers choose menthol cigarettes which makes it much easier to start smoking and also harder to quit. It’s also been found that menthol cigarette smoking leads to more severe lung inflammation than non-menthol.
Because of these smoking statistics, it’s also easy to assume that more African Americans will be subjected to secondhand smoke, whether in their homes when living with a smoker or in their communities.
Treatment Options for Those With COPD
The first step in the treatment of COPD is to stop smoking. As the leading cause of COPD, continuing will cause the disease to worsen more quickly, making any other treatment options less effective. Because there will likely already be significant damage to the air sacs and bronchial tubes by the time you experience symptoms, disease control will likely include short- and long-acting inhalers.
In addition to inhalers, most of those with COPD take medications to loosen and thin the phlegm that develops in the lungs, making it easier to cough up and clear the airways. Theophylline is a medication that helps to reduce the inflammation in the airways, making it easier to breathe and for the lungs to absorb needed oxygen. Steroids and antibiotics are used short-term to resolve flare-ups of symptoms or for common respiratory infections.
Pulmonary rehabilitation includes exercise and lifestyle changes to help improve daily functioning. With dietary changes, mental health counseling, education for both you and your caregivers, plus physical exercises, you may be able to slow disease progression. You will likely work with a team of experienced providers once your physician has referred you for a pulmonary rehabilitation program.
COPD Prevention
Because Black Americans are at higher risk for different reasons than white people and many other groups, prevention measures are also different. Yes, stopping smoking is important, but prevention also includes better access to preventative healthcare and healthcare education in low-income communities. Supportive resources to quit smoking, better health insurance coverage, and access to more local health clinics should be a major focus in these communities.
COPD and Black People
Black African populations are at higher risk of developing COPD, but there are ways you can help lower that risk for yourself and your family. As organizations like Black Health Matters continue raising awareness of the disparities affecting our communities, public health concerns like this can’t remain hidden. Instead, those communities can improve access to health education and resources through economic growth and improved race relations.
