Chronic obstructive pulmonary disease
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of COPD -- emphysema and/or chronic bronchitis.
Alternative Names
COPD; Alpha-1 antitrypsin deficiency; Bronchitis - chronic; Chronic bronchitis; Emphysema
Lifestyle Changes
Quitting Smoking and Avoiding Other Irritants
Quitting smoking is the first and most essential step in treating chronic obstructive lung disease and slowing its progress. In many people who quit, lung function stabilizes and eventually declines at about the rate of nonsmokers in the same age group. In some people, lung function may even improve slightly after quitting. A number of effective aids, including nicotine replacement devices and antidepressants, such as bupropion (Zyban), are available to help people quit.
Preventing Upper Respiratory Infections
Good Hygiene.
Everyone should wash his or her hands before eating and after going outside. Ordinary soap is sufficient. Antibacterial soaps add little protection, particularly against viruses. One study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia.
Vaccines.
Two important vaccinations help protect against respiratory infection.
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Influenza vaccination. People with emphysema should be vaccinated against influenza each year at least 6 weeks before flu season. Severely ill patients may experience mild initial adverse side effects. In general, however, the vaccination is very safe and appears to help reduce the severity of COPD during flu season.
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Pneumococcal vaccine. The pneumococcal vaccine protects against the major bacterium that causes pneumonia. The vaccine remains effective for years. Flu and pneumococcal vaccines can be administered at the same time without increasing any adverse effects.
[For more information,
see In-Depth
Report #94:
Colds and Flus.]
Breathing Exercises
Pursed-Lip Breathing.
A technique called pursed-lip breathing can help improve lung function before starting activities. It takes about 10 minutes. When first learning the technique, the patient should lie flat on a bed with his or her head on a pillow. Later, the technique can be performed while walking or enduring any activity requiring extra air.
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First, the patient inhales through the nose, moving the abdominal muscles outward so that the diaphragm lowers and the lungs fill with air.
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The patient then exhales through the mouth with the lips pursed, making a hissing sound.
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The exhalation should be twice as long as the inhalation, so that pressure is experienced in the windpipe, and chest and trapped air is forced out.
Breath Holding and Coughing.
A simple technique is to inhale deeply and slowly, holding the breath for five to 10 seconds. Then the patient coughs on exhalation.
Controlling Secretions
Fluids and Humidity.
Patients who experience congestion and heavy sputum can benefit from maintaining good fluid intake and keeping their homes humidified.
Expectorants.
Although unproven, many patients report benefits from using over-the-counter expectorant drugs that thin mucus. These drugs should not be used during an acute exacerbation of COLD, however.
Chest Therapy.
Chest therapy involves rhythmic inhalation for three or four deep breaths followed by coughing to produce sputum. Tapping the chest may also help in loosening and raising sputum. This should be avoided during an acute exacerbation of COLD.
Postural Drainage.
The patients should also practice postural drainage. This involves leaning over the side of the bed, head down with elbows on a pillow placed on the floor. A family member or caregiver thumps gently on the back while the patient coughs.
Mucus-Producing Coughs.
When coughing to produce mucus, one effective method is to lean forward and "huff" repeatedly, take relaxed breaths, and huff again. If possible, forceful coughing should be avoided.
Devices for Improving Lung Function
Flutter Valve.
The flutter valve is a small hand-held device that looks like a pipe. It contains a steel ball that sits in a small plastic cone. The patient inhales deeply, holding the breath for two to three seconds. As the patient exhales (keeping the cheeks in), the ball is pushed up toward the top of the device and then falls back down. About 10 to 50 vibrations per second are generated and transmitted to the lungs to help loosen secretions. This is repeated for up to 15 breath cycles. The patient coughs at the end.
Chest Compression Devices.
Devices are available that allow the patient to be passive and still expel air. One called the Vest (formerly the ThAIRapy Vest) consists of an inflatable vest attached by hoses to a generator that triggers pulses of air into the vest. The rapid pressure and release of the air around the chest acts like tiny hugs to create small coughs. It is very expensive (about $16,000), but may be covered by insurance for specific patients.
Neuromuscular Electrical Stimulation (NMES).
An investigative device uses electrical pulses to stimulate muscles in the legs. In an early study, patients were treated for 16 minutes per leg during the first week and 30 minutes per leg thereafter for a total of 30 sessions. At the end of 6 weeks, endurance capacity increased significantly, and patients reported less muscle fatigue and shortness of breath.
Physical Exercise
Certain physical exercise may be very helpful.
Strengthening Exercises for the Limbs.
Exercising and strengthening the limb muscles helps some patients improve their endurance and reduce breathlessness.
Walking
. In studies of lung rehabilitation, regular exercise increases walking distance and improves breathing. Walking is the best exercise for people with emphysema. Patients should try to walk three to four times daily for five to 15 minutes each time. Devices that assist ventilation may reduce breathlessness that occurs during exercise.
Yoga and Eastern Practices.
Yoga or tai chi practices, which use deep breathing and medication techniques, may be particularly beneficial for COPD patients. A clinical trial is underway to determine if yoga is helpful for COPD patients.
Breath Training
Inspiratory Muscle Training and Incentive Spirometer.
Inspiratory muscle training involves exercises and devices that make inhaling more difficult in order to strengthen breathing muscles. In a 2001 study, patients who took part in a training group improved their breathing, walking capacity, and quality of life. The use of an incentive spirometer for 15 minutes twice a day may also be helpful as part of a training program. It also helps loosen sputum. This is a small hand-held device that contains a breathing gauge. The patient exhales and then
inhales
forcefully through the tube, using the pressure of the inhalation to raise the gauge to the highest level possible. A device called a peak inspiratory flow (PIF) meter measures the patient's ability to draw air into the lungs and assesses the fitness of the breathing muscles.
Dietary Factors
Protein and Fats.
Many COLD patients are deficient in protein. Although most healthy diets emphasize proteins from fish, poultry, and lean meat, people with COLD may benefit from foods with a higher fat content than average. (People should still prefer healthy fats, however, such as those found in olive oil and oily fish.) Some evidence suggests that high-carbohydrate meals may reduce exercise capacity.
Fruits, Vegetables, and Whole Grains.
Healthy foods are as important for lung function as they are for health in general. Specific foods that may be important for healthy lungs are those that contain antioxidants (best obtained from fresh, deep green and yellow-orange fruits and vegetables), selenium (fish, red meat, grains, eggs, chicken, liver, garlic), plant chemicals called flavonoids (apples, onions), and magnesium (green leafy vegetables, nuts, whole grains, milk, and meats).
Fish Oil.
Omega-3 fatty acids, found in cold-water oily fish and in supplements (preferably DHA-EPA, the important compounds in fish oil), have anti-inflammatory effects. A new study showed a significant benefit for COPD patients who received omega-3 fatty acid supplements. Inflammatory chemicals in the sputum decreased in this group, and oxygen saturation and breathing during exertion improved.
Alcohol and Red Wine.
Some evidence suggests that resveratrol (a chemical found in red wine, grapes, and olive oil) may have various health benefits, including possible protection of the lungs. In people who are not at risk for abuse, moderate intake of wine may be healthful, although no evidence suggests that wine itself improves lung function, and high amounts can impair the immune system. Women who are pregnant or at high risk for breast cancer, people who can't drink moderately, and people with liver disease should avoid alcohol.
Dietary Supplements.
Some studies report benefits for COLD patients who took supplements of N-acetyl-cysteine, a powerful antioxidant that is a form of cysteine-a common amino acid in the body. Other antioxidants being studied include L-carnitine and coenzyme Q10. Evidence of benefit is weak, however, for all these chemicals.
No vitamin or mineral supplements have been shown to improve lung function. The trace elements zinc and selenium may have some effect in reducing the severity of upper respiratory tract infections, but they should be obtained in food. One study found protection from diets rich in vitamin C, but other specific antioxidants, including vitamins E, A, and beta carotene, had no effect. Furthermore, evidence suggests that high doses of antioxidant vitamin supplements can be harmful. A surprising study in 2002 reported a
higher
incidence and
greater
severity of respiratory infections in older adults who took 200 mg of vitamin E daily. Beta carotene supplements, in any case, are not recommended for smokers, because studies suggest an increased risk of lung cancer in this group.
Psychological Support
Patients with COLD have a high risk for depression and anxiety, which can impair outlook. Psychological and social supports are important for improving emotional states, for coping with daily stresses, and for maintaining independence and social relationships. Patients who have emotional difficulties should consider group support or individual counseling.
Minimizing Airborne Contaminants
As much as possible, a patient should avoid exposure to airborne irritants, including hair sprays, aerosol products, paint sprayers, and insecticides.
To minimize the amount of contaminants in the home, the following may be helpful:
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Ventilate by keeping windows open (weather permitting), using exhaust fans for stoves and vents for furnaces, and keeping fireplace flues open.
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Make sure wood-burning stoves or fireplaces are well ventilated and meet the Environmental Protection Agency's safety standards. Burn pressed wood products labeled "exterior grade" since they contain the least amount of pollutants from resins.
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Have furnaces and chimneys inspected and cleaned periodically.
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Eliminate molds and mildews that result from household water damage.
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People who are sensitive to allergens -- such as pollen, pet dander, house dust, and mold -- should avoid exposure to them. [
See In
-Depth
Repor
t#04:
Asthma in Adults.]
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Review Date: 4/28/2006
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Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
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