How Is Chronic Obstructive Pulmonary Disease Treated?

Although there is no cure for COPD, the disease can be prevented in many cases. And, in almost all cases the disabling symptoms can be reduced. Because cigarette smoking is the most important cause of COPD, not smoking almost always prevents COPD from developing, and quitting smoking slows the disease process.

There is no cure for COPD at present, but the disease is usually preventable. If the patient and medical team develop and adhere to a program of complete respiratory care, disability can be minimized, acute episodes prevented, hospitalizations reduced, and some early deaths avoided. On the other hand, none of the therapies has been shown to slow the progression of the disease, and only oxygen therapy has been shown to increase the survival rate.

Home oxygen therapy can improve survival of COPD patients. Home oxygen therapy can improve survival in patients with advanced COPD who have hypoxemia, low blood oxygen levels. This treatment can improve a patient's exercise tolerance and ability to perform on psychological tests which reflect different aspects of brain function and muscle coordination. Increasing the concentration of oxygen in blood also improves the function of the heart and prevents the development of cor pulmonale. Oxygen can also lessen sleeplessness, irritability, headaches, and the overproduction of red blood cells. Continuous oxygen therapy is recommended for patients with low oxygen levels at rest, during exercise, or while sleeping. Many oxygen sources are available for home use; these include tanks of compressed gaseous oxygen or liquid oxygen and devices that concentrate oxygen from room air. However, oxygen is expensive with the cost per patient running into several hundred dollars per month, depending on the type of system and on the locale.

Medications frequently prescribed for COPD patients include:
Bronchodilators help open narrowed airways. There are three main categories: sympathomimetics (isoproterenol, metaproterenol, terbutaline, albuterol) which can be inhaled, injected, or taken by mouth; parasympathomimetics (atropine, ipratropium bromide); and methylxanthines (theophylline and its derivatives) which can be given intravenously, orally, or rectally.
Corticosteroids or steroids (beclomethasone, dexamethasone, triamcinolone, flunisolide) lessen inflammation of the airway walls. They are sometimes used if airway obstruction cannot be kept under control with bronchodilators, and lung function is shown to improve on this therapy. Inhaled steroids given regularly may be of benefit in some patients and have few side effects.

Antibiotics (tetracycline, ampicillin, erythromycin, and trimethoprim-sulfamethoxazole combinations) fight infection. They are frequently given at the first sign of a respiratory infection such as increased sputum production with a change in color of sputum from clear to yellow or green. Expectorants help loosen and expel mucus secretions from the airways.

Diuretics help the body excrete excess fluid. They are given as therapy to avoid excess water retention associated with right-heart failure. Patients taking diuretics are monitored carefully because dehydration must be avoided. These drugs also may cause potassium imbalances which can lead to abnormal heart rhythms. Digitalis (usually in the form of digoxin) strengthens the force of the heartbeat. It is used very cautiously in patients who have COPD, especially if their blood oxygen tensions are low, because they are vulnerable to abnormal heart rhythms when taking this drug.

Other drugs sometimes taken by patients with COPD are tranquilizers, pain killers (meperidine, morphine, propoxyphene, etc.), cough suppressants (codeine, etc.), and sleeping pills (barbiturates, etc.). All these drugs depress breathing to some extent; they are avoided whenever possible and used only with great caution.

A number of combination drugs containing various assortments of sympathomimetics, methylxanthines, expectorants, and sedatives are marketed and widely advertised. These drugs are undesirable for COPD patients for several reasons. It is difficult to adjust the dose of methylxanthines without getting interfering side effects from the other ingredients. The sympathomimetic drug used in these preparations is ephedrine, a drug with many side effects and less bronchodilating effect than other drugs now available. The combination drugs often contain sedatives to combat the unpleasant side effects of ephedrine. They also contain expectorants which have not been proven to be effective for all patients and may have some side effects.

Bullectomy, or surgical removal of large air spaces called bullae that are filled with stagnant air, may be beneficial in selected patients. Recently, use of lasers to remove bullae has been suggested. Lung transplantation has been successfully employed in some patients with end-stage COPD. In the hands of an experienced team, the 1-year survival in patients with transplanted lungs is over 70 percent. Pulmonary rehabilitation programs, along with medical treatment, are useful in certain patients with COPD. The goals are to improve overall physical endurance and generally help to overcome the conditions which cause dyspnea and limit capacity for physical exercise and activities of daily living.

General exercise training increases performance, maximum oxygen consumption, and overall sense of well-being. Administration of oxygen and nutritional supplements when necessary can improve respiratory muscle strength. Intermittent mechanical ventilatory support relieves dyspnea and rests respiratory muscles in selected patients.

Continuous positive airway pressure (CPAP) is used as an adjunct to weaning from mechanical ventilation to minimize dyspnea during exercise. Relaxation techniques may also reduce the perception of ventilatory effort and dyspnea. Breathing exercises and breathing techniques, such as pursed lips breathing and relaxation, improve functional status.

Keeping air passages reasonably clear of secretions is difficult for patients with advanced COPD. Some commonly used methods for mobilizing and removing secretions are the following: Postural bronchial drainage helps to remove secretions from the airways. The patient lies in prescribed positions that allow gravity to drain different parts of the lung. This is usually done after inhaling an aerosol. In the basic position, the patient lies on a bed with his chest and head over the side and his forearms resting on the floor. Chest percussion or lightly clapping the chest and back, may help dislodge tenacious or copious secretions.

Controlled coughing techniques are taught to help the patient bring up secretions. Bland aerosols, often made from solutions of salt or bicarbonate of soda, are inhaled. These aerosols thin and loosen secretions. Treatments usually last 10 to 15 minutes and are taken three or four times a day. Bronchodilators are sometimes added to the aerosols.