“I get a little winded walking up the hill, Doc. But I’m 70. What do you expect?”
I heard versions of that sentence many times during my years in practice.
And sometimes the person was right. We do lose some lung capacity as we get older. Our chest wall becomes a little stiffer. Our breathing muscles may weaken. We may not be able to exercise quite as hard as we did at 30.
But there is an important point I want you to remember: Getting older does not automatically explain shortness of breath.
Sometimes breathlessness is a sign that something else is going on. One possibility is COPD—chronic obstructive pulmonary disease. Nearly 16 million American adults have been diagnosed with COPD, and many more may have it without knowing it. The disease often develops slowly. That makes it surprisingly easy to miss.
What Exactly Is COPD?
COPD is not one single disease. It is a term used for chronic lung disease that causes persistent problems moving air through the lungs.
Two conditions commonly associated with COPD are emphysema and chronic bronchitis.
Emphysema
Deep inside your lungs are millions of tiny air sacs called alveoli. Think of them as tiny balloons. When you breathe in, oxygen passes through these air sacs into your bloodstream. When you breathe out, carbon dioxide leaves your body.
With emphysema, the walls between some of these air sacs are damaged or destroyed. The lungs also lose some of their natural springiness.
That can make it harder to push air out. You may be able to breathe air in, but getting all of it out becomes more difficult. Air can become trapped inside the lungs.
Chronic Bronchitis
Chronic bronchitis mainly affects the breathing tubes that carry air through your lungs.
These airways can become inflamed, thickened, and filled with excess mucus. That makes it harder for air to move freely.
The classic definition of chronic bronchitis is cough and mucus production for at least three months a year during two consecutive years, although people can have significant airway disease without fitting neatly into that definition.
Many people with COPD have features of both emphysema and chronic bronchitis.
Smoking Is the Biggest Risk—But Not the Only One
When most people hear COPD, they immediately think of cigarettes. There is good reason for that. Cigarette smoking remains the leading cause of COPD in the United States.
But here is something many people don’t realize: You can develop COPD even if you never smoked.
As many as one in four Americans with COPD have never smoked cigarettes.
Other possible risk factors include long-term exposure to:
- Secondhand smoke
- Dust
- Chemical fumes
- Workplace pollutants
- Outdoor air pollution
- Smoke from wood or other fuels
Certain jobs may involve years of exposure to dust, fumes, vapors, gases, or chemicals that can damage the lungs over time.
There is also a genetic condition called alpha-1 antitrypsin deficiency that can increase the risk of emphysema, sometimes at a younger age.
So don’t automatically dismiss COPD simply because you never smoked.
COPD Can Sneak Up on You
One reason COPD can go unnoticed is that it usually doesn’t appear overnight. It develops gradually. At first you might notice that climbing stairs feels harder. So you start taking the elevator. Walking uphill makes you winded. So you choose a flatter route. You can’t keep up with your spouse anymore. So you tell them: “Go ahead. I’ll catch up.”
Without realizing it, you may slowly change your life to avoid activities that make you short of breath.
Then you explain the change by saying: “I’m just getting older.”
That is exactly where COPD can hide.
Symptoms You Should Pay Attention To
COPD symptoms can vary, but common ones include:
- Shortness of breath during activity
- A persistent cough
- Regular mucus or phlegm
- Wheezing
- Chest tightness
- Frequent respiratory infections
- Increasing fatigue
- Gradually decreasing ability to exercise
Shortness of breath with physical activity is especially common.
None of these symptoms automatically means you have COPD.
Heart disease, asthma, anemia, obesity, deconditioning, infections, and other medical conditions can also cause breathlessness.
That’s why persistent or worsening shortness of breath deserves an evaluation rather than an assumption.
“But Doc, I’m 70. Aren’t I Supposed to Get Winded?”
This is the part I really want you to remember. Some decline in lung function occurs with normal aging. But significant breathlessness that limits your normal activities should not simply be blamed on your birthday.
Ask yourself a better question: Am I becoming more short of breath than I used to be?
Maybe you could walk two miles comfortably last year, but now you’re stopping after half a mile. Maybe one flight of stairs suddenly feels like three. Maybe you’re avoiding activities you used to enjoy because breathing has become uncomfortable.
Those changes matter.
Your age may contribute. But age should not automatically be the diagnosis.
A Simple Test Can Help Find COPD
If your symptoms and history suggest COPD, one of the most important tests is called spirometry. It’s painless and relatively simple. You take a deep breath and blow as hard and completely as you can into a machine called a spirometer.
The test measures how much air you can blow out and how quickly you can blow it out.
One important measurement is called FEV1—the amount of air you can forcefully exhale during the first second.
Another is FVC, the total amount of air you can forcefully blow out after taking a deep breath.
The relationship between those measurements helps doctors determine whether airflow is obstructed. Testing is generally performed before and after medication that opens the airways when COPD is being evaluated.
Current COPD guidelines emphasize that spirometry is needed to confirm persistent airflow obstruction and establish the diagnosis in the appropriate clinical setting.
One important distinction: this does not mean every healthy older adult needs spirometry. Routine COPD screening is not recommended for adults without symptoms. Spirometry becomes particularly useful when someone has breathing symptoms or important risk factors that warrant evaluation.
What If You Do Have COPD?
COPD cannot simply be erased, but there is a lot we can do.
Depending on the individual, treatment may include stopping smoking, avoiding lung irritants, inhaled medications, appropriate vaccinations, regular physical activity, and pulmonary rehabilitation.
Treatment can help control symptoms, improve function, and reduce flare-ups.
And if you currently smoke, quitting remains one of the most important things you can do for your lungs. Continued smoking can accelerate lung damage.
Dr. Mike’s Take
One of the biggest mistakes we can make after 50 is assuming every change in our body is simply caused by aging.m. Sometimes it is. Sometimes it isn’t.
If you are 70 and need a little longer to recover after climbing a steep hill than you did at 30, that doesn’t necessarily worry me.
But if you’re becoming progressively more short of breath, avoiding activities because of your breathing, coughing regularly, wheezing, or producing a lot of mucus, don’t simply say: “Well, I’m getting old.”
Tell your doctor.
It might be COPD. It might be something else entirely. But finding the reason is much better than guessing.
Bottom Line
Your lungs change as you age, but significant or worsening breathlessness should not automatically be considered normal aging.
COPD can develop slowly enough that people adjust their lives without realizing what is happening.
If you have persistent shortness of breath, chronic cough, mucus production, wheezing, or a history of smoking or significant exposure to lung irritants, talk with your healthcare professional about whether further evaluation—including spirometry—makes sense.
Your birth certificate can tell us how old you are.
It can’t tell us why you’re short of breath.