What is chronic obstructive pulmonary disease (COPD) ?
Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive airway diseases (COAD), is a group of diseases characterized by the pathological limitation of airflow in the airway that is not fully reversible. It refers to an obstruction of airflow, which results in air becoming trapped in the lungs. COPD is the term that groups chronic bronchitis, emphysema and a range of other lung disorders and is most often a consequence of long term tobacco smoking.
Is it important?
Here is some data from http://www.copd-international.com/library/statistics.htm:
1. The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection). In the USA, it is the fourth leading cause of death and will be the third one by 2020.
2. It is estimated that there may currently be 16 million people in the United States currently diagnosed with COPD, with around 14 million or more undiagnosed.
3. According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.
4. The total estimated cost of COPD in 2002 was $32.1 billion.$18 billion were direct costs, $14.1 billion were from indirect costs.
How do I know if I have COPD?
The main symptoms of COPD are:
1. Dyspnea (shortness of breath) lasting for months or perhaps years
2. Wheezing
3. A persistent cough with sputum production.
4. Blood in sputum (hemoptysis)
5. Cyanosis (bluish decolorization usually in the lips and fingers) caused by a lack of oxygen in the blood when COPD is really bad.
Signs include a rapid breathing rate (tachypnea) and a wheezing sound heard through a stethoscope.
Why does COPD occur?
A. Cigarette smoking : A primary risk factor of COPD is chronic tobacco smoking. In the United States, around 80 to 90% of cases of COPD are due to smoking. Not all smokers will develop COPD, but continuous smokers have at least a 25% risk, after 25 years. Smoking cessation is one of the most important factors in slowing down the progression of COPD. Even at a late stage of the disease it can reduce the rate of deterioration and prolong the time taken for disability and death.
B. Occupational pollutants: Some occupational pollutants, such as cadmium and silica, have shown to be a contributing risk factor for COPD. Also, coal workers who smoke have increased risk for concomitmant pneumoconiosis and emphysema. Asbestos workers who smoke are at increased risk for concomitant emphysema, asbestosis and mesothelioma.
C. Air pollution: Urban air pollution may be a contributing factor for COPD as it is thought to impair the development of the lung function. In developing countries indoor air pollution has been found to be linked to COPD, especially in women.
D. Genetics : Very rarely, there may be a deficiency in a trypsin antagonist known as alpha 1-antitrypsin which causes a form of COPD.
How will a doctor diagnose COPD?
Your doctor might want to get a Chest X ray, which might show signs of COPD ( hyperinflation of the lungs ) . Also with the use of pulmonary function tests ( PFT's, spiromertry ) your doctor may see decreased airflow rates while exhaling and over-expanded lungs. Finally he can get a sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis).
Bear in mind that the diagnosis of COPD is suggested by symptoms; it is a clinical diagnosis and no single test is definitive. A history is taken of smoking and occupation exposure, and a physical examination is done. Later on studies such as a Chest X Ray and PFT's are done if needed.
Treatment
I. Conventional
The first part of the treatment if the patient is still smoking is getting him to quit! There needs to be counseling involved, medications ( such as Wellbutrin, Chantix or the nicotine patch ) can also help, but the main issue is that the patient needs to be resolved to quit smoking. The doctor plays an important role as he needs to be availiable and enquire in every visit about the desire of thepatient to quit smoking.
β2 agonists
There are several highly specific β2 agonists available. Albuterol (Ventolin) is the most widely used short acting β2 agonist to provide rapid relief and should be prescribed as a front line therapy for all classes of patients. Other β2 agonists are Fenoterol, and Formoterol . Long acting β2 agonists (LABAs) such as Salmeterol act too slowly to be used as relief for dypsnea so these drugs should be used as maintenance therapy in the appropriate patient population. The TORCH study showed that LABA therapy reduced COPD exacerbation frequency over a 3 year period, compared to placebo.
Anticholinergics
Specific antimuscarinics were found to provide effective relief to COPD. Ipratropium is widely prescribed with the β2 agonist salbutamol.
Tiotropium ( SPIRIVA ) provides improved specificity for M3 muscarinic receptors. It is a long acting muscarinic antagonist that has shown good efficacy in the reduction of exacerbations of COPD, especially when combined with a LABA ( long acting beta agonists such as salmeterol ) and inhaled steroid.
Leukotriene antagonists
More recently leukotriene antagonists block the signalling molecules used by the immune system. Montelukast, Pranlukast, Zafirlukast are some of the leukotrienes antagonists. Research doesn't support their use in COPD
Xanthines
Theophylline is the prototype of the xanthine class of drug. Although still in use mainly because of their property of bronchodilation and pulmonary function anhancement ( specially at night ), they are used less and less due to their need to be closely monitored due to their narrow therapeutic range.
Corticosteroids
Steroids by inhaler, by mouth and IM/IV has been the mainstay of treatment of COPD, and it has shown on research studies to reduce length of stay in hospital. Inhaled corticosteroids act in the inflammatory cascade and improve airway function considerably, and have been shown in the ISOLDE trial to reduce the number of COPD exacerbations by 25%. Corticosteroids are often combined with bronchodilators in a single inhaler. Bear in mind that these combinations ( specifically ADVAIR ) have not shown to decrease all cause mortality on research studies.
Supplemental Oxygen
This is the only intervention that HAS SHOWN TO INCREASE SURVIVAL IN COPD. In general, long-term administration of oxygen is usually reserved for individuals with COPD who have oxygen saturation below 88% on room air.
Vaccinations
Patients with COPD should be routinely vaccinated against influenza ( yearly ) , pneumococcus ( 2 times, once before age 65 and once after ).
Pulmonary rehabilitation
Pulmonary rehabilitation is a program of disease management, counseling and exercise coordinated to benefit the individual. Pulmonary rehabilitation has been shown to relieve difficulties breathing and fatigue. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions. Usually after a patient goes into the hospital they are referred for pulmonary rehabilitation.
Diet
A recent French study conducted over 12 years with almost 43,000 men concluded that eating a Mediterranean diet "halves the risk of serious lung disease like emphysema and bronchitis". Diet need to address the excess amount of energy the patient uses up everyday to breath, thus ensuring extra calories per day.
Antibiotics
Antibiotics are used during flare-ups of symptoms as infections can worsen COPD. Research doesn't back up the use of them, but certainly treatments of overinfections help to stabilize the patient.
Lung Transplant
Lung transplant is sometimes performed for severe cases, but due to its high cost and lack of donors, it is certainly reserved to a limited number of patients.
II. Alternative
Even despite being repetitive the first treatment will always be quit smoking!
Drink plenty of lukewarm fluids, constantly throughout the day. Add fresh garlic, onions and ginger for immune support to your warm foods.
Decrease or stop taking dairy products.
Vegetable juice fasts and water fasts are recommended at least once every month.
With respect to supplements you can use N-acetylcysteine ( 500mg twice daily ) to reduce mucus viscosity, Vitamin C 500mg to 1000mg 3 times a day for immune function, also echinacea and goldenseal may help on the immune enhancing arena. Mullein 500mg 4 times a day may help get rid of mucus. Licorice can also be used ( warning for hypertensives ) in the form of supplements or tea. Finally, take collidal silver 1 teaspoon 3 times a day orally. This will help avoid bacterial infections.
Homeopathy wise, please click on the following link to a homeopathic portal and choose your best remedies. Buy them at 30C concentration and take them 3 times a day ( 3 or 4 pillules ): http://www.hpathy.com/diseases/bronchitis-symptoms-treatment-cure.asp.
Acupuncture, acupressure and chinese herbs can definitively help optimize immune function and difficulty breathing. A general reduction in stress is also recommended.
Do consider changing your environment. Sometimes humid weather can worsen symptoms. Also be aware that exercise is still recommended for stable COPD patients.
Please review this informational video:
Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive airway diseases (COAD), is a group of diseases characterized by the pathological limitation of airflow in the airway that is not fully reversible. It refers to an obstruction of airflow, which results in air becoming trapped in the lungs. COPD is the term that groups chronic bronchitis, emphysema and a range of other lung disorders and is most often a consequence of long term tobacco smoking.
Is it important?
Here is some data from http://www.copd-international.com/library/statistics.htm:
1. The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection). In the USA, it is the fourth leading cause of death and will be the third one by 2020.
2. It is estimated that there may currently be 16 million people in the United States currently diagnosed with COPD, with around 14 million or more undiagnosed.
3. According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.
4. The total estimated cost of COPD in 2002 was $32.1 billion.$18 billion were direct costs, $14.1 billion were from indirect costs.
How do I know if I have COPD?
The main symptoms of COPD are:
1. Dyspnea (shortness of breath) lasting for months or perhaps years
2. Wheezing
3. A persistent cough with sputum production.
4. Blood in sputum (hemoptysis)
5. Cyanosis (bluish decolorization usually in the lips and fingers) caused by a lack of oxygen in the blood when COPD is really bad.
Signs include a rapid breathing rate (tachypnea) and a wheezing sound heard through a stethoscope.
Why does COPD occur?
A. Cigarette smoking : A primary risk factor of COPD is chronic tobacco smoking. In the United States, around 80 to 90% of cases of COPD are due to smoking. Not all smokers will develop COPD, but continuous smokers have at least a 25% risk, after 25 years. Smoking cessation is one of the most important factors in slowing down the progression of COPD. Even at a late stage of the disease it can reduce the rate of deterioration and prolong the time taken for disability and death.
B. Occupational pollutants: Some occupational pollutants, such as cadmium and silica, have shown to be a contributing risk factor for COPD. Also, coal workers who smoke have increased risk for concomitmant pneumoconiosis and emphysema. Asbestos workers who smoke are at increased risk for concomitant emphysema, asbestosis and mesothelioma.
C. Air pollution: Urban air pollution may be a contributing factor for COPD as it is thought to impair the development of the lung function. In developing countries indoor air pollution has been found to be linked to COPD, especially in women.
D. Genetics : Very rarely, there may be a deficiency in a trypsin antagonist known as alpha 1-antitrypsin which causes a form of COPD.
How will a doctor diagnose COPD?
Your doctor might want to get a Chest X ray, which might show signs of COPD ( hyperinflation of the lungs ) . Also with the use of pulmonary function tests ( PFT's, spiromertry ) your doctor may see decreased airflow rates while exhaling and over-expanded lungs. Finally he can get a sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis).
Bear in mind that the diagnosis of COPD is suggested by symptoms; it is a clinical diagnosis and no single test is definitive. A history is taken of smoking and occupation exposure, and a physical examination is done. Later on studies such as a Chest X Ray and PFT's are done if needed.
Treatment
I. Conventional
The first part of the treatment if the patient is still smoking is getting him to quit! There needs to be counseling involved, medications ( such as Wellbutrin, Chantix or the nicotine patch ) can also help, but the main issue is that the patient needs to be resolved to quit smoking. The doctor plays an important role as he needs to be availiable and enquire in every visit about the desire of thepatient to quit smoking.
β2 agonists
There are several highly specific β2 agonists available. Albuterol (Ventolin) is the most widely used short acting β2 agonist to provide rapid relief and should be prescribed as a front line therapy for all classes of patients. Other β2 agonists are Fenoterol, and Formoterol . Long acting β2 agonists (LABAs) such as Salmeterol act too slowly to be used as relief for dypsnea so these drugs should be used as maintenance therapy in the appropriate patient population. The TORCH study showed that LABA therapy reduced COPD exacerbation frequency over a 3 year period, compared to placebo.
Anticholinergics
Specific antimuscarinics were found to provide effective relief to COPD. Ipratropium is widely prescribed with the β2 agonist salbutamol.
Tiotropium ( SPIRIVA ) provides improved specificity for M3 muscarinic receptors. It is a long acting muscarinic antagonist that has shown good efficacy in the reduction of exacerbations of COPD, especially when combined with a LABA ( long acting beta agonists such as salmeterol ) and inhaled steroid.
Leukotriene antagonists
More recently leukotriene antagonists block the signalling molecules used by the immune system. Montelukast, Pranlukast, Zafirlukast are some of the leukotrienes antagonists. Research doesn't support their use in COPD
Xanthines
Theophylline is the prototype of the xanthine class of drug. Although still in use mainly because of their property of bronchodilation and pulmonary function anhancement ( specially at night ), they are used less and less due to their need to be closely monitored due to their narrow therapeutic range.
Corticosteroids
Steroids by inhaler, by mouth and IM/IV has been the mainstay of treatment of COPD, and it has shown on research studies to reduce length of stay in hospital. Inhaled corticosteroids act in the inflammatory cascade and improve airway function considerably, and have been shown in the ISOLDE trial to reduce the number of COPD exacerbations by 25%. Corticosteroids are often combined with bronchodilators in a single inhaler. Bear in mind that these combinations ( specifically ADVAIR ) have not shown to decrease all cause mortality on research studies.
Supplemental Oxygen
This is the only intervention that HAS SHOWN TO INCREASE SURVIVAL IN COPD. In general, long-term administration of oxygen is usually reserved for individuals with COPD who have oxygen saturation below 88% on room air.
Vaccinations
Patients with COPD should be routinely vaccinated against influenza ( yearly ) , pneumococcus ( 2 times, once before age 65 and once after ).
Pulmonary rehabilitation
Pulmonary rehabilitation is a program of disease management, counseling and exercise coordinated to benefit the individual. Pulmonary rehabilitation has been shown to relieve difficulties breathing and fatigue. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions. Usually after a patient goes into the hospital they are referred for pulmonary rehabilitation.
Diet
A recent French study conducted over 12 years with almost 43,000 men concluded that eating a Mediterranean diet "halves the risk of serious lung disease like emphysema and bronchitis". Diet need to address the excess amount of energy the patient uses up everyday to breath, thus ensuring extra calories per day.
Antibiotics
Antibiotics are used during flare-ups of symptoms as infections can worsen COPD. Research doesn't back up the use of them, but certainly treatments of overinfections help to stabilize the patient.
Lung Transplant
Lung transplant is sometimes performed for severe cases, but due to its high cost and lack of donors, it is certainly reserved to a limited number of patients.
II. Alternative
Even despite being repetitive the first treatment will always be quit smoking!
Drink plenty of lukewarm fluids, constantly throughout the day. Add fresh garlic, onions and ginger for immune support to your warm foods.
Decrease or stop taking dairy products.
Vegetable juice fasts and water fasts are recommended at least once every month.
With respect to supplements you can use N-acetylcysteine ( 500mg twice daily ) to reduce mucus viscosity, Vitamin C 500mg to 1000mg 3 times a day for immune function, also echinacea and goldenseal may help on the immune enhancing arena. Mullein 500mg 4 times a day may help get rid of mucus. Licorice can also be used ( warning for hypertensives ) in the form of supplements or tea. Finally, take collidal silver 1 teaspoon 3 times a day orally. This will help avoid bacterial infections.
Homeopathy wise, please click on the following link to a homeopathic portal and choose your best remedies. Buy them at 30C concentration and take them 3 times a day ( 3 or 4 pillules ): http://www.hpathy.com/diseases/bronchitis-symptoms-treatment-cure.asp.
Acupuncture, acupressure and chinese herbs can definitively help optimize immune function and difficulty breathing. A general reduction in stress is also recommended.
Do consider changing your environment. Sometimes humid weather can worsen symptoms. Also be aware that exercise is still recommended for stable COPD patients.
Please review this informational video:
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