Treatment of Chronic Obstructive Pulmonary Disease (COPD)

There are many forms of treatment available for COPD, both medical and surgical.

Smoking Cessation

Smoking cessation is primary in the prevention and treatment of COPD since it alone is responsible for 82 % of COPD.

Bronchodilators

Bronchodilators relax muscles of the bronchus and allow air to get in and out easier. These medications are available in pill or liquid form which are taken orally, or in aerosol spray form which is inhaled.

Steroids for COPD

Steroids dilate the bronchial tubes and decrease the swelling of the lining and inflammation of the cells. Up to 20 % of COPD patients, mostly those with a asthmatic or asthmatic bronchitis, benefit from steroid therapy. It has little to offer emphysema patients. The potential side effects of systemic steroids, including osteoporosis, diabetes, weight gain, cataracts, and hypertension, are always of major concern.

Anti-Infective Agents

Antibiotics are frequently used during bronchitic exacerabations to fight bacterial infections.

Flu and Pneumonia vaccinations are recommended for all patients with COPD. The influenza shot is administered yearly while the pneumonia shot is administered every five years.

Oxygen Therapy for COPD

Oxygen therapy has proven beneficial to those with oxygenation problems. Oxygen therapy has been shown to improve the quality and length of life in selected emphysema patients. Oxygen therapy in COPD patients is indicated if the pO2 is less than 55mmHg. If the O2 is 55-59mmHg, oxygen therapy is indicated if there is evidence of cardiac abnormalities, mental status changes or an elevated blood count.

Maintaining Proper Nutrition to Reduce COPD

Nutrition is another crucial concern for COPD patients. Weight loss is common in patients with advanced emphysema. While some weight loss can be caused by inadequate food intake in individuals too short of breath to eat, most of the weight loss is caused by the increased metabolic demand of respiratory muscles forced to overwork because of emphysema damage. Emphysema sufferers who lose weight are sicker and face increased mortality risks. The use of oral or parenteral supplements to improve nutritional health have not been shown to have long-term benefits. There is recent interest in anabolic steroid use in such patients.

Pulmonary Rehabilitation

Pulmonary rehabilitation has clear benefit in patients with COPD. It increases endurance, improves shortness of breath, increases maximal oxygen consumption, improves quality of life, and decreases the overall length of stay in the hospital. However, these improvements tend to be limited and eventually plateau. Additionally, there is no change in pulmonary function testing, no change in overall oxygen requirements, and survival benefits are unclear.

Lung Transplantation for COPD

Lung transplantation has been performed in patients with severe emphysema during the past decade. Overall results have been reasonable but lung transplantation is very expensive and many associated problems have not been resolved. There are ongoing concerns over post-transplant infection and rejection including a condition called bronchiolitis obliterans.

Lung Volume Reduction Surgery (LVRS)

Lung volume reduction surgery has been shown in recent years to have some promising results for patients with end stage emphysema. Because medical therapy for emphysema has had limited benefits for over 100 years, surgical options have been continuously sought. Over the years, many approaches have been tried including various surgical procedures to make the chest cavity smaller or larger. Mechanical devices have been tried in hope of improving diaphragm function. Many of these approaches were met with early enthusiasm but ultimately discarded because they proved ineffective.

In the 1950s, a surgeon named Otto Brantigan, recognizing the mechanical nature of the obstruction in emphysema, postulated that by removing the worst areas of emphysematous lung tissue and downsizing the lungs one could alleviate shortness of breath. Dr Brantigan published some initially encouraging results, but this procedure was discontinued because of increased risks.

In 1994, Joel Cooper, a thoracic surgeon in St. Louis, reintroduced Dr Brantigan's procedure, but with 40 years of medical progress including better screening, pulmonary function testing and radiographic studies, better anesthetic agents, double lumen endotrachial tubes, newer surgical techniques, and better postoperative pain control. With these advances, Dr Cooper published encouraging results. Subsequently, lung volume reduction surgery was performed at a number of medical centers around the country. In this operation some of the stretched out lung tissue is removed to make room for the remaining lung tissue to expand and contract with breathing.