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COPD
Overview

COPD or chronic obstructive pulmonary disease is a chronic lung disease that is the third leading cause of death in the United States. It affects over 12.7 million adult Americans, but statistics show that almost 24 million people in the U.S. have some type of lung impairment so the numbers may be much underdiagnosed with this disease.
For eleven years in a row, the deaths from COPD in women are far more than men. Research is ongoing for this severe respiratory condition and treatment is improving. This article will help you understand COPD, the risk factors, how it is treated, and give you helpful prevention tips.

What is COPD?

COPD – Chronic Obstructive Pulmonary Disease, is a severe and chronic respiratory disease. The disease worsens over time and is most often the cause of death or contributes to the development of other health conditions.
The disease causes the lungs to overproduce mucus and makes breathing difficult. People with COPD have a very poor tolerance to activity. This is because the lungs do not work well enough to move oxygen in and out to the body.
Your lungs have small thin tubes called bronchioles that lead to the air sacs, the alveoli. The alveoli contain tiny blood vessels, the capillaries. Oxygen goes through the alveoli and goes into your blood and the carbon dioxide out via the capillaries.
Your air sacs stretch easily and blow up like balloons each time you take a breath. They deflate as you breathe out. COPD hampers the air flow due to:

The air sacs are less elastic.
There is too much mucus clogging your airways.
There is damage to the walls of the alveoli.
The airways have inflammation.

There are Two Causes of COPD:
Emphysema
Emphysema causes damage to the walls of the alveoli. They are no longer elastic and the walls weaken and become loose. Most of the air sacs open and join with other air sacs and there is less gas exchange. When you have emphysema, it is very hard to get the air in and out of the lungs.
Chronic Bronchitis
This is chronic inflammation of the airways. The lungs overproduce copious amounts of mucus that clog and block the airways. It causes you to cough on an almost constant basis to bring up the mucus.

COPD Risk Factors

COPD Risk Factors

There are risk factors that can lead to COPD later in life. These include:

Smoking. This is the number one risk factor for COPD. People who don’t smoke can still get COPD, but people who do smoke have a much higher risk. People with asthma that smoke have and even higher risk. Even second hand smoke from others in your home or car can increase the risk.

Allergies and Exposure. If you have seasonal allergies that lead to respiratory issues or exposure to pollution, dusts, or chemical vapors you have a higher risk of COPD due to long-term lung damage.

Age. COPD isn’t an “old age” disease, but can begin to appear between the ages of 35 and 40. With a history of asthma, the symptoms could appear even earlier.

Family History. There is a gene deficiency in the alpha-1-antitrypsin gene that may be related to COPD. There are also genetic factors that include history of; Chronic bronchitis, asthma, and seasonal allergies that can raise the risk.

COPD Symptoms

COPD symptoms most often appear very slowly and are subtle. Since the disease is progressive, symptoms worsen over time and can become very severe. The symptoms of COPD include:

Productive cough that does not ease up
Wheezing or squeaking in the lungs
Trouble catching your breath after exercise
Tight feeling in chest
Excessive and repeated cases of; bronchitis, colds, and flu

Symptoms are different for everyone and the most common symptom that most people experience is repeated respiratory illnesses or symptoms of allergies that do not seem to clear up.
When COPD becomes more severe, most of the symptoms are too hard to control and this is when most people see the doctor. Far after the permanent lung damage has happened. Later symptoms include:

Decreased oxygen levels (below 90%)
Blue discoloration to the lips or fingers
Fast heartbeat
Shortness of breath even at rest
Confusion or memory loss

These symptoms need emergency medical help. If you cannot get your breath and notice blue discoloration to the lips or fingers, call 9-1-1 right away.

How is COPD Diagnosed?

In the beginning, COPD is often misread to be seasonal allergies, bronchitis, or asthma. COPD is often diagnosed in the later stages of the disease, when your symptoms cannot be controlled or your doctor notices the amount of visits you have had for respiratory illness over a course of time. The tests for COPD include:
Pulmonary Function Studies. The doctor will perform a preliminary test in the office by having you blow into a spirometer to measure the volume of air coming from the lungs. If the volume is low, they may give you a breathing treatment and have you use the spirometer again to recheck the results. If you are having a problem, you may be sent to the pulmonary testing lab for a more detailed spirometry that measures more details about your lung function.

The doctor may also order you to have your pulse oximetry measured overnight. A technician will bring a pulse oximetry machine that records your oxygen. A small light source that reads oxygen will be placed on your finger while you sleep

Arterial Blood Gases. You may be sent to the lab for a blood gas analysis to see how much oxygen and carbon dioxide you have in your blood. This test involves taking a small sample of blood from the artery in your wrist.
Chest X-Ray. If the doctor believes the cause of your COPD is emphysema, a chest x-ray will show the damage to the air sacs. They may also be able to see an enlarged heart/congestive heart failure that can also cause a moist cough.
CT Scan.A CT scan can see more details in the lungs than a chest x-ray. It may help the doctor decide between emphysema and chronic bronchitis as the cause. It can also detect lung cancer.

COPD Treatment

Being diagnosed with COPD isn’t as bad as you might think. There are treatments that can help manage the disease and slow the progression. Often the disease is so mild, it may not need much treatment at all other than quitting smoking and inhalers for emergencies. There is even very effective treatments to manage advanced COPD in later stages. The important thing is to follow your treatment plan decided by you and your doctor. Treatments include:
#1 Quit Smoking
The number one first line of treatment to start with is to quit smoking if you do smoke, don’t start smoking, and avoid all forms of second-hand smoke. If you have COPD, or are at high-risk you should not smoke or be near smoke. Talk to the doctor about getting help with quitting.
#2 Medications
If necessary, your doctor will prescribe you medications to help improve your breathing and decrease your cough. Medications are not a cure for COPD, but they can make you more comfortable and improve your lung function and help prevent complications. Medications include:
Inhaled Bronchodilators. Inhaled bronchodilators can help to relax and open up the airways. They help improve your breathing and reduce your cough. Some people only need a short-acting inhaler before and after physical activity, and/or the doctor can add something more long acting to relieve your symptoms over the course of the whole day. They come in two forms; an inhaler, and a nebulizer machine.
Steroid Inhalers. Steroids are powerful anti-inflammatories and do not work to increase breathing right away, but can work over time to reduce the inflammation in the airways. Steroid inhalers put the steroid right on the lung tissue and over time can relieve symptoms of COPD. Used early on in the disease, they can help slow the progression.
They do have side-effects that include; fungal infections in the mouth, easy bruising, and a hoarse voice.
Combination Medications. The doctor can prescribe an inhaler that uses both steroids to reduce inflammation and a bronchodilator to open the airways.
Corticosteroids (oral). For acute attacks of COPD, the doctor may choose to give you an oral steroid for short-term to rapidly reduce the inflammation and make your breathing better over the course of a week. These are only used if absolutely necessary and never for long periods of time due to risk of side-effects that include; bone thinning, risk of infection, high blood sugar, and weight gain. People who use oral steroids often are at increased risk of death due to COPD.
Theophylline. This medication can help open up the airways by relaxing the muscles in the lungs, lessening response to things that irritate the airways, and increases the flow of air. There are side-effects that include; headache, shakiness, rapid heart rate, nausea, and headache. The lower the dose the less side-effects.
PDE-4 Inhibitors (phosphodiesterase-4). These medications inhibit the cells in the immune system that break down lung tissue. They are most often used in chronic bronchitis type COPD that has severe symptoms. They help reduce inflammation in the lungs and improve air flow. The side-effects include; weight loss and diarrhea.
Antibiotics. People may get repeated bacterial infections along with COPD that can worsen the condition. In cases of pneumonia, acute bronchitis, or even influenza (virus) the doctor may choose to place you on antibiotics. In the case of them being used in viral infections, it is thought that antibiotics may help relieve the inflammation.
Oxygen. In severe cases where oxygen levels fall below 90%, you may need to be on supplemental oxygen. Some people only need oxygen at night or during physical activity, or some need oxygen around the clock. Pulmonary function studies will tell the doctor how often and how much oxygen you will need.
Pulmonary Rehab. You may need a special type of physical therapy to help you learn how to take care of yourself with COPD. They will teach you exercises that will help you improve your lung capacity, give you dietary advice, and how to do physical activities without losing too much oxygen or energy.
Surgical Intervention. In severe cases, there are a few types of surgery that can help improve lung function. These include:
Lung Volume Reduction. – The surgeon will remove some of the damaged tissue and make more space for the healthy part of the lungs to work better.
Lung Transplant Some people qualify for a healthy lung transplant that can improve quality of life and help them breathe better. Risks of lung transplant include; rejection, infection, bleeding, and need for immunosuppressant’s for life.

Living with COPD

COPD does require lifestyle changes that help you get the most oxygen and conserve your body’s energy. If you make the following changes, living with COPD is much easier and you prolong your lifespan:

Quit smoking and stay away from second-hand smoke
Stay inside on “bad-air” days if you live in a high pollution (smog) area
Get your annual flu shot
Stay away from people who are sick
Eat a healthy well-balanced diet
Ask about exercises for people with COPD
Talk to someone about your feelings to help reduce anxiety and depression

Alternative Medicine for COPD

Alternative and natural medicine should always be discussed with your doctor before you use them. There can be side-effects and drug interactions. Some of the natural treatments for COPD include:

Magnesium. COPD patients are often found to have magnesium deficiencies due to either a deficient diet or the medications used to treat the disease. Magnesium increases the lungs ability to work right, so if you have a deficiency your doctor may advise you to take supplements. Always ask your doctor before using this mineral. Side-effects include; diarrhea and low blood pressure.

N-Acetyl Cysteine – NAC. Taking 400 to 1,200 mg of this amino acid daily may improve symptoms by thinning mucus. It may help ward off infection. This supplement cannot be used with nitroglycerin.

Mullein. Mullein is an herb that is known to thin the mucus in the lungs. While not studied in COPD, it has been used for centuries to treat illnesses with a cough.

Eucalyptus.Eucalyptus is a common supplement that can help loosen mucus and comfort breathing issues in small amounts. Large amounts of eucalyptus may irritate the lungs.

Ginseng.Some studies show that 100 mg daily may improve exercise abilities in people with COPD. It should not be used by diabetics or people on blood thinners. There are numerous drug interactions.

COPD Complications and Prognosis

COPD with minimal treatment or no treatment can result in the following complications:

Pneumonia
Osteoporosis (From corticosteroids)
Weight loss or weight gain
Congestive heart failure
Collapsed lung(s)
Respiratory failure
Heart disease
Lung cancer

The prognosis for people who follow a healthy lifestyle and treatment plan is fair to good. Those with emphysema, poorly treated COPD, and continue to smoke may have a poor prognosis. Death is most often due to respiratory or heart failure.

COPD Prevention

If you are at risk or even if you aren’t, taking the steps to prevent COPD will protect your delicate lungs. Try these helpful tips:
Quit Smoking or Don’t Start Smoking. This is the number one cause of COPD and not starting or quitting greatly reduces your risk.
Eat Healthy and Exercise. This will keep the cells in your lungs healthy and exercise keeps your lungs strong.
Treat Asthma and Allergies. Over time, asthma and respiratory allergies can damage your lung tissue. Follow a good “asthma treatment plan” and treat any seasonal respiratory allergies that lead to coughing or bronchitis.
Get Your Influenza and Pneumonia Vaccines. Preventing repeated respiratory illness can help reduce the wear and tear on your lungs.
Breathe Clean Air. Avoid dust, fumes, and chemicals. Use a respirator if you work around these things. Keep your house dust-free and stay inside on “air alert” days.

Bibliography

American Lung Association. (2014, May). Chronic Obstructive Pulmonary Disease Fact Sheet. Retrieved from American Lung Association: https://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html?referrer=https://www.google.com/
Mayo Clinic. (2015, July 21). COPD: Risk Factors. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/copd/basics/risk-factors/con-20032017
National Heart, Lung, and Blood Institute. (2013, July 31). What is COPD? Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/health-topics/topics/copd
University of Maryland. (2013, July 31). Chronic Obstructive Pulmonary Disease. Retrieved from University of Maryland: https://umm.edu/health/medical/altmed/condition/chronic-obstructive-pulmonary-disease

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