How Chronic Obstructive Pulmonary Disease (COPD) Is Treated

Chronic obstructive pulmonary disease (COPD) is an irreversible lung disease that researchers haven't yet found a way to cure. However, a variety of medications and lifestyle habits can help control symptoms—difficulty breathing, wheezing, cough, and the production of mucus—and lower the risk of other conditions that are associated with COPD, such as emphysema and chronic bronchitis.

Managing COPD is also vital for preventing COPD exacerbation, a flare-up of symptoms in which coughing, wheezing, and shortness of breath become much worse, mucus production increases, and mucus may change in color from clear to yellow, green, tan, or bloody. A COPD exacerbation is often triggered by an infection, lasts for several days, and can even land you in the hospital, so staying healthy in general is as important in dealing with COPD as treating symptoms.

Lifestyle Changes

You can make some lifestyle changes and accommodations to help with your COPD symptoms and keep exacerbations to a minimum.

Quit Smoking

Kicking the cigarette habit is absolutely the most important step you can take to help manage COPD, and for some people, this one step is all they need to help keep symptoms of COPD at bay and prevent it from getting worse. However, it's not easy to quit, especially if you've been smoking for years.

If going cold turkey won't work for you, consider other options for quitting, such as nicotine replacement therapy using aids such as gum, inhalers, tablets, patches, or nasal sprays to reduce cravings; taking a drug such as bupropion, Chantix (varenicline), or clonidine, a hypertension drug thought to be helpful in treating nicotine withdrawal symptoms; and going for counseling or group therapy.

Regular Exercise

Getting regular exercise is always good for your overall health and mental wellbeing. It can also help you maintain your strength and endurance. Talk to your doctor about what kind of exercise is best for you.

Get Enough Calories

Medications for COPD, fatigue, and difficulty breathing may cause you to have less of an appetite or less energy to eat, so talk to your doctor about ways you can combat a lack of nutrition. Not getting enough calories can make your COPD symptoms worse and leave you more at risk for infections, which can also worsen symptoms. Eating more frequent, smaller meals and/or taking vitamins and supplements may be ways to get the nutrition you need.

Breathing Techniques

Learning techniques to help you breathe more efficiently can help you relax and give your lungs a bit of a break. Ask your doctor or your respiratory therapist for more information.

Get the Pneumonia Vaccine

Pneumococcal pneumonia is a lung disease caused by the bacterium Streptococcus pneumoniae. People with COPD and many other chronic health conditions are at an increased risk of developing pneumonia, which can make your COPD symptoms worse. Getting a vaccine can help prevent this illness, but check with your doctor first.

Get Your Flu Shot

There's data to show that flu shots not only reduce the number of hospitalizations and doctor's visits when you have COPD, they also lower the risk of sickness and even death. Even if it means taking an extra trip to the doctor or local drugstore, it's worth it to avoid the potential complications that can arise from getting the flu. As with the pneumonia vaccine, check with your doctor to make sure it's OK for you to get a flu shot.

Keep Appointments

Make sure you see your doctor for your regularly scheduled appointments, even if you feel well. It's important that he or she is monitoring you to track your progress, your lung function, and to keep on top of your treatments.

Prescriptions

The drugs used to treat COPD and related health problems fall into two main camps: Medications for managing specific symptoms of your disease and treatments for infections that, if left to progress, could make your COPD much worse.

Bronchodilators

Bronchodilators help relax the muscles in the walls of your airways so that it's easier to breathe, reducing coughing and shortness of breath. There are two types of bronchodilators for treating COPD:

  • Short-acting bronchodilators: These medications work within 15 to 20 minutes to relieve shortness of breath, but the effects only last four to six hours. Examples include Ventolin and ProAir (albuterol), Atrovent (ipratropium), and Xopenex (levalbuterol).
  • Long-acting bronchodilators: These medications are used to help keep your airways open and relaxed for longer periods of time (throughout the night, for example). Though the effects last longer, from 12 to 24 hours, these medications start working more slowly. Examples of this type of bronchodilator include Brovana (arformoterol), Arcapta (indacaterol), Serevent (salmeterol), and Spiriva (tiotropium).

You may need only one type or both, depending on your symptoms. Bronchodilators are usually administered either with an inhaler or through aerosol therapy, in which the medicine is given in the form of a fine mist through an instrument called a nebulizer.

Inhaled Corticosteroids

If you have exacerbations often, your doctor may prescribe a daily inhaled corticosteroid. This can help keep your inflammation down and reduce the number of exacerbations you have. Examples include Flovent (fluticasone) and Pulmicort (budesonide). Hoarseness, infections in your mouth, and skin bruising are potential side effects.

Combination Inhalers

If your COPD is severe and/or you have frequent exacerbations, your doctor may prescribe an inhaler or nebulized solution that's a combination of a bronchodilator and a corticosteroid. Examples of combination inhalers include Symbicort, which is a combination of formoterol and budesonide, and Advair, a combination of salmeterol and fluticasone.

Oral Corticosteroids

During a COPD exacerbation, oral corticosteroids can shorten your recovery time, improve your lung function, and relieve hypoxemia (low levels of oxygen in the blood). They also may reduce the risk of relapse, prevent treatment failure, and, if you end up in the hospital, shorten the amount of time you're there. Long-term use of oral corticosteroids can result in serious side effects, however, so these are typically used only for a short period of time. Prednisone is one such example of an oral corticosteroid. Side effects include osteoporosis, diabetes, an increased risk of infection, cataracts, and weight gain.

Phosphodiesterase-4 (PDE4) Inhibitors

COPD (as well as asthma) can cause an overproduction of an enzyme that increases inflammation in the lungs called phosphodiesterase-4 (PDE4). PDE4 inhibitors, which block this enzyme, are taken once a day in a tablet form and help to reduce COPD exacerbations in people with chronic bronchitis, a history of exacerbations, and severe to very severe COPD. Daliresp (roflumilast) is one such PDE4 inhibitor. Side effects can include diarrhea, weight loss, abdominal pain, disrupted sleep, nausea, loss of appetite, and headache.

Antibiotics

If you come down with a bacterial respiratory infection such as bronchitis or pneumonia, your doctor may prescribe an antibiotic. These medications work against bacteria but not viruses; in other words, they won't knock out a common cold or the flu. If you're prescribed a course of antibiotics, it's very important to take the entire prescription, even after you start feeling better. Not finishing the prescription can increase the risk of antibiotic resistance.

Past studies showed that taking antibiotics continuously didn't help exacerbations. However, newer research has indicated that taking Zithromax (azithromycin) or Erythrocin (erythromycin) for a year reduced the number of exacerbations in people who had previously had them frequently. There is no evidence that treatment beyond a year is helpful.

Lung Therapy

If you have moderate or severe COPD, your doctor may use lung therapy in addition to medications.

Oxygen Therapy

Depending on your individual needs, supplemental oxygen may be necessary 24 hours a day, only at night, or somewhere in between. Supplemental oxygen not only increases survival rates in patients with COPD, but it may help alleviate your symptoms and improve your quality of life by helping you sleep better at night, be more alert during the day, and engage in activities with fewer symptoms.

These benefits may well be worth the potential downsides of oxygen therapy: needing to wear a nasal cannula (a set of small tubes that deliver oxygen through the nose into the airways) or mask, as well as deal with oxygen canisters.

Pulmonary Rehabilitation

This interdisciplinary intervention for people with COPD, which includes assessment, exercise, education, and psychological support, is most beneficial for those who have such debilitating symptoms that they aren't able to go about their daily activities as usual. With the help of a team of specialists—which may include doctors, nurses, respiratory therapists, physical therapists, dietitians, occupational therapists, and psychologists—you can have less severe symptoms, enjoy a more normal daily life, and even have lower healthcare costs.

Pulmonary rehabilitation should last long enough to produce the maximum benefit without becoming burdensome. For some people, this can take as few as 10 days, while others may need as many as 18 months to show improvement.

Surgeries

If medications aren't improving your symptoms and they continue to be severe, your doctor may recommend surgery. However, not everyone is a candidate for lung surgery, so this may not be an option for you.

Bullectomy

This surgery involves the removal of bullae, which are large spaces of air that form when the walls of your air sacs are destroyed, such as in COPD. Removing one or more of these bullae can help improve your airflow.

Lung Volume Reduction Surgery

In this surgery, damaged tissue is removed from the upper part of your lungs. This allows your lungs to expand further so that you can breathe more easily, and it may even prolong your life.

Lung Transplant

This is a major surgery that involves replacing your damaged lung with a healthy lung from a donor. It may be an option if your lung is too damaged for other surgery. Though a lung transplant can improve your quality of life, there are risks, including that your body will reject the donor's lung. You will need to take medications that suppress your immune system for the rest of your life as well, which leaves you open to the risk of infection.

Over-the-Counter Therapies

There are certain vitamins and supplements that may help minimize your symptoms, but these benefits have not been proven in rigorous studies. Be sure to talk to your doctor before you add anything to your current treatment plan.

Vitamins C and E

A Korean community-based study showed that increasing your dietary intake of Vitamins C and E, both of which are antioxidants, can improve lung function, particularly in men. It's unclear what dose is necessary to benefit, but these supplements may be something to consider.

Eucalyptus Oil

Eucalyptus oil is often found in cough drops and touted as being able to loosen mucus. In a study on the effectiveness of eucalyptus oil in treating COPD, participants were given capsules of cineole, the main ingredient in eucalyptus oil, three times a day for six months, along with their regular medications and therapies. Not only were exacerbations less frequent, less severe, and shorter, but the cineole helped open up airways and reduce airway inflammation, decreasing shortness of breath and fatigue.

Complementary Medicine (CAM)

There are other complementary therapies that may help improve your overall quality of life—though not proven in rigorous scientific studies—when they're added to your treatment plan. Some people try herbal remedies to help their COPD symptoms, but there isn't much research on their effectiveness. Be sure to talk to your doctor before you try any of these alternatives.

Yoga

The American College of Chest Physicians (CHEST) says that yoga is beneficial when you have COPD. In a small study of people with stable COPD, after a 12-week period of yoga training, their lung function, shortness of breath, overall quality of life, and inflammation was significantly improved.

Acupuncture

The use of acupuncture, placing thin needles into specific points in the body, may be another complementary therapy to look into when you have COPD. One study of people with COPD who used either medication alone or in conjunction with acupuncture for eight weeks found that shortness of breath with exertion and quality of life was significantly improved in those using the combination of the two treatments. Another study, done over 10 weeks, showed similar results.

Because acupuncture has so few risks, it might be worth a try to see if it can help improve your symptoms. Other added potential benefits include sleeping better, relieving anxiety, and improving your mood.

Lung Flute

The Lung Flute is a handheld respiratory device that has been approved by the Food and Drug Administration (FDA) to help clear your lungs of mucus. It works by creating low-frequency vibrations deep in your lungs when you blow hard through the mouthpiece. This helps break up mucus, making it easier for you to cough up and expel.

One study in people with chronic bronchitis showed that using the Lung Flute resulted in fewer exacerbations, improvements in shortness of breath both when resting and when active, and less cough and phlegm production. The participants also said they found it to be effective and wanted to keep using it regularly. The Lung Flute is only available with a prescription in the United States, so talk to your doctor about whether or not this might be a good addition to your treatment arsenal.

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