pulmonary disease (COPD) is a type of lung disease that involves damage or
obstruction to the airways of the lungs, making it difficult to breathe. COPD
is an overall term referring to a group of chronic lung conditions, most
commonly including chronic bronchitis and emphysema, and possibly asthma or
asthmatic bronchitis. While chronic bronchitis and emphysema may occur
separately, it is common for patients to have both diseases at the same time.
Chronic bronchitis is
characterized by an ongoing, mucus-producing cough that that occurs most days
of the month, three months a year for two consecutive years or more. Constant
coughing causes the bronchial tubes to become inflamed. Eventually, the airways
become scarred. Long-term irritation also leads to the production of mucus,
which further irritates and blocks the bronchial tubes. As a result, less
oxygen is able to enter the airways.
In addition, the excessive
mucus in the bronchial tubes provides an environment for disease-causing
bacteria to grow. Therefore, lung infections are common complications of
Emphysema is an incurable
illness that occurs when the walls between the air sacs (alveoli) in the lungs
lose their ability to stretch and recoil, causing shortness of breath (SOB).
The Centers for Disease
Control (CDC) report that COPD affects up to 24 million Americans, and
according to the American Lung Association, is the fourth leading cause of
death in the United States. COPD patients typically die from complications,
such as severe lung infections, heart problems, or lung cancers.
The main risk factor for
COPD is smoking. Researchers estimate that smoking causes 80-90% of COPD
deaths. According to the American Lung Association, female smokers are nearly
13 times more likely to die from COPD than females who have never smoked. Male
smokers are nearly 12 times more likely to die from COPD than males who have
There is currently no cure
for COPD. Instead treatment focuses on reducing the symptoms and complications
of the disease. Treatment varies, depending on the specific condition. It can
range from medication and oxygen supplementation to transplant surgery.
Bronchodilators are commonly used to relax the bronchi muscles in the lungs
that can cause bronchospasms and restrict the airways.
Smoking: The single greatest risk factor for chronic
obstructive pulmonary disease (COPD) is smoking. COPD is most likely to develop
in cigarette smokers, but cigar and pipe smokers and marijuana smokers also are
susceptible. The risk of COPD increases with the number of years and amount
Exposure to secondhand smoke, also known as passive or
environmental tobacco smoke, also increases risk of developing COPD. Secondhand
smoke is smoke that is inadvertently inhaled from someone else's cigarette,
pipe, or cigar.
Age: Although the lung damage that occurs in emphysema
develops gradually, most people with tobacco-related emphysema begin to
experience symptoms of the disease between the ages of 50-60.
Exposure to pollution: An individual breathing fumes from
certain chemicals, such as chlorine or pesticides, dust from grain, cotton,
wood, or working around toxic fumes has an increased risk of developing COPD.
Breathing indoor pollutants, such as fumes from heating fuel, as well as
outdoor pollutants, such as car exhaust, increases the risk of COPD.
Heredity: A rare, inherited deficiency of the protein,
alpha-1-antitrypsin (AAt), can cause emphysema, especially before age 50, and
even earlier if the individual smokes.
Connective tissue disorders: Some conditions that affect
connective tissue (provides body framework and support) are associated with
emphysema. Connective tissues are the supporting tissues of the body, such as
tendons, ligaments, bone, and cartilage. These conditions include cutis laxa (a
rare disease that causes premature aging) and Marfan syndrome (a disorder that
affects many different organs, especially the heart, eyes, skeleton and lungs).
SIGNS AND SYMPTOMS
General: Symptoms of chronic obstructive pulmonary disease
(COPD) usually develop gradually over many years. They typically worsen over
time. Some patients may suffer from either chronic bronchitis or emphysema,
while other may have both diseases.
Patients who have had COPD for many years may develop bluish
discoloration of the lips and nail beds (cyanosis). This occurs when there is
not enough oxygen in the blood. Some patients may develop headaches in the
morning because they are unable to remove carbon dioxide from the blood. Many
people with COPD also experience weight loss because their body requires more
energy to breathe than the average person.
Chronic bronchitis: Symptoms of chronic bronchitis include
chronic cough, increased mucus that is yellow-greenish in color, frequent
clearing of the throat, wheezing, and shortness of breath (SOB). Patients
typically experience fatigue because the body has to work harder to get enough
Emphysema: Shortness of breath (dyspnea), especially during
activity, is one of the earliest symptoms of emphysema. As the disease
progresses, shortness of breathe becomes constant, even during rest. An
individual is likely to feel tired both because it is more difficult to breathe
and because the body is getting less oxygen.
Other symptoms include distress resulting from the inability
to get enough air, wheezing, chronic mucus production, exhaling through pursed
(puckered) lips or grunting before exhaling, and needing to lean forward to
breathe while sitting. Individuals with emphysema are often thin and have very
pink skin. Individuals with advanced disease may have the characteristic barrel
chests from the increase in lung size.
Death: Individuals with chronic obstructive pulmonary
disease (COPD) may die from complications of the disease. Causes of death may
include lung cancer, lack of blood flow and oxygen to the brain (stroke),
respiratory failure, lung infections, and heart attack.
Heart problems: For unknown reasons, COPD increases risk of
developing heart disease, including heart attacks. The heart may become
enlarged because it is strained. COPD may cause high blood pressure in the
arteries that bring blood to the lungs.
Infections: Patients with COPD may suffer from frequent
infections, including the common cold, flu, and pneumonia. Lung infections make
breathing even more difficult for COPD patients. Infections also cause even
more irreversible damage to the lung tissue. Patients should talk to their
healthcare providers about recommended vaccines. The flu shot is usually
recommended in non-allergic COPD patients.
Lung cancer: Smokers with chronic bronchitis have a higher
risk of developing lung cancer than smokers who do not have chronic bronchitis.
Quality of life: People with advanced emphysema are often
incapacitated. They experience shortness of breath even when resting or sitting
in a chair or bed. Patients should consult their healthcare providers if they
experience feelings of sadness, low self-esteem, loss of pleasure, apathy, and
sometimes, difficulty functioning for two weeks or longer, with no known
underlying cause. These may be signs of depression.
Pulmonary function tests (PFTs): Pulmonary function tests
(PFTs) can detect chronic obstructive pulmonary disease (COPD) before symptoms
are seen. These noninvasive tests measure how much air the lungs can hold and
the flow of air in and out of the lungs. They can also measure the amount of
oxygen and carbon dioxide exchanged in the lungs. They include a spirometry
test and lung volume test.
In a spirometry test, a person breathes into mouthpiece that
is connected to an instrument called a spirometer. The spirometer records the
amount and the rate of air that is breathed in and out over a specified time.
Some of the test measurements are obtained by normal, quiet breathing, and
other tests require forced inhalation or exhalation after a deep breath.
Lung volume measurement detects restrictive lung diseases.
In this set of diseases, a person cannot inhale a normal volume of air.
Restrictive lung diseases may be caused by inflammation or scarring of the lung
tissue (interstitial lung disease) or by abnormalities of the muscles or
skeleton of the chest wall.
Lung volume measurement can be performed in two ways. The
most accurate way is for an individual to sit in a sealed, transparent box
called a body plethysmograph. This box looks similar to a telephone booth. The
patient then breathes in and out a mouthpiece while inside the plethysmograph.
Changes in pressure inside the box allow determination of the lung volume. Lung
volume can also be measured when an individual breathes nitrogen or helium gas
through a tube for a specified period of time. The concentration of the gas in
a chamber attached to the tube is measured, allowing estimation of the lung
Chest X-ray: A chest X-ray may be performed to rule out
other lung problems, such as lung cancer. Even in the advanced stages of
emphysema, chest X-rays are often normal.
Blood tests: Arterial blood gases (ABGs) measure how well
the lungs transfer oxygen to the bloodstream and how effectively they remove
carbon dioxide from the bloodstream. A blood test for the alpha-1-antitrypsin
(AAt) gene, which is found in some individuals with emphysema, may also be
Pulse oximetry: This test involves use of a small device
that attaches to the fingertip to measure the amount of oxygen in the blood. To
help determine whether or not the individual needs supplemental oxygen, the
test may be performed at rest, during exercise, and overnight.
Sputum examination: A healthcare provider may take a sample
of the patient's mucus (sputum) to help determine the cause of some lung
problems. If disease-causing microorganisms (e.g. bacteria) are present, there
is infection. If there is blood in the sputum, this may indicate lung damage or
Computerized tomography (CT) scan: A CT scan allows a
healthcare professional to see the organs in two-dimensional images or
"slices." Split-second computer processing creates these images as a
series of very thin X-ray beams are passed through the body. A CT scan can
detect emphysema sooner than an X-ray can, but it cannot assess the severity of
emphysema as accurately as a pulmonary function test.
General: There is currently no cure for chronic obstructive
pulmonary disease (COPD). Treatment focuses on reducing symptoms and preventing
complications. Patients should take their medications exactly as prescribed to
help prevent life-threatening complications, such as heart attack, from
occurring. Patients should also tell their healthcare providers if they are
taking any other drugs (prescription or over-the-counter), herbs, or
supplements, because they may interact with treatment.
Smoking cessation: Smoking cigarettes may worsen symptoms of
COPD. Therefore, Patients are encouraged to stop smoking. Nicotine replacement
products, including the patch (Habitrol©, Nicoderm CQ©, Nicotrol©), chewing gum
(Nicorette©), lozenges (Commit©), inhalers (Nicotrol Inhaler©), nasal sprays
(Nicotrol NS©), and the antidepressant bupropion (Zyban©), may help patients
quit smoking. These drugs work in part by continuing to release low levels of a
brain chemical called dopamine. In this way, these smoking cessation medications
decrease the craving for nicotine and reduce the signs and symptoms of
Varenicline (Chantix©) is a newer drug that works in a
similar way. Chantix© stimulates the release of low levels of dopamine in the
brain to help reduce the signs and symptoms of withdrawal. In addition,
Chantix© blocks nicotine receptors in the brain. The U.S. Food and Drug
Administration (FDA) has approved the course of Chantix© treatment for 12
weeks. Individuals who successfully quit smoking during Chantix© treatment may
continue to use Chantix© for an additional 12 weeks to further increase the
likelihood of long-term smoking cessation. Side effects of Chantix© include
changes in taste, nausea, vomiting, gas, and insomnia (inability to sleep).
Bronchodilators: Medications called bronchodilators may help
relieve coughing, shortness of breath, and difficulty breathing by opening
constricted airways. Bronchodilators relax the muscles around the airways,
making it easier to breath. Patients typically use an inhaler to take
bronchodilators, but tablets are also available for some. Depending on the
severity of the disease, a patient may need a short-acting bronchodilator
before physical activities, a long-acting bronchodilator that is used every
day, or both. Commonly prescribed bronchodilators include albuterol (Ventolin©
or Proventil©), metaproterenol (Alupent©), terbutaline (Brethine©),
theophylline (Theo-Dur© or Slo-bid©), and perbuterol (Maxair©).
Steroids: Steroids are used to prevent and reduce airway
swelling, as well as decrease the amount of mucus in the lungs. Steroids may
either be inhaled with an inhaler or taken by mouth. Examples of inhaled
steroids include beclomethasone (Beclovent© or Vanceril©), budesonide
(Pulmicort Respules©), flunisolide (Aerobid©), fluticasone (Flovent©), and
triamcinolone (Azmacort©). Inhaled steroids seem to have fewer side effects
than steroids that are taken by mouth. These drugs are typically used to treat
moderate or severe COPD. Prolonged use of inhaled steroids may weaken the bones
and increase the risk of cataracts, diabetes, and heart disease, including high
blood pressure, high cholesterol levels, chest pain, and heart attack.
Commonly prescribed corticosteroids that are taken by mouth
include prednisone (Prednisone Intensol©, Sterapred©, or Sterapred© DS), and
Liquid corticosteroids, such as Pediapred© or Prelone©, are
available for children. These medications can be used short-term for severe
symptoms, such as extreme shortness of breath.
Leukotriene modifiers: Leukotriene modifiers, such as
zafirlukast (Accolate©) or montelukast (Singulair©), are a new type of
long-term control medication. They help prevent airway inflammation and
swelling. They also help decrease the amount of mucus in the lungs.
Supplemental oxygen: Patients who have extreme difficulty
breathing may benefit from supplement oxygen. Various forms of oxygen are
available, as well as different devices to deliver them to the lungs. A
healthcare provider will help the patient set up oxygen for home use.
Lung transplant: Patients with severe emphysema may benefit
from lung transplantations. Usually just one lung is transplanted because the
survival rate has been proven to be higher for individuals with single-lung
transplants than for individuals with double-lung transplants.
Surgery: In a procedure called lung volume reduction surgery
(LVRS), surgeons remove small pieces of damaged lung tissue. The extra space
that is created in the lungs after surgery appears to help the remaining lung
tissue work more efficiently.
Pulmonary rehabilitation program: A key part of COPD
treatment involves a pulmonary rehabilitation program, which combines
education, exercise training, and behavioral intervention to help restore the
individual with emphysema to the highest possible level of independent living.
Good scientific evidence:
Boswellia: Boswellia has been proposed as a potential
therapy for asthma. Future studies are needed to assess the long-term efficacy
and safety of boswellia and to compare the efficacy of boswellia to standard
therapies. Boswellia should not be used for the relief of acute asthma
exacerbations. Boswellia is generally believed to be safe when used as
directed, although safety and toxicity have not been well studied in humans.
Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or
stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble
medications, agents metabolized by the liver's cytochrome P450 enzymes, or
sedatives. Use cautiously with impaired liver function or liver damage or lung
disorders. Use cautiously in children. Avoid if pregnant due to potential
abortifacient effects or if breastfeeding.
Buteyko breathing technique: The Buteyko breathing technique
(BBT) consists of breathing techniques, relaxation exercises, and asthma
education. The technique aims to reduce hyperventilation. Studies have shown
reduced use of rescue inhalers among patients receiving BBT. Improvements in
other measures of asthma severity have not been shown. Additional study is
BBT is generally considered safe. Avoid with asthma that
changes suddenly ("brittle asthma"). BBT may interact with asthma
medications and should be used with caution when decreasing asthma medication.
Asthma should be treated by a qualified healthcare professional and patients
should always carry a rescue inhaler. Avoid if pregnant or breastfeeding.
Choline: Choline is possibly effective when taken orally for
asthma. Choline supplements seem to decrease the severity of symptoms, number
of symptomatic days and the need to use bronchodilators in asthma patients.
There is some evidence that higher doses of 3 grams daily might be more
effective than lower doses of 1.5 grams daily. Choline is generally regarded as
safe and appears to be well-tolerated. Avoid if allergic/hypersensitive to
choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver
disorders or trimethylaminuria. Use cautiously with a history of depression. If
pregnant or breastfeeding it seems generally safe to consume choline within the
recommended adequate intake (AI) parameters; supplementation outside of dietary
intake is usually not necessary if a healthy diet is consumed.
Coleus: There is a lack of sufficient data to recommend for
or against the use of coleus in the treatment of bronchial asthma. Preliminary
data appears to be promising. However, larger, randomized, controlled trials
are needed to confirm the safety and efficacy of coleus in bronchial asthma.
Coleus is generally regarded as safe, as very few reports have documented
adverse effects. However, only a few short-term trials have assessed its safety
in a small sample size of patients. Avoid if allergic to Coleus forskohlii and
related species or with bleeding disorders. Avoid if pregnant or breastfeeding.
Ephedra: Ephedra contains the chemicals ephedrine and
pseudoephedrine, which are bronchodilators (expand the airways to assist in
easier breathing). It has been used and studied to treat asthma and chronic
obstructive pulmonary disease, such as asthmatic bronchoconstriction, in both
children and adults. Other treatments such as beta-agonist inhalers (for
example, albuterol) are more commonly recommended due to safety concerns with
ephedra or ephedrine. However, the U.S. Food and Drug Administration (FDA) has
collected thousands of reports of serious toxicity linked to ephedra (including
over 100 deaths). Ephedra products are banned from dietary supplements because
of serious health risks, including heart attack, heart damage, breathing
difficulties and fluid retention in the lungs. Avoid ephedra if pregnant or
Psychotherapy: Family psychotherapy may slightly improve
wheezing and thoracic gas volume for asthma in children, according to several
Psychotherapy is not always sufficient to resolve mental or
emotional conditions. Psychiatric medication is sometimes needed. The
reluctance to seek and use appropriate medication may contribute to worsening
of symptoms or increased risk for poor outcomes. In order to be successful,
psychotherapy requires considerable personal motivation and investment in the
process. This includes consistent attendance and attention to treatment
recommendations provided by the practitioner. Not all therapists are
sufficiently qualified to work with all problems. The client or patient should
seek referrals from trusted sources and should also inquire of the
practitioner's training and background before committing to work with a
particular therapist. Some forms of psychotherapy evoke strong emotional
feelings and expression. This can be disturbing for people with serious mental
illness or some medical conditions. Psychotherapy may help with post-partum
depression, but is not a substitute for medication, which may be needed in
Pycnogenol: Pycnogenol© is the patented trade name for a
water extract of the bark of the French maritime pine (Pinus pinaster spp.
atlantica), which is grown in coastal south-west France. Pycnogenol may offer
clinical benefit to both children and adults with asthma. Additional study is
needed before a conclusion can be made. Avoid if allergic/hypersensitive to
pycnogenol, its components, or members of the Pinaceae family. Use cautiously
with diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking
hypolipidemics, medications that may increase the risk of bleeding,
hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if
pregnant or breastfeeding.
Yoga: Multiple human studies report benefits of yoga (such
as breathing exercises), when added to other treatments for mild-to-moderate
asthma (such as standard drug therapy, diet, or massage). Better research is
needed before a firm conclusion can be drawn.
Yoga is generally considered to be safe in healthy
individuals when practiced appropriately. Avoid some inverted poses with disc
disease of the spine, fragile or atherosclerotic neck arteries, risk for blood
clots, extremely high or low blood pressure, glaucoma, detachment of the
retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga
breathing techniques should be avoided in people with heart or lung disease.
Use cautiously with a history of psychotic disorders. Yoga techniques are
believed to be safe during pregnancy and breastfeeding when practiced under the
guidance of expert instruction (the popular Lamaze techniques are based on
yogic breathing). However, poses that put pressure on the uterus, such as
abdominal twists, should be avoided in pregnancy.
Unclear or conflicting scientific evidence:
Acupressure, shiatsu: Preliminary research suggests that
acupressure may be of benefit in improving quality of life in asthma. Further
well-designed studies are needed before firm conclusions can be drawn. A
combination of acupressure and massage may reduce dyspnea (labored breathing)
and anxiety in patients with chronic obstructive pulmonary disease (COPD) who
use prolonged mechanical ventilatory support. Further study of acupressure
alone is needed before a recommendation can be made. A small study of patients
undergoing pulmonary rehabilitation reported acupressure to be beneficial for
decreasing dyspnea. Larger, well-designed studies are needed before clear
conclusions can be drawn.
With proper training, acupressure appears to be safe if
self-administered or administered by an experienced therapist. No serious
long-term complications have been reported, according to scientific data. Hand
nerve injury and herpes zoster ("shingles") cases have been reported
after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Some research suggests acupuncture may help
prevent exercise-induced asthma and that it may reduce the perceived level of
breathlessness associated with asthma or emphysema. However, reviewers agree
that the available studies are small, poorly designed, and insufficient for
making recommendations. A few studies have found no support for the use of
acupuncture for asthma. Overall there is insufficient evidence on which to base
recommendations for acupuncture to treat breathlessness in chronic obstructive
pulmonary disease (COPD).
Needles must be sterile in order to avoid disease
transmission. Avoid with valvular heart disease, infections, bleeding disorders
or with drugs that increase the risk of bleeding (anticoagulants), medical
conditions of unknown origin, neurological disorders. Avoid on areas that have
received radiation therapy and during pregnancy. Use cautiously with pulmonary
disease (like asthma or emphysema). Use cautiously in elderly or medically
compromised patients, diabetics, or with history of seizures. Avoid
electroacupuncture with arrhythmia (irregular heartbeat) or in patients with
Alexander technique: The Alexander technique is an
educational program that teaches movement patterns and postures, with an aim to
improve coordination and balance, reduce tension, relieve pain, alleviate
fatigue, improve various medical conditions, and promote well-being. There is
currently not enough scientific evidence to make a strong recommendation for
the use of the Alexander technique in chronic asthma patients. More study is
needed in this area. There is a lack of high-quality research describing the
effect of the Alexander technique on respiration. No serious side effects have
been reported with use of the Alexander technique. It has been suggested that
the technique may be less effective with learning disabilities or mental
illnesses. The Alexander technique has been used safely in pregnant women.
Applied kinesiology: Applied Kinesiology (AK) is an
assessment technique that uses muscle strength testing with the aim to identify
nutritional deficiencies and health problems. It is based on the concept that
weakness in certain muscles corresponds to specific disease states or body
imbalances. Study results are mixed in regards to bronchial asthma. Further research
is needed before conclusions can be drawn. Applied kinesiology techniques in
themselves are harmless. However, medical conditions should not be treated with
AK alone, and should not delay appropriate medical treatment.
Aromatherapy: Early evidence suggests that aromatherapy may
aid mucus clearance in chronic obstructive pulmonary disease (COPD). More
studies are needed before conclusions about this application of aromatherapy
can be made. Essential oils should be administered in a carrier oil to avoid
toxicity. Avoid if history of allergic dermatitis. Use cautiously if
driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct
contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
Ayurveda: There is early evidence that daily supplementation
with gum resin of Boswellia serrata, known in Ayurveda as Salai guggal, may
reduce dyspnea (shortness of breath), rhonchi, and the number of attacks in
bronchial asthma. Another herb, Devadaru (Cedrus deodara), may have antispasmodic
effects and reduce symptoms in bronchial asthma, particularly for patients with
shorter histories of asthma and lower frequencies of attacks. Further research
is needed in this area before a recommendation can be made.
Ayurvedic herbs should be used cautiously because they are
potent and some constituents can be potentially toxic if taken in large amounts
or for a long time. Some herbs imported from India have been reported to
contain high levels of toxic metals. Ayurvedic herbs can interact with other
herbs, foods and drugs. A qualified healthcare professional should be consulted
before use of any herbs or supplements. Use guggul cautiously with peptic ulcer
disease. Avoid sour food, alcohol, and heavy exercise. Mahayograj guggul should
not be taken for long periods of time. Pippali (Piper longum) should be taken
with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica
officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid
Ayurveda with traumatic injuries, acute pain, advanced disease stages and
medical conditions that require surgery.
Smoking cessation: The primary cause of chronic obstructive
pulmonary disease (COPD) is smoking. Patients who do not smoke are less likely
to develop COPD than patients who do.
Patients who have COPD should not smoke. Smoking cigarettes
may worsen symptoms of COPD.
Avoidance of respiratory infections: Avoid being around
crowds during the cold and flu season (colder months). Washing the hands
frequently, along with carrying a small bottle of hand sanitizer, helps keep
viruses and bacteria away. Touching the nose or rubbing the eyes increases a
patient's risk of developing viral or bacterial infections. Patients should
talk to their healthcare providers about recommended vaccines.
Control breathing: Patients should talk to their healthcare
providers or respiratory therapists to about breathing techniques that may help
manage symptoms. Therapists may recommend relaxation exercises that may make it
easier to breath. These breathing techniques may also help reduce symptoms of
anxiety or distress, which occur in patients who have difficulty breathing.
Drink fluids: With COPD, mucus tends to collect in the air passages
and can be difficult to clear. Drinking plenty of fluids, such as water or 100%
fruit juices, help to keep secretions thin and easy to bring up.
Eat healthy foods: A healthy diet may help COPD patients
maintain their strength and improve energy. Patients who are underweight should
talk to their healthcare providers to determine whether or not they need
Regular exercise: Regular exercise can significantly
increase the capacity for physical activity. Simple breathing techniques (deep
breathing) may also help.
Visit the doctor: Patients should visit regularly visit
their healthcare providers to have their lung function monitored.
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