How Is COPD Treated?
Quitting smoking is the single most important thing
you can do to reduce your risk of developing chronic obstructive pulmonary
disease (COPD) and slow the progress of the disease.
Your doctor will recommend treatments that help
relieve your symptoms and help you breathe easier. However, COPD cannot be
cured.
The goals of COPD treatment are to:
- Relieve your symptoms with no or minimal side
effects of treatment
- Slow the progress of the disease
- Improve exercise tolerance (your ability to stay
active)
- Prevent and treat complications and sudden onset
of problems
- Improve your overall health
The treatment for COPD is different for each person.
Your family doctor may recommend that you see a lung specialist called a
pulmonologist (pull-mon-OL-o-gist).
Treatment is based on whether your symptoms are
mild, moderate, or severe.
Medicines and pulmonary rehabilitation (rehab) are
often used to help relieve your symptoms and to help you breathe more easily
and stay active.
COPD Medicines
Bronchodilators
Your doctor may recommend medicines called
bronchodilators that work by relaxing the muscles around your airways. This
type of medicine helps to open your airways quickly and make breathing easier.
Bronchodilators can be either short acting or long acting.
- Short-acting bronchodilators last about 4 to 6
hours and are used only when needed.
- Long-acting bronchodilators last about 12 hours
or more and are used every day.
Most bronchodilator medicines are inhaled, so they
go directly into your lungs where they are needed. There are many kinds of
inhalers, and it is important to know how to use your inhaler correctly.
If you have mild COPD, your doctor may recommend
that you use a short-acting bronchodilator. You then will use the inhaler only
when needed.
If you have moderate or severe COPD, your doctor may
recommend regular treatment with one or more inhaled bronchodilators. You may
be told to use one long-acting bronchodilator. Some people may need to use a
long-acting bronchodilator and a short-acting bronchodilator. This is called
combination therapy.
Inhaled glucocorticosteroids (steroids)
Inhaled steroids are used for some people with
moderate or severe COPD. Inhaled steroids work to reduce airway inflammation.
Your doctor may recommend that you try inhaled steroids for a trial period of 6
weeks to 3 months to see if the medicine is helping with your breathing
problems.
Flu shots
The flu (influenza) can cause serious problems in
people with COPD. Flu shots can reduce the chance of getting the flu. You
should get a flu shot every year.
Pneumococcal vaccine
This vaccine should be administered to those with
COPD to prevent a common cause of pneumonia. Revaccination may be necessary
after 5 years in those older than 65 years of age.
Pulmonary Rehabilitation
Pulmonary rehabilitation (rehab) is a coordinated
program of exercise, disease management training, and counseling that can help
you stay more active and carry out your day-to-day activities. What is included
in your pulmonary rehab program will depend on what you and your doctor think
you need. It may include exercise training, nutrition advice, education about
your disease and how to manage it, and counseling. The different parts of the
rehab program are managed by different types of health care professionals
(doctors, nurses, physical therapists, respiratory therapists, exercise
specialists, dietitians) who work together to develop a program just for you.
Pulmonary rehab programs can include some or all of the following aspects.
Medical evaluation and management
To decide what you need in your pulmonary rehab
program, a medical evaluation will be done. This may include getting
information on your health history and what medicines you take, doing a
physical exam, and learning about your symptoms. A spirometry measurement may
also be done before and after you take a bronchodilator medicine.
Setting goals
You will work with your pulmonary rehab team to set
goals for your program. These goals will look at the types of activities that
you want to do. For example, you may want to take walks every day, do chores
around the house, and visit with friends. These things will be worked on in
your pulmonary rehab program.
Exercise training
Your program may include exercise training. This
training includes showing you exercises to help your arms and legs get
stronger. You may also learn breathing exercises that strengthen the muscles
needed for breathing.
Education
Many pulmonary rehab programs have an educational
component that helps you learn about your disease and symptoms, commonly used
treatments, different techniques used to manage symptoms, and what you should
expect from the program. The education may include meeting with (1) a dietitian
to learn about your diet and healthy eating; (2) an occupational therapist to
learn ways that are easier on your breathing to carry out your everyday
activities; or (3) a respiratory therapist to learn about breathing techniques
and how to do respiratory treatments.
Program results (outcomes)
You will talk with your pulmonary rehab team at
different times during your program to go over the goals that you set and see
if you are meeting them. For example, if your goal is to walk every day for 30
minutes, you will talk to members of your pulmonary team and tell them how
often you are walking and for how long. The team is interested in helping you
reach your goals.
Oxygen Treatment
If you have severe COPD and low levels of oxygen in
your blood, you are not getting enough oxygen on you own. Your doctor may
recommend oxygen therapy to help with your shortness of breath. You may need
extra oxygen all the time or some of the time. For some people with severe
COPD, using extra oxygen for more than 15 hours a day can help them:
- Do tasks or activities with less shortness of
breath
- Protect the heart and other organs from
damage
- Sleep more during the night and improve alertness
during the day
- Live longer
Surgery
For some people with severe COPD, surgery may be
recommended. Surgery is usually done for people who have:
- Severe symptoms
- Not had improvement from taking medicines
- A very hard time breathing most of the time
The two types of surgeries considered in the
treatment of severe COPD are:
- Bullectomy. In this procedure, doctors remove one
or more very large bullae from the lungs of people who have emphysema. Bullae
are air spaces that are formed when the walls of the air sacs break. The air
spaces can become so large that they interfere with breathing.
- Lung volume reduction surgery (LVRS). In this
procedure, surgeons remove sections of damaged tissue from the lungs of
patients with emphysema. A major NHLBI study of LVRS recently showed that
patients whose emphysema was mostly in the upper lobes of the lung and who had
this surgery, along with medical treatment and pulmonary rehabilitation, were
more likely to function better after 2 years than patients who received medical
therapy only. They also did not have a greater chance of dying than the other
patients.
- A small group of these patients
who also had low exercise capacity after pulmonary rehabilitation but before
surgery were also more likely to function better after LVRS than similar
patients who received medical treatment only.
A lung transplant may be done for some people with
very severe COPD. A transplant involves removing the lung of a person with COPD
and replacing it with a healthy lung from a donor. |