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Bodies in Motion: Treating Advanced COPD

Medically Reviewed on December 2, 2013 by George Krucik, MD, MBA
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Introduction

Chronic obstructive pulmonary disease, also known as COPD, actually refers to a group of diseases that affect the lungs—the most common being chronic bronchitis and emphysema. 

In this interactive video experience, you will learn how advancing COPD affects lung function, how several key medications treat symptoms and exacerbations, the differences between standard inhalers and nebulizers, as well as surgical options for treating COPD. 

Use the blue arrow keys to advance through the five levels of the experience, and click the play button to start each video.

How Severe COPD Affects Your Lungs

Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition characterized by declining lung function due to longterm damage to lung tissues. Exposure to tobacco smoke is the most common source of tissue damage. Although COPD can affect two distinct sets of structures in the lungs—the bronchi and the alveoli—and symptoms may vary, longterm outlook is effectively the same. As airflow gradually declines, the body increasingly struggles to get enough oxygen.

When COPD affects the bronchi—the branching tubes that transport air in and out of the lungs—bronchial tissues become inflamed, causing bronchitis. The airways produce excess mucus, which restricts airflow through the tubes. Involuntary muscles lining the airways may contract, further restricting airflow. Excess mucus triggers coughing, which is usually accompanied by sputum production. A hacking, productive cough that lasts for more than three months annually, for two or more years, is a defining symptom of chronic bronchitis. Absent other illnesses, such as tuberculosis, this condition is defined as COPD.

COPD may also affect the small sacs where gases are exchanged in the lungs—the alveoli. These delicate sacs are surrounded by elastic tissues, which expand and contract with each breath. When damaged, these tissues lose elasticity, making it difficult for the alveoli to inflate and deflate. The result is emphysema. In either case, primary symptoms will include shortness of breath and a reduced ability to perform ordinary tasks of living.

Treating Severe COPD Symptoms with Bronchodilators

Beta agonists are the most commonly prescribed drugs for the treatment of COPD. Another class of medications, called anticholinergics, may also be used. Collectively, these drugs are called bronchodilators. They are usually delivered into the lungs through an inhaler. The drugs coat the interior of the air passages, where they help relax the muscles lining the bronchi and bronchioles. As airways expand, more air flows in and out of the lungs, providing relief from COPD symptoms. 

There are two main types of beta-agonists; short-acting and long-acting. Patients with mild COPD are more likely to be prescribed short-acting inhaled bronchodilators. They can be taken during symptom flare-ups, or before engaging in activities such as exercise, which might trigger shortness of breath or coughing.

Patients with moderate to severe COPD are usually prescribed long-acting beta agonists. Short-acting beta-agonists only work for about three hours, but they take effect within 3-5 minutes. Long-acting bronchodilators provide up to 12 hours of airway relief, but require up to 20 minutes to take effect. These drugs are used for “maintenance” drug therapy, when round-the-clock airway relaxation is needed.

Treating COPD Symptoms with Nebulizers

Disposable inhaler devices deliver medications such as beta agonists, anticholinergics and/or anti-inflammatory corticosteroids into the lungs as particles of dry powder. But when severe COPD drastically reduces lung capacity, it may be difficult for these drugs to reach target tissues deep within the lungs. In these instances, it may be helpful to use a nebulizer. 

A nebulizer is a portable (or tabletop) device that can deliver drugs deep into the lungs as a fine liquid mist. The patient inhales the mist through a mask or mouthpiece. Some units deliver pressurized mist, which enhances the penetration of the drug-bearing liquid droplets into the farther reaches of the airways. When long-acting bronchodilator drugs are inhaled in this way, it’s possible to achieve up to 12 hours of relief from airway constriction.

Treating COPD Flare-Ups and Exacerbations

COPD is a chronic, progressive condition. While disease progression may be slowed or even halted by drug therapy, once damage has occurred the lungs will not regain lost function. Even with maintenance therapy, patients may occasionally experience exacerbations, or flare-ups. During a flare-up, COPD symptoms suddenly become worse.

A flare up poses a serious threat to the patient’s health if he or she is rendered incapable of getting enough oxygen. This condition, called hypoxia, can permanently damage the brain or other vital organs, so it must be addressed immediately. Symptoms of hypoxia may include an inability to catch the breath, mental confusion, an abnormally rapid heartbeat, and lips or fingernails that turn bluish or gray.

During COPD exacerbations, a doctor may prescribe oxygen therapy to prevent hypoxia. Supplemental oxygen comes in a metal cylinder and is delivered to the patient’s lungs through a mask or nasal cannula (a branched plastic tube that can be inserted in the nostrils). Ordinary room air contains about 21% oxygen. Supplemental oxygen therapy increases the concentration of oxygen available to the lungs, making it easier to get enough oxygen into the bloodstream.  

Flare ups may also warrant the use of potent anti-inflammatory drugs called corticosteroids. These medications help control inflammation in the lungs and slow the production of mucus in the bronchi. A doctor may prescribe a corticosteroid that can be taken by mouth, or an inhaler that delivers the drug directly into the lungs.

Surgical Options for Severe COPD

When severe COPD progresses to the point that mobility is limited and quality of life suffers dramatically, surgery may be considered as a last resort. Patients at this advanced stage of disease often struggle to breathe, and hypoxia is an ever-present danger.

The tiny air sacs where gases are exchanged—the alveoli-—often become enlarged and their tissues stiffened. This is especially common among patients suffering from advanced emphysema. These enlarged sacs take up precious space in the chest cavity, making it even harder for remaining functional alveoli to perform the vital work of exchanging gases. When alveoli swell to one centimeter in diameter or larger (about one-third of an inch), doctors may recommend a procedure called a bullectomy, to surgically remove these dysfunctional air sacs. 

Another procedure, called lung volume reduction surgery (LVRS), also alleviates crowding in the lungs. Damaged portions of the lungs are carefully cut away creating more space in the chest cavity. This allows healthier tissues to expand more readily and work more efficiently. About one-fifth to one-third of total lung tissue may be removed during LVRS. 

Complete lung transplant is a final, extreme option available to certain patients that meet very specific criteria. This highly invasive procedure involves the removal of the diseased lung, and replacement with a donor lung. Successful lung transplant can greatly improve a patient’s ability to breathe, but risks are formidable. Among other concerns, organ rejection is a distinct possibility. To reduce the risk of rejection, transplant patients must take potent anti-rejection drugs for the remainder of their lives. 

Managing COPD Symptoms

Chronic obstructive pulmonary disease (COPD) is a long-term condition that can’t be completely cured. However, by managing your condition, you can improve your quality of life, relieve your symptoms, and slow progress of the disease. Other treatment goals include preventing and treating related complications, improving your ability to stay active, and improving your overall health. 

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Introduction

Chronic obstructive pulmonary disease, also known as COPD, actually refers to a group of diseases that affect the lungs—the most common being chronic bronchitis and emphysema. 

In this interactive video experience, you will learn how advancing COPD affects lung function, how several key medications treat symptoms and exacerbations, the differences between standard inhalers and nebulizers, as well as surgical options for treating COPD. 

Use the blue arrow keys to advance through the five levels of the experience, and click the play button to start each video.

How Severe COPD Affects Your Lungs

Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition characterized by declining lung function due to longterm damage to lung tissues. Exposure to tobacco smoke is the most common source of tissue damage. Although COPD can affect two distinct sets of structures in the lungs—the bronchi and the alveoli—and symptoms may vary, longterm outlook is effectively the same. As airflow gradually declines, the body increasingly struggles to get enough oxygen.

When COPD affects the bronchi—the branching tubes that transport air in and out of the lungs—bronchial tissues become inflamed, causing bronchitis. The airways produce excess mucus, which restricts airflow through the tubes. Involuntary muscles lining the airways may contract, further restricting airflow. Excess mucus triggers coughing, which is usually accompanied by sputum production. A hacking, productive cough that lasts for more than three months annually, for two or more years, is a defining symptom of chronic bronchitis. Absent other illnesses, such as tuberculosis, this condition is defined as COPD.

COPD may also affect the small sacs where gases are exchanged in the lungs—the alveoli. These delicate sacs are surrounded by elastic tissues, which expand and contract with each breath. When damaged, these tissues lose elasticity, making it difficult for the alveoli to inflate and deflate. The result is emphysema. In either case, primary symptoms will include shortness of breath and a reduced ability to perform ordinary tasks of living.

Treating Severe COPD Symptoms with Bronchodilators

Beta agonists are the most commonly prescribed drugs for the treatment of COPD. Another class of medications, called anticholinergics, may also be used. Collectively, these drugs are called bronchodilators. They are usually delivered into the lungs through an inhaler. The drugs coat the interior of the air passages, where they help relax the muscles lining the bronchi and bronchioles. As airways expand, more air flows in and out of the lungs, providing relief from COPD symptoms. 

There are two main types of beta-agonists; short-acting and long-acting. Patients with mild COPD are more likely to be prescribed short-acting inhaled bronchodilators. They can be taken during symptom flare-ups, or before engaging in activities such as exercise, which might trigger shortness of breath or coughing.

Patients with moderate to severe COPD are usually prescribed long-acting beta agonists. Short-acting beta-agonists only work for about three hours, but they take effect within 3-5 minutes. Long-acting bronchodilators provide up to 12 hours of airway relief, but require up to 20 minutes to take effect. These drugs are used for “maintenance” drug therapy, when round-the-clock airway relaxation is needed.

Treating COPD Symptoms with Nebulizers

Disposable inhaler devices deliver medications such as beta agonists, anticholinergics and/or anti-inflammatory corticosteroids into the lungs as particles of dry powder. But when severe COPD drastically reduces lung capacity, it may be difficult for these drugs to reach target tissues deep within the lungs. In these instances, it may be helpful to use a nebulizer. 

A nebulizer is a portable (or tabletop) device that can deliver drugs deep into the lungs as a fine liquid mist. The patient inhales the mist through a mask or mouthpiece. Some units deliver pressurized mist, which enhances the penetration of the drug-bearing liquid droplets into the farther reaches of the airways. When long-acting bronchodilator drugs are inhaled in this way, it’s possible to achieve up to 12 hours of relief from airway constriction.

Treating COPD Flare-Ups and Exacerbations

COPD is a chronic, progressive condition. While disease progression may be slowed or even halted by drug therapy, once damage has occurred the lungs will not regain lost function. Even with maintenance therapy, patients may occasionally experience exacerbations, or flare-ups. During a flare-up, COPD symptoms suddenly become worse.

A flare up poses a serious threat to the patient’s health if he or she is rendered incapable of getting enough oxygen. This condition, called hypoxia, can permanently damage the brain or other vital organs, so it must be addressed immediately. Symptoms of hypoxia may include an inability to catch the breath, mental confusion, an abnormally rapid heartbeat, and lips or fingernails that turn bluish or gray.

During COPD exacerbations, a doctor may prescribe oxygen therapy to prevent hypoxia. Supplemental oxygen comes in a metal cylinder and is delivered to the patient’s lungs through a mask or nasal cannula (a branched plastic tube that can be inserted in the nostrils). Ordinary room air contains about 21% oxygen. Supplemental oxygen therapy increases the concentration of oxygen available to the lungs, making it easier to get enough oxygen into the bloodstream.  

Flare ups may also warrant the use of potent anti-inflammatory drugs called corticosteroids. These medications help control inflammation in the lungs and slow the production of mucus in the bronchi. A doctor may prescribe a corticosteroid that can be taken by mouth, or an inhaler that delivers the drug directly into the lungs.

Surgical Options for Severe COPD

When severe COPD progresses to the point that mobility is limited and quality of life suffers dramatically, surgery may be considered as a last resort. Patients at this advanced stage of disease often struggle to breathe, and hypoxia is an ever-present danger.

The tiny air sacs where gases are exchanged—the alveoli-—often become enlarged and their tissues stiffened. This is especially common among patients suffering from advanced emphysema. These enlarged sacs take up precious space in the chest cavity, making it even harder for remaining functional alveoli to perform the vital work of exchanging gases. When alveoli swell to one centimeter in diameter or larger (about one-third of an inch), doctors may recommend a procedure called a bullectomy, to surgically remove these dysfunctional air sacs. 

Another procedure, called lung volume reduction surgery (LVRS), also alleviates crowding in the lungs. Damaged portions of the lungs are carefully cut away creating more space in the chest cavity. This allows healthier tissues to expand more readily and work more efficiently. About one-fifth to one-third of total lung tissue may be removed during LVRS. 

Complete lung transplant is a final, extreme option available to certain patients that meet very specific criteria. This highly invasive procedure involves the removal of the diseased lung, and replacement with a donor lung. Successful lung transplant can greatly improve a patient’s ability to breathe, but risks are formidable. Among other concerns, organ rejection is a distinct possibility. To reduce the risk of rejection, transplant patients must take potent anti-rejection drugs for the remainder of their lives. 

Managing COPD Symptoms

Chronic obstructive pulmonary disease (COPD) is a long-term condition that can’t be completely cured. However, by managing your condition, you can improve your quality of life, relieve your symptoms, and slow progress of the disease. Other treatment goals include preventing and treating related complications, improving your ability to stay active, and improving your overall health.