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COPD

What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a lung disease in which the lung is damaged, making it hard to breathe. In COPD, the airways-the tubes that carry air in and out of your lungs-are partly obstructed, making it difficult to get air in and out.

Cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or former smokers. Breathing in other kinds of lung irritants, like pollution, dust, or chemicals over a long period of time may also cause or contribute to COPD.

The airways branch out like an upside-down tree, and at the end of each branch are many small, balloon-like air sacs. In healthy people, each airway is clear and open, the air sacs are small and dainty, and both are elastic and springy. When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. (See the section, "How Do the Lungs Work," for details.) In COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out because:
 

The airways and air sacs lose their elasticity (like an old rubber band)
The walls between many of the air sacs are destroyed
The walls of the airways become thick and inflamed (swollen)
Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.

COPD develops slowly, and it may be many years before you notice symptoms like feeling short of breath. Most of the time, COPD is diagnosed in middle-aged or older people.

COPD is a major cause of death and illness throughout the world. It is the 4th leading cause of death in the U.S. and the world.

There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to feel better and slow the damage to your lungs.

COPD is not contagious-you cannot catch it from someone else.

Lung
-Treatment of COPD and Asthma
What can you do if you have an early stage of asthmatic bronchitis, chronic bronchitis, or emphysema?
Certainly you should change any behavior that can make it worse. The single most important thing you can do for yourself is to stop smoking. In fact, if you don't stop smoking, none of your other efforts will be as effective as they could be, and your COPD will get worse.

As a COPD patient-

You need clean air. Therefore, you should also avoid being around smokers and fume-laden air. During fog or smog, try to stay indoors with windows closed. If possible, fumeless appliances should be used for heating.
Polluted air also can irritate your breathing passages. Try not to go out when the air quality is rated poor. But if you cannot avoid excessive air pollution, protecting your mouth and nose with a mask may improve your breathing.
You should see your doctor on a regular basis and especially if you have a chest cold or any time you cough up mucus.
It is also important to guard against catching the flu by getting an influenza vaccine each fall, well before winter starts. A pneumonia vaccine should also be given to anyone over age 60, and all persons with COPD.

There are many different types of treatments that can help you cope with a chronic lung disease and live your life to the fullest. Next, we will discuss some of these treatments. Your doctor will select the ones that will be helpful for you.

Clearing Your Lungs
Coughing has an important "cleaning action" and is something you should do every morning and evening. You must learn to cough in such a way that you can clear your lungs of mucus with two or three coughs. There are many ways to do this; your doctor will teach you the way that is best for your particular problem.

As an aid to this cleaning, your doctor might recommend breathing moist or humid air, and drinking plenty of fluids every day. This helps to thin out the mucus so that you can cough it up more easily.

Your doctor might also recommend inhaled bronchodilating drugs or anti-inflammatory drugs that open your airways and help increase the normal flow of mucus out of your lungs (See below).

Breathing Techniques
Learning to breathe properly is another very important lesson for people with asthmatic bronchitis, chronic bronchitis, or emphysema. If you have COPD, you usually work very hard to breathe. However, because you are not breathing properly, your hard work does not make you feel better and you become tired easily.
There are several things you can do to improve your breathing:

First, it is important to relax. You must be relaxed when you breathe.
Breathe out against pursed lips, like when whistling. This slows down the number of breaths you take. This allows each breath to do more good for you.
Lean forward while exercising. This also helps stop shortness of breath.
"Belly breathing" will also help shortness of breath. This is done by allowing your belly to stick out while breathing in and then pulling your belly in while breathing out against pursed lips.

Physical Activity
Often people make the mistake of believing that if they try to avoid becoming short of breath, they will protect their lungs and heart. Nothing could be less true. Remaining physically active will improve your breathing ability and help you feel better and enjoy life more.

You can learn how to exercise more even if you have COPD. As we all know, muscles will become weak if we don't use them. This is true for the muscles of your chest, which are important in breathing, as well. Strengthening these muscles will help stop shortness of breath.

Don't let COPD change your normal attitudes about exercise. You should walk every day, going farther each day than you did the one before. First, walk in your house, then out of doors - walking longer distances each time. You will soon notice that you are breathing better because using the muscles in your chest helps stop shortness of breath.

Your doctor will tell you which exercises are best for you and plan an exercise program based upon your ability. Ask about local pulmonary programs.

Oxygen
Oxygen is a very helpful treatment that enables many patients with severe COPD to lead a more normal and productive life.
If your doctor feels your body is not getting enough oxygen, he or she may prescribe it for you. Portable cylinders will allow you to carry oxygen with you, or your doctor might tell you to use it at night during sleep when a lack of oxygen is most severe. Liquid portable oxygen is the most practical ambulatory system. Your doctor must order the proper oxygen system which can benefit you the most. A supplier cannot change your doctor's prescription. Follow the directions you are given carefully, as you would for any medication that is prescribed.

Medications
Many different medications are used as treatment for asthmatic bronchitis, chronic bronchitis, or emphysema. Your doctor will decide which medicine is best for you based on your medical history, breathing tests, and laboratory tests.
To help you breathe easier, your doctor may give you bronchodilator drugs. Bronchodilators relax the muscles that surround the breathing tubes and widen them, letting air travel in and out more easily.
Your doctor may also prescribe drugs to liquefy the mucus in your lungs, or even drugs called steroids, which reduce the swelling in your breathing tubes. If you have an infection in your respiratory system, your medications may include antibiotics.
These medications may be available in many different forms. In addition to pills or syrups, your doctor may prescribe a metered-dose inhaler, which has medication that you breathe in. Liquid medications may be used with special equipment that will turn them into a mist that will provide moisture for your respiratory system. This mist-maker is called a nebulizer. It is discussed below.

Metered-Dose Inhalers
Most of these devices, which deliver medication to your lungs as a spray, require a prescription from your doctor. The medication in a metered-dose inhaler that can be bought without a prescription such as Primatine MistTM is adrenaline, a short-acting drug which may be dangerous for persons with heart disease. It is inadequate to treat COPD.
In order to get the maximum benefit from the medication, it is important that the inhaler be used properly. Here are some helpful tips for using a metered-dose inhaler:

1. Remove the cap from the mouthpiece.
2. Shake the inhaler for a few seconds. Breathe out.
3. Hold the inhaler upright and place it in front of your mouth. Keep your mouth slightly open. Breathe in deeply and at the same time press the inhaler between your thumb and forefinger. This will force the medication from the inhaler into your throat and lungs.
4. Remove the inhaler and hold your breath for a few seconds; then resume normal breathing. Wait at least two minutes before repeating the process. (Most inhaler medications specify that two puffs should be taken. Wait at least two minutes between each puff.)

Do not exceed the dose prescribed by your doctor. If you continue to have difficulty breathing, contact
Contact your doctor immediately.
A device called a spacer or volume chamber should also be used to make it easier to take your medication. This device catches the mist produced by a metered-dose inhaler and holds it so that you can breathe it in at a slower rate.

Mist-Generating Devices
This type of treatment, which must be prescribed by your doctor, delivers a mist of medication and moisture to your lungs. The device that is most often used to create this mist is a "pump-driven nebulizer." The liquid medication is placed in the nebulizer where it is changed into a mist that you inhale. When taking this treatment, here are some points to remember:

1. Be sure you know the amount of medication and solution to use as well as the length and timing of your treatment. Follow your doctor's or respiratory therapist's instructions carefully about when each treatment should be scheduled and the length of time that it should be done.
2. Relax and sit in a comfortable chair in an upright position.
3. Make sure the tubing is not bent or dented, and that the handhold is at the same level as your mouth.
4. Put the mouthpiece in front of your teeth and keep your mouth slightly open.
5. Take a deep, slow breath and activate the nebulizer control. Let the mist fill your lungs. Hold your breath for about two seconds before exhaling. Remember to exhale slowly and completely each time.

If your mouth becomes dry during your treatment, don't be afraid to stop and drink some water. Also -- and this is very important -- if you bring up mucus during the treatment, turn your machine off and stop and cough it up. These treatments are helpful in eliminating mucus.

If you experience any discomfort after treatment, notify your doctor.

New Developments
Progress is continually being made in the treatment of asthmatic bronchitis, chronic bronchitis, and emphysema.

Another type of bronchodilator medication (an anticholinergic), is available in metered-dose devices. The other major type of inhaled bronchodilator is called a beta agonist.
Beta agonist medications are also available as solutions for use with pump-driven nebulizers. Anticholinergic solutions are also useful in COPD. Both medications can be used together in the same nebulizer. Both are sold in a metered-dose inhaler (separately and mixed together for convenience). Since these bronchodilators work on the respiratory system in different ways, they can be used together to treat COPD.
A new treatment that may be effective in a rare hereditary form of emphysema is being tested on volunteers. A replacement for the inherited deficiency of alpha antitrypsin is commercially available. Although it restores a protective material in the lungs, its effectiveness in preventing the progress of emphysema remains to be proven.

Surgical approaches to improving dyspnea by removing areas of major lung damage from emphysema are called lung volume reduction surgery, (LVRS).

In selected patients, this operation can improve shortness of breath and quality of life. The mechanisms behind this improvement are complex. They include a restoration of the curvature of the diaphragm through a reduction in overinflation of diseased parts of the lung. These regions of excessive destruction are often in the upper parts of the lung, (apices). These areas contribute little to lung function, but they take up a lot of space for expansion of the rest of the lung, which is relatively normal. Extensive evaluations must be done through scans and tests of heart function to determine good candidates.

At the present time, Medicare does not reimburse for this operation, pending the results of a study. This study contrasts the results from surgery following a period of pulmonary rehabilitation compared to pulmonary rehabilitation alone. This study is known as the National Emphysema Therapy Trial, (NETT).
It will be five years or more before the results of NETT are known. Qualified surgeons are presently offering this operation to selected patients on an individual basis when patients have financing resources outside of Medicare. Patients should be evaluated by pulmonologists and surgeons, working together before going ahead with this treatment.