Chronic obstructive pulmonary disease
Chronic bronchitis; COPD; Emphysema
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
Risk Factors
- Smoking. The longer you smoke, and the more often you smoke, the higher your risk. People who smoke pipes and cigars, and those who are exposed to large amounts of secondhand smoke, are also at 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. Your doctor 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 will 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 symptoms become obvious.
Your doctor may also order a chest x-ray 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.
- Eat foods that are rich in antioxidants, magnesium and other minerals, and omega-3 fatty acids (including fruits, vegetables, and fish) to 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 recommend lifestyle changes to help relieve the symptoms of COPD, such as exercising and eating a healthy diet. Support groups or therapy 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 that may help improve lung function, such as:
- The pursed lip technique
- Breathing from the diaphragm
- Using a breathing device called a spirometer, twice a day
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 to learn appropriate exercises.
Medications
Medications for COPD have not 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
Severe flare ups may require supplemental oxygen, especially those involving hospitalizations. 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. Severe cases of COPD may require a lung transplant.
Nutrition and Dietary Supplements
Because supplements may have side effects, or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Be sure to talk to your doctor about any supplements you are taking or considering taking.
- N-acetylecysteine (NAC). NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies suggest NAC may help relieve COPD symptoms by acting as an antioxidant in the lungs. Although not all studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis. NAC also helps 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. NAC may slow the rate at which the blood clots and therefore potentially interfere with blood-thinning medications, such as warfarin (Coumadin) and others. There have been reports of brochospasms caused by NAC in people with asthma. Speak with your physician.
- 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 COPD flare up were able to breathe easier and reduce the number of days they spent in the hospital. Scientists do not know whether taking magnesium orally would have the same effect. Your doctor may recommend checking your magnesium level through a 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 blood-thinning medications including warfarin (Coumadin), and others. People with an underactive thyroid, or a history of seizures, should talk to their doctor before taking L-carnitine supplements.
Herbs
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs 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 doctor about any herbs you are taking or considering taking.
- Eucalyptus (Eucalyptus globulus). Eucalyptus is frequently used in cough drops 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). One study suggested that taking ginseng helped people with COPD improve their exercise tolerance and lung function. 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 medications, so it is 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 and may potentially affect heart rate or rhythm. There are some concerns that ginseng may stimulate the immune system and perhaps may not be appropriate for people with autoimmune disease. 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.
Acupuncture
Preliminary studies suggest that acupuncture may help relieve shortness of breath in those with COPD. More recent studies suggest that accupuncture therapies help improve quality of life measures among people 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 manage. 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.
Other Considerations
Prognosis and Complications
COPD is considered a chronic illness. Any damage to your lungs will not get better. If you stop smoking, the damage may not get worse. However, if you continue to smoke, your lungs and lung function will continue to deteriorate.
Potential complications of COPD include:
- Peptic ulcer bleeding.
- Abnormally high pressure in the lungs, called pulmonary hypertension.
- Enlargement of the heart and heart failure, leading to fluid retention and weight gain.
- Abnormal rhythms of the heart.
- Having to use a respirator and/or oxygen therapy.
- Pneumothorax, collapsing of part of the lung due to air leaking from the lung.
- Pneumonia and other infections.
- Eventually, weight loss and wasting can occur.
- People with COPD have an increased risk of dying during hospitalization due to immobility.
- Diabetes.
- Lung cancer.
- Malnutrition
Supporting Research
Ambrosino N, Palmiero G, Strambi SK. New approaches in pulmonary rehabilitation. Clin Chest Med. 2007 Sep;28(3):629-38, vii. Review.
Bartolome R. Update on the management of COPD. Chest. 2008;133(6).
Booker R. Chronic obstructive pulmonary disease. Part two--management. Nurs Times. 2007 May 1-7;103(18):28-9.
Bourjeily G, Rochester CL. Exercise training in chronic obstructive pulmonary disease. Clin Chest Med. 2000;21(4):763-81.
Cahalin LP, Braga M, Matsuo Y, Hernandez ED. Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease: a review of the literature. J Caridopulm Rehabil. 2002;22(1):7-21.
Chuck A, Jacobs P, Mayers I, Marciniuk D. Cost-effectiveness of combination therapy for chronic obstructive pulmonary disease. Can Respir J. 2008;15(8):437-43.
Collins EG, Langbein WE, Fehr L, Maloney C. Breathing pattern retraining and exercise in persons with chronic obstructive pulmonary disease. AACN Clin Issues. 2001;12(2):202-9.
Coyle ME, Shergis JL, Huang ET, et al. Acupuncture therapies for chrnoic obstructive pulmonary disease: a systematic review of randomized, controlled trials. Altern Ther Health Med. 2014; 20(6):10-23.
Davis CL, Lewith GT, Broomfield J, Prescott P. A pilot project to assess the methodological issues involved in evaluating acupuncture as a treatment for disabling breathlessness. J Altern Complement Med. 2001;7(6):633-9.
Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet. 2012; 379(9823):1341-51.
Ferri F. Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier Mosby; 2015.
Gigliotti F, Romagnoli I, Scano G. Breathing retraining and exercise conditioning in patients with chronic obstructive pulmonary disease (COPD): a physiological approach. Respir Med. 2003;97(3):197-204.
Gross D, Shenkman Z, Bleiberg B, Dayan M, Gittelson M, Efrat R. Ginseng improves pulmonary functions and exercise capacity in patients with COPD. Monaldi Arch Chest Dis. 2002 Oct-Dec;57(5-6):242-6.
Guell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000;117(4):976-83.
Guo R, Pittler MH, Ernst E. Herbal medicines for the treatment of COPD: a systematic review. Eur Respir J. 2006 Aug;28(2):330-8. Review.
Huang KW, Luo JC, Leu HB, et al. Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study. Ailment Pharmacol Ther. 2012; 35(7):796-802.
Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 2002;29(2):231-61.
Jones A. Causes and effects of chronic obstructive pulmonary disease. Br J Nurs. 2001;10(13):845-50.
McKeever TM, Scrivener S, Broadfield E, Jones Z, Britton J, Lewis SA. Prospective study of diet and decline in lung function in a general population. Am J Respir Crit Care Med. 2001;165(9):1299-1303.
Odencrants S, Bjustrom T, Wiklund N, Blomberg K. Nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease. J Clin Nurs. 2013; 22(19-20):2822-9.
Piazza G, Goldhaber SZ, Kroll A, et al. Venous thromboembolism in patients with chronic obstructive pulmonary disease. Am J Med. 2012; 125(10):1010-18.
Qaseem A, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Annals of Int Med. 2007;147(9):633-38.
Rahman I, Kilty I. Antioxidant therapeutic targets in COPD. Curr Drug Targets. 2006 Jun;7(6):707-20.
Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev. 2001;23(2):268-87.
Rosenberg S, Kalhan R. An Integrated Approach to the Medical Treatament of Chronic Obstructive Pulmonary Disease. Medical Clinics of North America. Philadelphia, PA: Elsevier Saunders; 2012:96(4).
Seamark DA, Seamark CJ, Halpin DM. Palliative care in chronic obstructive pulmonary disease: a review for clinicians. J R Soc Med. 2007 May;100(5):225-33. Review.
Smit HA. Chronic obstructive pulmonary disease, asthma and protective effects of food intake: from hypothesis to evidence? Respir Res. 2001;2(5):261-4.
Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J. 2000 Aug;16(2):253-62.
Wrobel JP, Thompson BR, Williams TJ. Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: a pathophysiologic review. J Heart Lung Transplant. 2012; 31(6):557-64.