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In this article, learn how COPD is treated as well as underlying causes, diagnostic techniques, possible prevention strategies, and prognosis.
What Is COPD?
COPD encompasses a spectrum of breathing and lung function diseases, many of which have much more recognizable names than COPD itself.
According to the COPD Foundation, related diseases that fall underneath the COPD umbrella include emphysema, chronic bronchitis, non-reversible (refractory) asthma and a rare genetic disease called Alpha-1 Antitrypsin deficiency.
In most cases, smoking or exposure to secondhand smoke is the cause of COPD. But additional compounding factors can include exposure to dust, toxins or chemical fumes and rare genetic diseases.
Emphysema is a disease that arises when the tiny air sacs inside the lungs, called alveoli, get damaged. Each alveolus contains multiple tiny air sacs that are responsible for respiration - the ongoing exchange of oxygen and carbon dioxide.
When these tiny air sacs are damaged, their walls disintegrate and what used to be multiple tiny sacs becomes one larger sac. The more alveoli that are affected, the less efficiently the lungs can do their job and the harder it is for the person to breathe.
Bronchitis is fundamentally an irritation of the bronchial tubes. Each tube has tiny hairlike structures that line the inside walls (cilia). The cilia have the job of moving mucus up and out of the tubes.
When bronchitis occurs repeatedly, the cilia can get damaged or destroyed. This, in turn, can cause chronic bronchitis.
An asthma attack is prompted by the swelling of the bronchial airways. When asthma doesn't respond to the usual medications, it is considered non-reversible.
Alpha-1 Antitrypsin deficiency (AATD).
AATD deficiency can cause a number of concerning health issues, including emphysema and cirrhosis of the liver as well as skin disease. This is a relatively rare genetic (heritable) disease.
How Is COPD Diagnosed?
COPD can be diagnosed in a number of ways. Tests also exist to help confirm a diagnosis of COPD.
Major symptoms of COPD.
The major symptoms that a physician will look for to diagnose COPD include these:
- Trouble breathing, shortness of breath or breathlessness.
- A persistent cough (both with and without mucus present).
- Feeling of chest tightness.
The American Lung Association states that the first thing a doctor will do is to take a personal and family medical and lifestyle history.
Common diagnostic questions typically focus on identifying whether the person has a history of smoking or secondhand smoke exposure as well as exposure to other airborne toxins (such as smog, dust, chemicals).
In a small percentage of cases, COPD may be inherited.
Diagnostic tests for COPD.
A number of helpful tests exist to confirm the diagnosis of COPD.
- Spirometry. This simple, non-invasive test measures lung function. All you have to do is blow into a tube connected to a machine that measures your lung function.
- Chest X-ray or CT Scan. These tests take an image of your lungs to detect whether there has been damage to any of the critical structures.
- Bronchodilator reversibility testing. This test looks for a positive response to medication designed to treat COPD.
- AATD blood test. When AATD is suspected, a blood test will be ordered to test for levels of the protein. Low levels can indicate a diagnosis of Alpha-1 Antitrypsin deficiency (AATD) related COPD. This test can also be ordered as a part of advance family planning where there is a suspected family history of COPD or AATD.
The COPD Foundation also offers a free short online risk screener test you can take to determine whether to pursue further diagnostic tests for COPD.
How Is COPD Treated?
There are three basic treatment strategies that may be used alone or in concert with each other: medications, breathing rehabilitation and surgery.
The goal of all treatment options is to improve breathing and lung function, improve the overall quality of life and reduce symptoms over the long-term.
Five main types (classes) of drugs are typically used to treat COPD: corticosteroids, antibiotics, beta2-agonists and anticholinergics, vaccinations and oxygen.
- Corticosteroids fight inflammation.
- Antibiotics fight infection.
- Beta2-agonists and anticholinergics act to relax tightened bronchial muscles to reopen your airways.
- Vaccinations protect you against respiratory diseases such as cold and flu that can weaken your lungs further through congestion and infection.
- Oxygen to supplement what your lungs can respire on their own.
Both short-acting (quick to take effect and quick to wear off) and long-acting (slow to take effect and slow to wear off) versions of both classes of drugs exist.
Six basic delivery methods are used for COPD medications: inhaler, oral pill, nebulizer, dilator, shot and oxygen tank.
- Inhaler. An inhaler similar to what asthma sufferers use delivers anti-inflammatory medications known as corticosteroids in spray form into the airways.
- Pills. Corticosteroids and antibiotics can also be taken as an oral pill either alone or in concert with other treatments.
- Nebulizer. A nebulizer can transform any liquid medication into a very fine mist that you breathe in through a face mask. This way the mist gets right to your lungs fast.
- Dilator. A bronchodilator can deliver beta2-agonists and anticholinergics.
- Shot. Shots are typically used to deliver vaccines like cold and flu.
- Oxygen tank. An oxygen tank equipped with a face mask or nasal prongs can administer extra oxygen as needed.
NOTE: COPD clinical trials are ongoing to test new medications and treatments. For some patients, participating in a clinical trial may produce positive results and/or stave off the need for more invasive treatment such as surgery.
Breathing or pulmonary rehabilitation typically includes five treatments: education, exercise, breathing guidance, nutrition and counseling/support.
Education helps patients learn about their own anatomy, lung function and how breathing techniques, exercise, and medications work to improve breathing.
Exercise modifications, including the use of supplemental oxygen, are often required to keep patients with COPD active and fit.
Breathing guidance includes learning techniques like pursed-lip breathing and diaphragmatic breathing to make full use of oxygen without placing stress on the lungs.
Nutritional guidance aims to help patients learn how to take the pressure off the lungs while still preparing and consuming healthy meals.
Counseling and emotional support can be a critical part of helping patients and carers manage symptoms and maintain quality of life.
Three main surgical approaches are used to treat COPD that has stopped responding to other less-invasive treatments or is beyond the scope of what medication and breathing therapy can treat.
The most important factor here is to ensure the patient is a good candidate to undergo surgery. The patient must be sufficiently strong to have general anesthesia and withstand the recovery process. The patient is also typically required to undergo pulmonary (breathing) rehabilitation. Patients who smoke are usually ineligible for COPD surgery.
Bullectomy surgery removes bullae, or large sacs, which form when alveoli die off. When the bullae are gone, the patient often finds that they experience improved lung function and easier breathing.
Lung volume reduction surgery, or LVRS, removes diseased lung tissue to help facilitate improved quality of life for patients. This surgery not only aids lung function but helps improve diaphragm function as well.
Lung transplants can be a last resort surgery when the lungs are too damaged to respond to other surgical interventions. While lung transplants can greatly enhance the quality of life and breathing function, they also require special measures to guard against systemic organ rejection while managing the risk of infection.
Are There Any Alternative Treatments for COPD?
Some COPD patients find great benefit in pursuing alternative treatments in addition to their regular treatment protocol.
While there are no alternative treatments to date that have been FDA-approved to treat COPD, and COPD itself currently cannot be cured, you may discover much additional quality of life benefits from learning about meditation, deep breathing, visualization, yoga, massage, acupuncture, chiropractic, and other complementary treatments.
Discovering you have COPD is undoubtedly a life-changing diagnosis for you and your loved ones. But it is important to remember that many effective strategies and COPD treatments do exist that can help you manage symptoms and continue to enjoy a high quality of life over the long-term.
As always, the best course of action is to follow your doctor's guidance to the letter and consult with your treatment team before adding any complementary treatments or supplements to your regular daily health and wellness regimen.