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Background |
Causes |
Signs and symptoms |
Complications |
Diagnosis |
Treatment |
Integrative therapies |
Prevention |
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Bibliography
Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a type of lung disease that involves damage or obstruction to the airways of the lungs, making it difficult to breathe. COPD is an overall term referring to a group of chronic lung conditions, most commonly including chronic bronchitis and emphysema, and possibly asthma or asthmatic bronchitis. While chronic bronchitis and emphysema may occur separately, it is common for patients to have both diseases at the same time.Chronic bronchitis is characterized by an ongoing, mucus-producing cough that that occurs most days of the month, three months a year for two consecutive years or more. Constant coughing causes the bronchial tubes to become inflamed. Eventually, the airways become scarred. Long-term irritation also leads to the production of mucus, which further irritates and blocks the bronchial tubes. As a result, less oxygen is able to enter the airways.
In addition, the excessive mucus in the bronchial tubes provides an environment for disease-causing bacteria to grow. Therefore, lung infections are common complications of chronic bronchitis.
Emphysema is an incurable illness that occurs when the walls between the air sacs (alveoli) in the lungs lose their ability to stretch and recoil, causing shortness of breath (SOB).
The Centers for Disease Control (CDC) report that COPD affects up to 24 million Americans, and according to the American Lung Association, is the fourth leading cause of death in the United States. COPD patients typically die from complications, such as severe lung infections, heart problems, or lung cancers.
The main risk factor for COPD is smoking. Researchers estimate that smoking causes 80-90% of COPD deaths. According to the American Lung Association, female smokers are nearly 13 times more likely to die from COPD than females who have never smoked. Male smokers are nearly 12 times more likely to die from COPD than males who have never smoked.
There is currently no cure for COPD. Instead treatment focuses on reducing the symptoms and complications of the disease. Treatment varies, depending on the specific condition. It can range from medication and oxygen supplementation to transplant surgery. Bronchodilators are commonly used to relax the bronchi muscles in the lungs that can cause bronchospasms and restrict the airways.
Background
Chronic obstructive pulmonary disease (COPD) is a type of lung disease that involves damage or obstruction to the airways of the lungs, making it difficult to breathe. COPD is an overall term referring to a group of chronic lung conditions, most commonly including chronic bronchitis and emphysema, and possibly asthma or asthmatic bronchitis. While chronic bronchitis and emphysema may occur separately, it is common for patients to have both diseases at the same time.Chronic bronchitis is characterized by an ongoing, mucus-producing cough that that occurs most days of the month, three months a year for two consecutive years or more. Constant coughing causes the bronchial tubes to become inflamed. Eventually, the airways become scarred. Long-term irritation also leads to the production of mucus, which further irritates and blocks the bronchial tubes. As a result, less oxygen is able to enter the airways.
In addition, the excessive mucus in the bronchial tubes provides an environment for disease-causing bacteria to grow. Therefore, lung infections are common complications of chronic bronchitis.
Emphysema is an incurable illness that occurs when the walls between the air sacs (alveoli) in the lungs lose their ability to stretch and recoil, causing shortness of breath (SOB).
The Centers for Disease Control (CDC) report that COPD affects up to 24 million Americans, and according to the American Lung Association, is the fourth leading cause of death in the United States. COPD patients typically die from complications, such as severe lung infections, heart problems, or lung cancers.
The main risk factor for COPD is smoking. Researchers estimate that smoking causes 80-90% of COPD deaths. According to the American Lung Association, female smokers are nearly 13 times more likely to die from COPD than females who have never smoked. Male smokers are nearly 12 times more likely to die from COPD than males who have never smoked.
There is currently no cure for COPD. Instead treatment focuses on reducing the symptoms and complications of the disease. Treatment varies, depending on the specific condition. It can range from medication and oxygen supplementation to transplant surgery. Bronchodilators are commonly used to relax the bronchi muscles in the lungs that can cause bronchospasms and restrict the airways.
Causes
Smoking: The single greatest risk factor for chronic obstructive pulmonary disease (COPD) is smoking. COPD is most likely to develop in cigarette smokers, but cigar and pipe smokers and marijuana smokers also are susceptible. The risk of COPD increases with the number of years and amount smoked.Exposure to secondhand smoke, also known as passive or environmental tobacco smoke, also increases risk of developing COPD. Secondhand smoke is smoke that is inadvertently inhaled from someone else's cigarette, pipe, or cigar.
Age: Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 50-60.
Exposure to pollution: An individual breathing fumes from certain chemicals, such as chlorine or pesticides, dust from grain, cotton, wood, or working around toxic fumes has an increased risk of developing COPD. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants, such as car exhaust, increases the risk of COPD.
Heredity: A rare, inherited deficiency of the protein, alpha-1-antitrypsin (AAt), can cause emphysema, especially before age 50, and even earlier if the individual smokes.
Connective tissue disorders: Some conditions that affect connective tissue (provides body framework and support) are associated with emphysema. Connective tissues are the supporting tissues of the body, such as tendons, ligaments, bone, and cartilage. These conditions include cutis laxa (a rare disease that causes premature aging) and Marfan syndrome (a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs).
Signs and symptoms
General: Symptoms of chronic obstructive pulmonary disease (COPD) usually develop gradually over many years. They typically worsen over time. Some patients may suffer from either chronic bronchitis or emphysema, while other may have both diseases.Patients who have had COPD for many years may develop bluish discoloration of the lips and nail beds (cyanosis). This occurs when there is not enough oxygen in the blood. Some patients may develop headaches in the morning because they are unable to remove carbon dioxide from the blood. Many people with COPD also experience weight loss because their body requires more energy to breathe than the average person.
Chronic bronchitis: Symptoms of chronic bronchitis include chronic cough, increased mucus that is yellow-greenish in color, frequent clearing of the throat, wheezing, and shortness of breath (SOB). Patients typically experience fatigue because the body has to work harder to get enough oxygen.
Emphysema: Shortness of breath (dyspnea), especially during activity, is one of the earliest symptoms of emphysema. As the disease progresses, shortness of breathe becomes constant, even during rest. An individual is likely to feel tired both because it is more difficult to breathe and because the body is getting less oxygen.
Other symptoms include distress resulting from the inability to get enough air, wheezing, chronic mucus production, exhaling through pursed (puckered) lips or grunting before exhaling, and needing to lean forward to breathe while sitting. Individuals with emphysema are often thin and have very pink skin. Individuals with advanced disease may have the characteristic barrel chests from the increase in lung size.
Complications
Death: Individuals with chronic obstructive pulmonary disease (COPD) may die from complications of the disease. Causes of death may include lung cancer, lack of blood flow and oxygen to the brain (stroke), respiratory failure, lung infections, and heart attack.Heart problems: For unknown reasons, COPD increases risk of developing heart disease, including heart attacks. The heart may become enlarged because it is strained. COPD may cause high blood pressure in the arteries that bring blood to the lungs.
Infections: Patients with COPD may suffer from frequent infections, including the common cold, flu, and pneumonia. Lung infections make breathing even more difficult for COPD patients. Infections also cause even more irreversible damage to the lung tissue. Patients should talk to their healthcare providers about recommended vaccines. The flu shot is usually recommended in non-allergic COPD patients.
Lung cancer: Smokers with chronic bronchitis have a higher risk of developing lung cancer than smokers who do not have chronic bronchitis.
Quality of life: People with advanced emphysema are often incapacitated. They experience shortness of breath even when resting or sitting in a chair or bed. Patients should consult their healthcare providers if they experience feelings of sadness, low self-esteem, loss of pleasure, apathy, and sometimes, difficulty functioning for two weeks or longer, with no known underlying cause. These may be signs of depression.
Diagnosis
Pulmonary function tests (PFTs): Pulmonary function tests (PFTs) can detect chronic obstructive pulmonary disease (COPD) before symptoms are seen. These noninvasive tests measure how much air the lungs can hold and the flow of air in and out of the lungs. They can also measure the amount of oxygen and carbon dioxide exchanged in the lungs. They include a spirometry test and lung volume test.In a spirometry test, a person breathes into mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that is breathed in and out over a specified time. Some of the test measurements are obtained by normal, quiet breathing, and other tests require forced inhalation or exhalation after a deep breath.
Lung volume measurement detects restrictive lung diseases. In this set of diseases, a person cannot inhale a normal volume of air. Restrictive lung diseases may be caused by inflammation or scarring of the lung tissue (interstitial lung disease) or by abnormalities of the muscles or skeleton of the chest wall.
Lung volume measurement can be performed in two ways. The most accurate way is for an individual to sit in a sealed, transparent box called a body plethysmograph. This box looks similar to a telephone booth. The patient then breathes in and out a mouthpiece while inside the plethysmograph. Changes in pressure inside the box allow determination of the lung volume. Lung volume can also be measured when an individual breathes nitrogen or helium gas through a tube for a specified period of time. The concentration of the gas in a chamber attached to the tube is measured, allowing estimation of the lung volume.
Chest X-ray: A chest X-ray may be performed to rule out other lung problems, such as lung cancer. Even in the advanced stages of emphysema, chest X-rays are often normal.
Blood tests: Arterial blood gases (ABGs) measure how well the lungs transfer oxygen to the bloodstream and how effectively they remove carbon dioxide from the bloodstream. A blood test for the alpha-1-antitrypsin (AAt) gene, which is found in some individuals with emphysema, may also be used.
Pulse oximetry: This test involves use of a small device that attaches to the fingertip to measure the amount of oxygen in the blood. To help determine whether or not the individual needs supplemental oxygen, the test may be performed at rest, during exercise, and overnight.
Sputum examination: A healthcare provider may take a sample of the patient's mucus (sputum) to help determine the cause of some lung problems. If disease-causing microorganisms (e.g. bacteria) are present, there is infection. If there is blood in the sputum, this may indicate lung damage or lung cancer.
Computerized tomography (CT) scan: A CT scan allows a healthcare professional to see the organs in two-dimensional images or "slices." Split-second computer processing creates these images as a series of very thin X-ray beams are passed through the body. A CT scan can detect emphysema sooner than an X-ray can, but it cannot assess the severity of emphysema as accurately as a pulmonary function test.
Treatment
General: There is currently no cure for chronic obstructive pulmonary disease (COPD). Treatment focuses on reducing symptoms and preventing complications. Patients should take their medications exactly as prescribed to help prevent life-threatening complications, such as heart attack, from occurring. Patients should also tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements, because they may interact with treatment.Smoking cessation: Smoking cigarettes may worsen symptoms of COPD. Therefore, Patients are encouraged to stop smoking. Nicotine replacement products, including the patch (Habitrol®, Nicoderm CQ®, Nicotrol®), chewing gum (Nicorette®), lozenges (Commit®), inhalers (Nicotrol Inhaler®), nasal sprays (Nicotrol NS®), and the antidepressant bupropion (Zyban®), may help patients quit smoking. These drugs work in part by continuing to release low levels of a brain chemical called dopamine. In this way, these smoking cessation medications decrease the craving for nicotine and reduce the signs and symptoms of withdrawal.
Varenicline (Chantix®) is a newer drug that works in a similar way. Chantix® stimulates the release of low levels of dopamine in the brain to help reduce the signs and symptoms of withdrawal. In addition, Chantix® blocks nicotine receptors in the brain. The U.S. Food and Drug Administration (FDA) has approved the course of Chantix® treatment for 12 weeks. Individuals who successfully quit smoking during Chantix® treatment may continue to use Chantix® for an additional 12 weeks to further increase the likelihood of long-term smoking cessation. Side effects of Chantix® include changes in taste, nausea, vomiting, gas, and insomnia (inability to sleep).
Bronchodilators: Medications called bronchodilators may help relieve coughing, shortness of breath, and difficulty breathing by opening constricted airways. Bronchodilators relax the muscles around the airways, making it easier to breath. Patients typically use an inhaler to take bronchodilators, but tablets are also available for some. Depending on the severity of the disease, a patient may need a short-acting bronchodilator before physical activities, a long-acting bronchodilator that is used every day, or both. Commonly prescribed bronchodilators include albuterol (Ventolin® or Proventil®), metaproterenol (Alupent®), terbutaline (Brethine®), theophylline (Theo-Dur® or Slo-bid®), and perbuterol (Maxair®).
Steroids: Steroids are used to prevent and reduce airway swelling, as well as decrease the amount of mucus in the lungs. Steroids may either be inhaled with an inhaler or taken by mouth. Examples of inhaled steroids include beclomethasone (Beclovent® or Vanceril®), budesonide (Pulmicort Respules®), flunisolide (Aerobid®), fluticasone (Flovent®), and triamcinolone (Azmacort®). Inhaled steroids seem to have fewer side effects than steroids that are taken by mouth. These drugs are typically used to treat moderate or severe COPD. Prolonged use of inhaled steroids may weaken the bones and increase the risk of cataracts, diabetes, and heart disease, including high blood pressure, high cholesterol levels, chest pain, and heart attack.
Commonly prescribed corticosteroids that are taken by mouth include prednisone (Prednisone Intensol®, Sterapred®, or Sterapred® DS), and triamcinolone (Aristocort®).
Liquid corticosteroids, such as Pediapred® or Prelone®, are available for children. These medications can be used short-term for severe symptoms, such as extreme shortness of breath.
Leukotriene modifiers: Leukotriene modifiers, such as zafirlukast (Accolate®) or montelukast (Singulair®), are a new type of long-term control medication. They help prevent airway inflammation and swelling. They also help decrease the amount of mucus in the lungs.
Supplemental oxygen: Patients who have extreme difficulty breathing may benefit from supplement oxygen. Various forms of oxygen are available, as well as different devices to deliver them to the lungs. A healthcare provider will help the patient set up oxygen for home use.
Lung transplant: Patients with severe emphysema may benefit from lung transplantations. Usually just one lung is transplanted because the survival rate has been proven to be higher for individuals with single-lung transplants than for individuals with double-lung transplants.
Surgery: In a procedure called lung volume reduction surgery (LVRS), surgeons remove small pieces of damaged lung tissue. The extra space that is created in the lungs after surgery appears to help the remaining lung tissue work more efficiently.
Pulmonary rehabilitation program: A key part of COPD treatment involves a pulmonary rehabilitation program, which combines education, exercise training, and behavioral intervention to help restore the individual with emphysema to the highest possible level of independent living.
Integrative therapies
Unclear or conflicting scientific evidence:Acupressure, shiatsu: During acupressure finger pressure is applied to specific acupoints on the body. A combination of acupressure and massage may reduce symptoms of labored breathing and anxiety in patients with chronic obstructive pulmonary disease (COPD) who use prolonged mechanical breathing support. Further study of acupressure alone is needed before a firm conclusion can be made.
A small study of patients undergoing lung rehabilitation reported acupressure to be a beneficial treatment for shortness of breath. Larger, well-designed studies are needed before clear conclusions can be drawn.
With proper training, acupressure appears to be safe if self-administered or performed by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures. The technique is used to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve medical conditions, and promote well-being. There is a small amount of research on the effects of the Alexander technique on lung function in healthy people and musicians who play wind instruments. These studies are small, poorly designed, and report mixed results. Until better evidence is available, it remains unclear if the Alexander technique improves lung capacity.
No serious side effects have been reported with Alexander technique. It has been suggested that the technique may be less effective in patients with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled, or applied to the skin. Essential oils are usually mixed with a carrier oil, usually a vegetable oil or alcohol. Preliminary evidence from one small trial suggests aromatherapy may aid mucus clearance in COPD patients. More studies are needed before conclusions about this application of aromatherapy can be made.
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
Belladonna: Belladonna has been used for centuries to treat many medical conditions. Belladonna may cause relaxation of the airway and reduce the amount of mucus produced. However, due to lack of high-quality human research in this area, there is not enough evidence to form a clear conclusion.
Avoid if allergic to belladonna or plants of the Solanaceae (nightshade) family, such as bell peppers, potatoes, eggplants. Avoid with history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, glaucoma (narrow angle), psychotic illness, Sjogren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders (such as myasthenia gravis), or Down's syndrome. Avoid if pregnant or breastfeeding.
Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oils, and vegetables, such as green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. The prevalence of bronchitis and shortness of breath in male smokers with chronic obstructive pulmonary disorder (COPD) seems to be lower in those patients who consume a diet containing high amounts of beta-carotene. However, beta-carotene supplements have not been proven to benefit COPD and may actually increase cancer rates in smokers.
Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
Bromelain: Bromelain is an herb that contains a digestive enzyme that comes from the stem and the fruit of the pineapple plant. Bromelain has been suggested as a possible treatment for COPD. However, further research is needed to determine whether or not this is a safe and effective treatment.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birth pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceae family. Use cautiously with a history of bleeding disorder, stomach ulcers, heart disease, liver disease, or kidney disease. Use cautiously before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
Chiropractic therapy: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques for respiratory tract infections that cause difficulty breathing.
Use cautiously cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Coleus: The root extract of coleus is known as forskolin. Coleus may be a beneficial treatment before intubation for patients with breathing disorders. However, more research is needed before a firm conclusion can be made.
Avoid if allergic or hypersensitive to coleus. Avoid with bleeding disorders or heart problems. Use cautiously with thyroid disorders, seizures disorders, or with history of ulcers. Avoid if pregnant or breastfeeding.
Creatine: Creatine is an amino acid that is found in muscles. Skeletal muscle wasting and dysfunction are strong independent predictors of mortality in patients with chronic obstructive pulmonary disease (COPD). Creatine nutritional supplementation produces increased muscle mass and exercise performance in individuals with COPD. More studies are needed before a firm conclusion can be made.
Avoid if allergic to creatine or with diuretics (such as hydrochlorothiazide, furosemide). Use cautiously with asthma, diabetes, gout, kidney disorders, liver disorders, muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
English ivy: English ivy (Hedera helix) is native to most of Europe and southwest Asia. Although it is often used as a landscaping groundcover in the United States, it is also an invasive species that is considered a noxious weed in some areas. Currently, there is insufficient available information to determine whether or not English ivy is an effective treatment for chronic obstructive pulmonary disease (COPD). Additional study is needed in this area.
Avoid if allergic or hypersensitive to English ivy, its constituents, or members of the Araliaceae family. In addition, cross-sensitivity has been noted between Hedera helix and Dendropanax trifidus, Schefflera arboricola, dandelion (Taraxacum officinale), false ragweed (Ambrosia acanthicarpa), giant ragweed (Ambrosia trifida), short ragweed (Ambrosia artemisifolia), sagebrush (Artemisia tridentata), wild feverfew (Parthenium hysterophorus), yarrow (Achillea millifolium), tansy (Tanacetum vulgare), and some Dahlia species. Use cautiously with cancer or if taking antineoplastic (anti-cancer) agents. Avoid if pregnant or breastfeeding.
Ginseng: For more than 2,000 years, the roots of this slow-growing plant have been valued in Chinese medicine. In one study, ginseng was reported to improve lung function and exercise capacity in patients with COPD. Further research is needed to confirm these results.
Avoid ginseng if known allergy to plants in the Araliaceae family, such as English ivy. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
Guided imagery: Guided imagery describes many techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. A small study reports increased relaxation outcomes in people with COPD (emphysema or chronic bronchitis) who use guided imagery techniques. Additional research is needed to confirm these results.
Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.
Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. There is preliminary evidence that daily breathing exercises in a warm pool may improve lung function measurements in patients with COPD. It is not clear if this technique is superior to breathing exercises alone. Evidence from controlled trials is necessary before a clear conclusion can be drawn.
Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
L-carnitine: L-carnitine is an amino acid that is made in the muscles and liver. Currently, there is insufficient evidence to support the use of carnitine for respiratory distress in adults.
Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Lutein: Carotenoids, such as lutein and zeaxanthin, are found in high levels in foods, such as green vegetables, egg yolk, kiwi fruit, grapes, orange juice, zucchini, squash, and corn. Lutein has been suggested as a possible treatment to enhance lung function in patients with lung infections. However, further research is needed to determine the safety and efficacy of this treatment.
Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for heart disease or cancer. Avoid if pregnant or breastfeeding.
Nasal irrigation: Nasal irrigation is used to clear the sinuses. There are three forms of nasal irrigation therapies. Saline lavage uses a warm liquid solution (such as Rhinomer®), while large-particle nebulized aerosol therapy uses aerosolized saline solution. A humidified warm air lavage (hyperthermia) is also used. Occasionally, antibiotics are added to the solution. Nasal irrigation can be performed by the patient at home or by a professional up to twice daily. Preliminary evidence suggests that nasal irrigation may help remove mucus from the lungs, which may make it easier for COPD patients to breathe. Further research is warranted in this area.
Nasal irrigation is generally well tolerated. Use cautiously with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
Physical therapy: According to the American Physical Therapy Association, the goal of physical therapy, or physiotherapy, is to improve mobility, restore function, reduce pain, and prevent further injury. Many techniques, including exercises, stretching, traction, electrical stimulation, and massage are used. There may be a beneficial effect of respiratory rehabilitation in terms of improved tolerance to exercise and improved quality of life for patients with chronic obstructive pulmonary diseases (COPDs). Studies have investigated the use of physical therapy with drugs, as well as the difference between manual and mechanical techniques. Few studies have compared respiratory physiotherapy to control groups. Examples of manual respiratory physical therapy techniques include postural drainage, chest percussion, vibration, chest shaking, directed coughing, and forced exhalation technique. Higher-quality trials are needed to make a firm recommendation.
Preliminary research suggests that physical therapy may also improve lung function. However, further research is needed.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare providers before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings and behavior to help with problem solving. Psychotherapy may decrease anxiety and depression in COPD patients, but it does not seem to improve physical performance. In addition, studies suggest that supportive psychotherapy may help reduce psychiatric symptoms of patients with emphysema. More research needs to be done in this area.
Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that both intramuscular and oral thymus extract may be useful for reducing the presence of respiratory tract symptoms. Additional study is need in this area.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if receiving immunosuppressants or hormonal therapy. Avoid if pregnant or breastfeeding. Thymic extract increases human sperm motility and progression.
Traditional Chinese medicine: Traditional Chinese medicine (TCM) is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique, or theory, rooted in ancient Chinese philosophy (Taoism) that dates back over 5,000 years. TCM herbs have been reported to improve symptoms and improve immune function in patients with COPD. However, research designs have been weak, and more studies of better design are needed before conclusions can be made.
Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga has been described as "the union of mind, body, and spirit," which addresses physical, mental, intellectual, emotional, and spiritual dimensions towards an overall harmonious state of being. Limited adult human study exists for the treatment of lung conditions. Better-designed research is necessary before any firm conclusions can be made.
Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of severe mental illness (psychotic disorders). Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. Poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
Fair negative scientific evidence:
Lycopene: Lycopene is found tomatoes, and it is present in human serum, liver, adrenal glands, lungs, prostate, colon, and skin. A daily dose of lycopene for one week does not seem to affect lung function after exercise and does not provide any protective effect against clinical difficulty in breathing in young athletes.
Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
Prevention
Smoking cessation: The primary cause of chronic obstructive pulmonary disease (COPD) is smoking. Patients who do not smoke are less likely to develop COPD than patients who do.Patients who have COPD should not smoke. Smoking cigarettes may worsen symptoms of COPD.
Avoidance of respiratory infections: Avoid being around crowds during the cold and flu season (colder months). Washing the hands frequently, along with carrying a small bottle of hand sanitizer, helps keep viruses and bacteria away. Touching the nose or rubbing the eyes increases a patient's risk of developing viral or bacterial infections. Patients should talk to their healthcare providers about recommended vaccines.
Control breathing: Patients should talk to their healthcare providers or respiratory therapists to about breathing techniques that may help manage symptoms. Therapists may recommend relaxation exercises that may make it easier to breath. These breathing techniques may also help reduce symptoms of anxiety or distress, which occur in patients who have difficulty breathing.
Drink fluids: With COPD, mucus tends to collect in the air passages and can be difficult to clear. Drinking plenty of fluids, such as water or 100% fruit juices, help to keep secretions thin and easy to bring up.
Eat healthy foods: A healthy diet may help COPD patients maintain their strength and improve energy. Patients who are underweight should talk to their healthcare providers to determine whether or not they need nutritional supplements.
Regular exercise: Regular exercise can significantly increase the capacity for physical activity. Simple breathing techniques (deep breathing) may also help.
Visit the doctor: Patients should visit regularly visit their healthcare providers to have their lung function monitored.
Author information
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
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National Emphysema Foundation. www.nef-usa.org. Accessed June 20, 2007.
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2007. Accessed June 20, 2007.
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Related Terms
Alpha-1-antitrypsin deficiency (AAt), Arterial blood gases (ABGs), bronchial tubes, bronchitis, bronchodilators, chronic bronchitis, corticosteroids, cutis laxa, dyspnea, emphysema, inhaled steroids, leukotriene modifiers, lung disease, lung transplant, Marfan syndrome, plethysmograph, pulmonary disease, pulmonary function tests, pulse oximetry, PFTs, respiratory failure, shortness of breath (SOB), smoking cessation, spirometry test, sputum examination, supplemental oxygen.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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