How to Treat COPD

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1Making Lifestyle Changes

2Seeking Medical Treatment

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Article Summary

Chronic obstructive pulmonary disease, or COPD, is an inflammatory lung condition that causes obstructed airflow from the lungs and difficulty breathing. It's triggered primarily by chronic smoking and/or long-term exposure to irritating gases or particulate matter. There are two primary variants of COPD: emphysema or chronic bronchitis. COPD is treatable with specific lifestyle changes and medical management. Preventing or early treatment of COPD reduces the risk of developing heart disease and lung cancer.

Steps

Part 1

Part 1 of 2:

Making Lifestyle Changes

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   Quit smoking. The main cause of COPD in developed countries is tobacco smoking — at least 25% of chronic smokers develop symptomatic COPD. Cigarette smoke contains chemicals that damage the bronchial tubes and air sacs of the lungs, which causes them to lose elasticity. As a result, air is trapped in the lungs during exhalation, essentially making breathing very inefficient. The situation can be acerbated by emphysema, which involves inflammation and overproduction of mucus in the lungs and bronchi.

   • Stopping smoking is the best preventative measure you can take in avoiding COPD, although the addictive qualities of nicotine make it difficult to quit.
   • It often takes many years without smoking for a former smoker to achieve near-full lung health again (similar to that of a non-smoker); however, there is usually drastic improvement in lung health annually for every successful year after quitting.
   • Other related irritants that can cause or acerbate COPD include cigar/pipe smoke and secondhand smoke.
   • Smoking is a factor in 80 to 90% of all COPD-related deaths and is the leading cause of emphysema. Emphysema causes damage to the air sacs (alveoli) in your lungs, making it difficult to breathe. People with emphysema often have a blue hue on their lips and fingernail beds, develop a barrel chest, and experience a reduced appetite and weight loss.
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   Avoid long-term exposure to irritating fumes. COPD is also caused by chronic exposure to irritating fumes, chemicals and air pollution, particularly in developing countries. In poorer regions of the world, people are routinely exposed to fumes and smoke from burning fuel for cooking food and heating their homes. The situation is often compounded due to poorly ventilated dwellings that don't allow the irritating fumes/smoke to dissipate.

   • Try to cook in well-ventilated spaces if you're using fuel (oil, kerosene, gas) or burning wood to prepare food and boil water.
   • Exposure to chemical fumes, smoke and particulate matter (dust, small fibers) from working in an industrial setting is also a relatively common cause of COPD.
   • If you work in a plant, factory or garage with such irritants, use appropriate facial protection and breathing devices to reduce your risk of COPD.
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   Focus on cardiovascular exercises. Although it's difficult to exercise when you have trouble breathing, it can significantly improve the overall strength and endurance of your respiratory muscles. Building up lung strength through cardiovascular exercises helps lung tissue expand and contract better, which makes breathing and exchanging gases (oxygen for carbon dioxide) more efficient. Expect shortness of breath and wheezing initially with exercise, but these common COPD symptoms should fade away as you get more fit.

   • Start with less intense exercise, such as walking around your neighborhood three times per week, then progress to more intense workouts that increase heart and respiratory rates.
   • More intense cardiovascular exercise includes walking on an inclined treadmill, stair climbing, hiking, jogging and swimming.
   • You'll likely be winded at first and have to breathe through your mouth, but as you develop better cardiovascular fitness, try to take deeper breathes through your nose (see below).
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   Perform specific breathing exercises. The breathing pattern of people with COPD tends to be short and shallow due to loss of elasticity in their lung tissues; however, there are two types of breathing patterns that can help promote deeper inhalation/exhalation and provide more comfort: diaphragmatic breathing and pursed-lip breathing. Talk to your doctor or respiratory therapist about learning these breathing and relaxation techniques so you can practice them on a daily basis, particularly to combat shortness of breath.

   • Diaphragmatic breathing involves using your diaphragm and abdominal muscles to push out your stomach with each breath in through your nose, then pushing all the air out through your mouth.
   • You can do diaphragmatic breathing while lying down with your head supported by a pillow. Start with between five to 10 minutes of breathing this way about three to four times daily, then gradually increase.
   • Pursed-lip breathing helps to strengthen the airways and remove trapped air in the lungs by prolonging exhalation through pursed lips.
   • While sitting up in a chair, inhale slowly through your nose, then purse your lips (like you're going to whistle) and exhale slowly through your mouth while counting to four. Practice this technique throughout the day.
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   Clear your airways. In addition to shortness of breath and wheezing, overproduction of mucus is also common with COPD caused by chronic bronchitis. Mucus is produced by goblet cells in the mucus membranes of the bronchi and other lung tissues in response to chemicals and irritants — your body tries to trap and get rid of them; however, the excess mucus collects in your bronchial tubes and contributes to breathing problems. Mucus can be difficult to clear, but clearing your throat, using a humidifier and drinking lots of water can help get rid of it.

   • Having to clear your airways first in the morning is common with COPD, because the mucus collects while you're laying in bed. Propping yourself up with pillows in your bed may help.
   • Productive coughing with COPD often brings up mucus (sputum) that's yellow or greenish.
   • When you have chronic bronchitis, the lining of the bronchial tubes in your lungs becomes swollen. This, along with the increase of mucus, can make it difficult to breathe and lead to a "phlegmy" cough.
   • Other symptoms of COPD due to chronic bronchitis include chest tightness, wheezing, fatigue, frequent respiratory infections, and shortness of breath (especially when exercising).
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Part 2

Part 2 of 2:

Seeking Medical Treatment

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   Get your lungs tested. Get lung testing done through spirometry testing. These test can provide a great deal of information about lung health and which medications would be most helpful in treating your COPD.

   • Spirometry tests how much air you can inhale and exhale and how quickly you can perform these function.
   • In addition, your doctor may wish to perform an x-ray or CT scan, A1AT deficiency tests, and a blood test to measure the amount of oxygen and carbon dioxide in your blood.
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   Ask your doctor about bronchodilators and inhalers. Medications called bronchodilators relax the muscles lining your airways and are usually administered in inhalers. It's a common treatment for asthma, but helpful also for COPD for opening up the airways and making breathing easier. Inhalers are small plastic devices that are positioned over your mouth and shoot the vaporized medication directly into your lungs.

   • Depending on the severity of the COPD, you may need either a short-acting bronchodilator drug before activities, a long-acting one that you use daily, or both.
   • Short-acting bronchodilator medications include: albuterol (ProAir HFA, Ventolin HFA), levalbuterol (Xopenex) and ipratropium (Atrovent).
   • Long-acting bronchodilator medications include: tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza).
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   Consider inhaled steroids. Inhaled corticosteroid drugs can quickly reduce airway inflammation and help combat shortness of breath and wheezing associated with COPD. Corticosteroids can be inhaled like bronchodilator medications or taken orally as pills. Examples of inhaled steroids include fluticasone (Flovent) and budesonide (Pulmicort). Methylprednisolone is an oral steroid. Steroids are useful for people with frequent exacerbations of COPD symptoms.

   • Some bronchodilators can also be combined with inhaled steroids in the same inhaler. Examples of combo inhalers include salmeterol with fluticasone (Advair) and formoterol with budesonide (Symbicort).
   • Corticosteroids can cause significant side effects if used frequently. Common issues include oral oral infections, hoarseness, reduced immune response, weight gain and tissue bruising (or other changes).
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   Consider pulmonary rehabilitation. Your doctor may refer you to a pulmonary rehabilitation program, which will use a combination of exercise and education to help you improve your health and teach you how to manage your COPD once the program has ended.

   • A pulmonary rehabilitation program may teach you about the following: breathing techniques, medications, nutrition, relaxation, oxygen, travel, accomplishing daily tasks, and avoiding things that make your COPD worse.
   • In addition, you may receive counseling and assistance in coping with disorders that often occur as a result of living with COPD, such as depression, panic, and anxiety. You will also meet others with COPD, which can provide a sense of community and support.
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   Receive A1AT replacement therapy if this is causing your emphysema. Though rare, emphysema is sometimes caused by the heredity disorder alpha-1 antitrypsin (A1AT) deficiency. A1AT is a protein that protects the lungs, and those with this disorder do not produce enough A1AT to prevent damage. If you have COPD due to this deficiency, you can receive intravenous augmentation therapy to elevate your A1AT levels.
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   Get oxygen therapy. If there isn't enough oxygen being absorbed in your lungs and into your bloodstream, your doctor may recommend using supplemental oxygen. There are many lightweight and portable units that contain an oxygen bottle and mouth/nose piece for breathing. Some may need oxygen only during activity, others for sleeping and still others full time.

   • Oxygen therapy improves the quality of life and is the only COPD therapy proven to extend lifespan.
   • Patients cannot get oxygen unless they go through formal testing and meet certain criteria. Too much oxygen in COPD patients can be dangerous.
   • Oxygen therapy can protect the heart and other organs from damage due to cyanosis.
   • Oxygen therapy can be administered as a long-term continuous therapy or just for short-term periods of time. Consult your doctor about how many supplemental litres of oxygen you need per day.
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   Consider lung surgery as a last resort. Lung surgery is a last resort for people who have severe and advanced COPD symptoms who have not significantly improved by taking the above-mentioned medicines. Surgery can be very beneficial, especially for those with emphysema. Surgeries for people with emphysema-related COPD include a bullectomy and lung volume reduction surgery (LVRS). In the most severe cases of COPD, entire lung transplants are performed.

   • When the air sacs of the lung are destroyed, large air spaces called bullae form. A bullectomy involves removing the bullae so breathing is made easier.
   • With LVRS, damaged and diseased lung tissue is removed from the upper lungs, which creates extra space in the chest cavity for the remaining healthy tissue to expand and work more efficiently.
   • A lung transplant is an option for people who have very severe COPD and are older than 65 who don't have heart, liver or kidney disease. The damaged lung is completely removed and replaced with one from a deceased donor.
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Tips

• About 15 million Americans report that they've been diagnosed with COPD.
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• The following risk factors are associated with COPD: age (older than 65), female, white, smokers, history of asthma, lower income, unemployed or inactive.
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• A new type of drug approved for people with severe COPD is roflumilast (Daliresp), which decreases inflammation and relaxes the airways.
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