Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the term used to describe chronic lung conditions that cause severe shortness of breath and block the airways in your lungs. Usually it refers to long-lasting bronchitis or emphysema, but can also include asthmatic bronchitis (bronchial asthma). All of these diseases cause the air sacs and tubes in your lungs to become blocked.

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With chronic bronchitis, a constant cough that produces mucus causes bronchial tubes to become inflamed. Eventually, scar tissue forms in the lungs, which don’t allow in as much oxygen as you need. With emphysema, the walls of your lungs lose their elasticity — they can’t constrict to allow you to exhale. People with COPD can have either or both of these diseases.

The main risk factor for COPD is smoking. There is no cure for COPD, and while treatments may help control symptoms, they can’t undo the damage to the lungs. The most important thing you can do to prevent COPD or to stop the damage from getting worse if you have it is to not smoke.

Signs and Symptoms

Ongoing cough, often with phlegm that may be hard to “bring up”

  • Shortness of breath, especially during exercise
  • Production of increased mucus
  • Difficulty exhaling
  • Wheezing
  • Frequent respiratory infections

Causes

Smoking is the primary cause of COPD. It can also be caused by exposure to pollutants or toxic chemicals. One rare form of COPD is inherited (see Risk Factors).

Risk Factors

  • Smoking — the longer you smoke and the more packs of cigarettes you smoke, the higher your risk. People who smoke pipes and cigars, and those who are exposed to large amounts of secondhand smoke, also have greater risk.
  • Genetics — people with a rare hereditary disorder called alpha-1 anti-trypsin deficiency lack an enzyme that helps protect the lungs from damage
  • Being over age 50
  • Exposure to toxic chemicals such as silica or cadmium
  • Working around industrial smoke, excessive dust, or other air pollutants (for example, miners, furnace workers, and grain farmers)

Diagnosis

Your doctor will listen to your chest for wheezes and decreased breath sounds. He or she will also look for signs that you are having trouble breathing, like flaring of your nostrils and contracting of the muscles between your ribs. Your respiratory rate — number of breaths per minute — may be high.

Your doctor may order tests to determine your lung function. The most common test is spirometery, where you’ll be asked to blow into a tube connected to a machine called a spirometer. The spirometer measures how much air you have in your lungs, and can help detect COPD before your symptoms become obvious.

Your doctor may also order a chest x-ray will to look for over-expanded areas in the lungs; a CT scan to check the severity of your COPD; an examination of your sputum; or a blood test to measure the levels of oxygen and carbon dioxide in your blood.

Preventive Care

  • If you smoke, quit.
  • If you have COPD, avoiding respiratory infections is very important. Your doctor will recommend that you receive an influenza vaccine (flu shot) each year and a pneumococcal vaccine to protect you from pneumonia.
  • Eating foods rich in antioxidants, magnesium and other minerals, and omega-3 fatty acids (including fruits, vegetables, and fish) may help lower your risk for COPD.

Treatment Approach

Not smoking is the key to preventing COPD or stopping it from getting worse. Treatment varies depending on the severity of the disease. Your doctor may talk with you about lifestyle changes you can make to help relieve the symptoms of COPD, such as exercising and eating a healthy diet. Support groups or therapy (see Mind/Body Medicine) can help make it easier to live with the condition.

Lifestyle

Quitting smoking is crucial. Other lifestyle measures you can take include dietary changes and exercise as described below.

Diet

People with COPD often lack essential nutrients in their bodies. Low levels of antioxidants and certain minerals including vitamins A, C, and E, potassium, magnesium, selenium, and zinc are associated with having COPD and may contribute to poor lung function. Eating lots of fruits, vegetables, and whole grains is recommended to get the nutrients you need.

Exercise

Although it may seem strange to recommend exercise when you have trouble breathing, exercise does help many people with COPD. By strengthening your legs and arms and improving endurance, you may be able to breathe better. Walking is a good exercise to build endurance. Talk to your doctor and respiratory therapist about how to build up slowly and safely. Participating in pulmonary rehabilitation is the best way to learn exercise and safe breathing techniques (see below).

Breathing

There are breathing exercises — for example, a pursed lip technique, breathing from the diaphragm, or using a breathing device called a spirometer twice a day — that may help improve lung function. You can also learn which breathing and relaxation techniques work best when you are short of breath. Talk to your doctor about working with a respiratory therapist in order to learn such exercises.

Medications

None of the current medications for COPD has been shown to stop the long-term decline in lung function. However, there are several types of medications used to control symptoms.

  • Bronchodilators — increase airflow by opening airways and making it easier to breathe
  • Corticosteroids — reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe COPD
  • Leukotriene modifiers — help prevent inflammation and swelling in airways, and reduce mucus
  • Antibiotics — used to treat respiratory infections
  • Combination therapy — taking inhaled corticosteroids and bronchodilators together is an effective treatment in stable COPD

Surgery and Other Procedures

When flare ups are severe, requiring hospitalization, you may need supplemental oxygen. At later stages of the disease, many people with COPD need continuous oxygen at home.

Lung reduction surgery is a procedure where a surgeon removes damaged parts of your lung to create more space for your lung to work better. A lung transplant is sometimes done for severe cases of COPD.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable health care provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

  • N-acetylecysteine (NAC, 400 – 1,200 mg per day)
    NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies using it to treat COPD suggest that it may help relieve symptoms by acting as an antioxidant in the lungs. Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis. NAC also helps to thin mucus and lessen symptoms. Some doctors think NAC may be absorbed into the mucus in the lungs and make the lungs more resistant to bacterial infections. Do not take NAC if you take nitroglycerin.
  • Magnesium
    People with COPD often have low levels of magnesium. Lack of magnesium may be associated with poor nutrition — often a problem for people with COPD — or it may be caused by drugs taken to manage COPD. Magnesium is important for normal lung function. One study found that giving intravenous (IV) magnesium to people who were having a flare-up of COPD helped them breathe easier and reduce the number of days they spent in the hospital. Scientists don’t know whether taking magnesium orally would have the same effect. Your doctor may recommend checking your magnesium level through a simple blood test if you have COPD and taking magnesium supplements if your levels are low. Magnesium can lower blood pressure and cause diarrhea, and it interacts with a number of medications. Talk to your doctor before taking magnesium supplements.
  • L-carnitine
    A few studies suggest that L-carnitine may help people with COPD increase the amount they can exercise. People with hypothyroidism or a history of seizures should not take l-carnitine. Taking l-carnitine may increase the effects of the blood-thinner warfarin (Coumadin) and possibly other blood-thinners.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine. Also, be sure to talk to your physician about any herbs that you are taking or considering taking.

  • Eucalyptus (Eucalyptus globulus) — is frequently used in cough drops and acts as an expectorant, which means that it loosens phlegm in your lungs. A combination of eucalyptus, a kind of citrus oil, and an extract from pine called essential oil monoterpenes has been studied for respiratory problems. In one study, essential oil monoterpenes appeared to help prevent acute flare ups of chronic bronchitis. Breathing in strong concentrations of eucalyptus oil may be irritating. Do not take eucalyptus oil by mouth.
  • Ginseng (Panax ginseng, 100 mg per day) — One study suggested that taking ginseng helped people with COPD improve their exercise tolerance and lung function, but more studies are needed to see if there is any real benefit. Ginseng may lower blood sugar levels, so people with diabetes should ask their doctor before taking it. Ginseng increases the risk of bleeding, especially if you already take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Ginseng can also interact with a number of other medications, so it’s best to talk to your doctor to see if ginseng is safe for you. Some people may find ginseng to be stimulating and that it makes insomnia worse. Do not take ginseng if you are pregnant or breastfeeding, or if you have a history of or are at risk for hormone-related cancers such as breast cancer, uterine cancer, or ovarian cancer.
  • Lobelia (Lobelia inflata)
    Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should not be used except under a doctor’s supervision. Lobelia can interact with lithium and other medications.
  • Mullein (Verbascum densiflorum, 3 g per day)
    Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for COPD.

Acupuncture

Preliminary studies suggest that acupuncture may help relieve shortness of breath in those with COPD. More research is needed.

If you are trying to quit smoking, acupuncture can help you break the habit.

Mind/Body Medicine

  • COPD is a difficult disease to live with, and joining a support group where members share common experiences and problems can help relieve stress of the disease.
  • Yoga and tai chi use deep breathing techniques and meditation, and may be helpful for someone with COPD. Ask your doctor whether these practices are right for you.
  • Relaxation techniques may help reduce anxiety and shortness of breath associated with COPD.

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