COPD

Respiratory

COPD, or chronic obstructive pulmonary disease, is a chronic inflammatory lung disease that obstructs the airflow within the lungs. In the United States, COPD is estimated to affect between 16-24 million people and is the third leading cause of death. Currently, more women than men are dying of the disease. This progressive inflammatory condition is actually a group of diseases (including bronchitis and emphysema) that cause restricted airflowand breathing-related problems. The disease causes the lungs to overproduce mucus and makes breathing difficult. People with COPD will experience respiratory difficulties, including frequent coughing or wheezing, shortness of breath, and excessive phlegm, sputum, and mucus production. Adults living with COPD are prone to emergency room visits and live with limited abilities due to dependence on portable oxygen to supplement their limited air supply. The biggest risk factor for COPD is smoking. Quitting smoking and early detection of COPD may stop the disease from progressing and the lungs recover from damage.

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Symptoms

Early in the disease, COPD symptoms are subtle and may appear very slowly. Because the disease is progressive, the symptoms worsen over time with severe life-changing effects in the later stages of the disease. The symptoms of COPD include:

  • Productive cough that does not ease up
  • Wheezing or squeaking in the lungs
  • Trouble catching your breath after exercise
  • Tight feeling in your chest
  • Excessive and repeated cases of; bronchitis, colds, and flu

Symptoms are different for everyone. The most common symptoms that people experience are repeated respiratory illnesses or symptoms of allergies that do not seem to clear up.
When COPD becomes more severe, many of the symptoms are too hard to control and this is when people seek medical care. Unfortunately, this is far after the permanent lung damage has happened. Later symptoms include:

  • Decreased oxygen levels (below 90%)
  • Blue discoloration to the lips or fingers
  • Rapid heartbeat
  • Shortness of breath even at rest
  • Confusion or memory loss

These symptoms need emergency medical help. If you cannot catch your breath and notice blue discoloration to the lips or fingers, call 9-1-1 right away.

Types

The two main forms of chronic obstructive pulmonary disease are chronic bronchitis and emphysema.

Emphysema. Emphysema causes damage to the walls of the alveoli – the air sacs of the lungs that exchange oxygen and carbon dioxide. In patients with emphysema, the alveoli are no longer elastic, and the walls weaken and become loose. Most of the air sacs open and join with other air sacs and there is less gas exchange. When you have emphysema, it is extremely hard to get the air in and out of the lungs.

Chronic bronchitis. This is a chronic inflammation of the airways. The lungs overproduce copious amounts of mucus that clog and block the airways. It causes you to frequently cough to bring up the mucus.

Risk Factors

The risk factors are similar to the causes. Certain behaviors and preexisting conditions increase the risk of developing COPD. These include:

  • Smoking
  • Seasonal allergies
  • Chronic bronchitis
  • Asthma
  • Age
  • Family history(i.e., alpha-1 deficiency, chronic bronchitis, asthma)

Diagnosis

In the beginning, COPD is often misdiagnosed as seasonal allergies, bronchitis, or asthma. COPD is often diagnosed in the later stages of the disease when your symptoms cannot be controlled, or when your doctor notices the number of visits you have had for respiratory illness over a course of time. The tests for COPD include:

Pulmonary function studies. Your physician will perform a preliminary test in the office by having you blow into a spirometer to measure the volume of air coming from the lungs. If the volume is low, they may give you a breathing treatment and have you use the spirometer again to recheck the results. If you are having a problem, you may be sent to the pulmonary testing lab for an additional detailed spirometry test that measures specific details about your lung function.

Pulse oximetry. Your physician may also order you to have your pulse oximetry measured overnight. A technician will bring a pulse oximetry machine that records your oxygen. A small light source that reads oxygen will be placed on your finger while you sleep.

Arterial blood gases. You may be sent to the lab for a blood gas analysis to measure the amount of oxygen and carbon dioxide in your blood. This test involves taking a small sample of blood from the artery in your wrist.

Chest X-ray. If the doctor believes the cause of your COPD is emphysema, a chest x-ray will show the damage to the air sacs. This x-ray can also reveal an enlarged heart (a sign of congestive heart failure) that can also cause a moist cough.

CT scan. A CT scan shows more details in the lungs than a chest x-ray. It may help the doctor decide between emphysema and chronic bronchitis as the cause. It can also detect lung cancer.

Treatments

If you are diagnosed with COPD, know some treatments can help manage the disease and slow the progression. If the disease is caught early, your doctor may prescribe an inhaler to be used for emergencies and order you to quit smoking. There are very effective treatments to manage advanced COPD in later stages. The important thing is to follow your treatment plan decided by you and your doctor. Treatments include:

Quit smoking. The number one first line of treatment to start with is to quit smoking if you do smoke, don’t start smoking and avoid all forms of second-hand smoke. If you have COPD or are at high-risk you should not smoke or be near smoke. Talk to the doctor about getting help with quitting.

Medications. If necessary, your doctor will prescribe medications to help improve your breathing and decrease your cough. Medications are not a cure for COPD, but they can make you more comfortable and improve your lung function and help prevent complications.

Inhaled bronchodilators. Inhaled bronchodilators can help to relax and open up the airways. They help improve your breathing and reduce your cough. Some people only need a short-acting inhaler before and after physical activity, and/or the doctor can add something more long-acting to relieve your symptoms for the whole day. They come in two forms: an inhaler, and a nebulizer machine.

Steroid inhalers. Steroids are powerful anti-inflammatories and do not work to increase breathing right away but can work overtime to reduce the inflammation in the airways. Steroid inhalers put the steroid right on the lung tissue and over time can relieve symptoms of COPD. Used early on in the disease, they can help slow the progression.
They do have sideeffects that include fungal infections in the mouth, easy bruising, and a hoarse voice.

Combination medications. The doctor can prescribe an inhaler that uses both steroids to reduce inflammation and a bronchodilator to open the airways.

Corticosteroids (oral). For acute attacks of COPD, the doctor may choose to give you an oral steroid for the short-term to rapidly reduce the inflammation and make your breathing better over a week. These are only used if necessary and never for long periods due to the risk of sideeffects that include bone thinning, risk of infection, high blood sugar, and weight gain. People who use oral steroids often are at increased risk of death due to COPD.

Theophylline. This medication can help open up the airways by relaxing the muscles in the lungs, lessening response to things that irritate the airways, and increases the flow of air. Some side-effects include headache, shakiness, rapid heart rate, nausea, and headache. The lower the dose the fewer side-effects.

PDE-4 inhibitors (phosphodiesterase-4). These medications inhibit the cells in the immune system that break down lung tissue. They are most often used in chronic bronchitis type COPD that has severe symptoms. They help reduce inflammation in the lungs and improve airflow. The side-effects include weight loss and diarrhea.

Antibiotics. People may get repeated bacterial infections along with COPD that can worsen the condition. In cases of pneumonia, acute bronchitis, or even influenza (virus) the doctor may choose to place you on antibiotics. In the case of them being used in viral infections, it is thought that antibiotics may help relieve the inflammation.

Oxygen. In severe cases when oxygen levels fall below 90%, you may need to be on supplemental oxygen. Some people only need oxygen at night or during physical activity, or some need oxygen around the clock. Pulmonary function studies will tell the doctor how often and how much oxygen you will need.

Pulmonary rehab. You may need a special type of physical therapy to help you learn how to take care of yourself with COPD. They will teach you exercises that will help you improve your lung capacity, give you dietary advice, and how to do physical activities without losing too much oxygen or energy.

Surgical intervention. In severe cases, there are a few types of surgery that can help improve lung function. These include:

Lung volume reduction. The surgeon will remove some of the damaged tissue and make more space for the healthy part of the lungs to work better.

Lung Transplant. Some people qualify for a healthy lung transplant that can improve their quality of life and help them breathe better. Risks of lung transplant includerejection, infection, bleeding, and the need for immunosuppressants for life.

Alternative Treatments and Home Remedies

Living with COPD can be very difficult, especially when you are not able to perform any physical activity without feeling out of breath and not like your full self. There are some natural treatments available for you to help improve your quality of life alongside the treatment regimen you have established with your doctor. Here are some alternative treatment suggestions that may help you manage your symptoms and feel less fatigued and breathless when you move. Always discuss any natural treatment, supplements, or herbs you are taking with your doctor before trying them.

Nutrition. The best way to receive nutrients is through your food. Eating fresh fruit and vegetables combined with a low-fat/high-fiber diet will help you to build a healthy immune system and give you more energy throughout the day. Avoiding mucus-producing foods like dairy may also improve your symptoms.

Vitamins. Vitamin D deficiency is common in people with COPD. Talk with your doctor to see if you are deficient and then supplement accordingly. Vitamins A and C are valuable antioxidant and anti-inflammatory vitamins that may boost your immune function and reduce inflammation. These vitamins are found in dark leafy green vegetables, salmon or other fatty fish, broccoli, berries, and citrus fruit. Vitamin E has been shown in research to protect against cell damage and improve the strength of the vascular system.

Eucalyptus oil. This essential oil helps to clear nasal passages, break up congestion, and expel phlegm.

Herbal remedies. Some herbal remedies that help improve COPD symptoms are ginger, peppermint, oregano, and red sage. Peppermint contains the active constituent menthol which helps to relax the muscles in the respiratory tract and open airways. Red sage has been found in studies to promote healing in injured blood vessels, help people with low blood oxygen levels, and is a valuable antioxidant.

Prevention

If you are at risk, or even if you aren’t, taking the steps to prevent COPD will protect your delicate lungs. Try these helpful tips:

Quit smoking or don’t start smoking. This is the number one cause of COPD and not starting or quitting greatly reduces your risk.

Eat healthy and exercise. This will keep the cells in your lungs healthy and exercise keeps your lungs strong.

Treat asthma and allergies. Over time, asthma and respiratory allergies can damage your lung tissue. Follow a good “asthma treatment plan” and treat any seasonal respiratory allergies that lead to coughing or bronchitis.

Get your influenza and pneumonia vaccines. Preventing repeated respiratory illness can help reduce the wear and tear on your lungs.

Breathe clean air. Avoid dust, fumes, and chemicals. Use a respirator if you work around these things. Keep your house dust-free and stay inside on “air alert” days.

Lifestyle Changes

COPD does require lifestyle changes that help you get the most oxygen and conserve your body’s energy. If you make the following changes, living with COPD is much easier and you prolong your lifespan:

  • Quit smoking and stay away from second-hand smoke
  • Stay inside on “bad-air” days if you live in a high pollution (smog) area
  • Get your annual flu shot
  • Stay away from people who are sick
  • Eat a healthy well-balanced diet
  • Ask about exercises for people with COPD
  • Talk to someone about your feelings to help reduce anxiety and depression

References

American Lung Association. (2014, May). Chronic obstructive pulmonary disease fact sheet. Retrieved from American Lung Association: https://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html?referrer=https://www.google.com/

Centers for Disease Control and Prevention. (2018, June 18). Chronic obstructive pulmonary disease. Retrieved from Centers for Disease Control and Prevention:https://www.cdc.gov/copd/index.html

Mayo Clinic. (2015, July 21). COPD: Risk Factors. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/copd/basics/risk-factors/con-20032017

National Heart, Lung, and Blood Institute. (2013, July 31). What is COPD? Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/health-topics/topics/copd

The University of Maryland. (2013, July 31). Chronic Obstructive Pulmonary Disease. Retrieved from University of Maryland: https://umm.edu/health/medical/altmed/condition/chronic-obstructive-pulmonary-disease

Vijayasaratha, K. &Stockly, R. A. (2007, March). Causes and management of exacerbations of COPD. Breathe, 3(3). Retrieved from: https://breathe.ersjournals.com/content/breathe/3/3/250.full.pdf

Wu, T. C., Huang, Y. C., Hsu, S. Y., Wang, Y. C., Yeh, S. L. (2007, July). Vitamin E and vitamin C supplementation in patients with chronic obstructive pulmonary disease. International Journal for Vitamin and Nutrition Research,77(4), 272-9 Retrieved from:

https://pubmed.ncbi.nlm.nih.gov/18271282/

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