Chronic obstructive pulmonary disease (COPD) is a medical condition characterized by damage to your lungs and airways. It’s considered progressive because it gets worse over time. However, lifestyle changes and medical treatments can slow the course of the illness and improve your quality of life.
Available Treatment Options
Bronchodilators such as albuterol and salmeterol, which come in an inhaler, relax the muscles around your airways so that breathing becomes more comfortable. Some bronchodilators are designed for short-term or “rescue” use, to help open your airways quickly. Others are long-acting and work to help you breathe easier throughout the day.
Corticosteroids like prednisone help reduce irritation and swelling in your airways. Because they may result in side effects like weight gain, fluid retention, and a depressed immune system, they’re usually reserved for flare-ups or for people who aren’t helped by other treatments.
Supplemental oxygen is delivered through an oxygen concentrator that you can set up in your home. There are also portable concentrators and packs that you can take with you when you want to get out of the house.
Pulmonary rehabilitation offers a combination of different services to help you control your COPD and become more active. Pulmonary rehabilitation programs usually offer education about the disease, counseling, and help planning a healthy diet and exercise program.
Treatment Guidelines for COPD
Different treatments are recommended at different stages of the disease process. Specifically, there are treatment recommendations for ?symptomatic but stable COPD, for COPD exacerbations or flare-ups, and for end-stage COPD.
Treatments for Symptomatic but Stable COPD
“Symptomatic” means that you experience symptoms of COPD like coughing, increased mucus production, and shortness of breath. “Stable” means that your symptoms don’t change much from day to day and that you aren’t having an acute flare-up or exacerbation of your COPD.
In 2011, Dr. A. L. Qaseem and colleagues conducted a thorough review of COPD research. They published a set of recommendations based on this research in Annals of Internal Medicine to guide physicians in their diagnosis and treatment of COPD. These guidelines were approved by the American College of Physicians, the American Thoracic Society, and the European Respiratory Society.
Qaseem et al. categorize their recommendations by the patient’s forced expiratory volume (FEV), the amount of air that you can exhale in one second. The FEV is expressed in percentages—the lower the FEV, the more advanced the disease.
The authors suggest that patients who still have a relatively high FEV (60 to 80 percent) and experience respiratory symptoms may benefit from treatment with inhaled bronchodilators. They cautioned, however, that although not much research has been performed on this group, patients appeared to benefit from using regular inhalers at this early stage.
The people who clearly benefit the most from treatment with inhaled bronchodilators are those who both experience symptoms and have an FEV of less than 60 percent. The authors also found evidence to support the use of monotherapy (treatment using one regular or long-acting medication). Because the literature doesn’t show a clear benefit to using two or more regular medications, the authors suggest that physicians should decide to add more medications to the treatment plan on a case-by-case basis.
The authors also looked into the benefits of pulmonary rehabilitation. They cite solid evidence that pulmonary rehabilitation can benefit people who have an FEV of less than 50 percent. There’s not enough research to justify making assumptions about whether or not rehabilitation can help people with a higher FEV. The authors suggest, however, that pulmonary rehabilitation may be worth a try if your COPD keeps you from moving around easily and if therapy with medications hasn’t been successful.
Finally, the authors recommend the use of continuous supplemental oxygen for COPD patients who have low (SpO2 of 88 percent or less) blood-oxygen saturation level. Oxygen saturation is measured with a device called a pulse oximeter that fits over the tip of a finger.
Treatments for COPD Exacerbation
A COPD exacerbation is a flare-up or an acute decline in your condition that’s serious enough to require a change in your treatment. Common causes for a COPD exacerbation include infections such as influenza or pneumonia, air pollutants, and extreme temperatures. Some exacerbations occur without a known cause.
While some COPD exacerbations are mild and require only an adjustment in the dosage of previously prescribed medications, others are severe and require hospitalization.
After conducting a literature review, Dr. A. E. Evensen published the following treatment suggestions for exacerbations in the journal American Family Physician:
The goal of giving supplemental oxygen is to keep your SpO2 at 90% or above. Oxygen may be given by nasal canula, or via small prongs that fit just inside the nostrils, or by noninvasive positive pressure ventilation (NIPPV).
If these two measures aren’t successful, you may be offered the choice of intubation or invasive ventilation. This involves inserting a tube down your throat and into your lungs to breathe for you until you’re able to breathe for yourself again. The risk of this procedure is that, once intubated, some people with COPD are never able to breathe for themselves again.
These medications are used to open blocked airways. In combination with supplemental oxygen, they can help increase your SpO2.
The literature examined by Evensen shows that patients who receive a short course (around eight days) of corticosteroids are less likely to experience treatment failure and more likely to avoid hospitalization than those who don’t receive such treatment.
Antibiotics are used to treat the infections that can cause an exacerbation.
Because there is no cure for COPD, it’s considered a terminal illness, even though you can live well with it for many years. End-stage COPD is diagnosed when you’re unable to perform most of the activities of daily living and when your FEV drops below 30 percent. Statistically, people with end-stage COPD usually pass away within a year of diagnosis. However, some people live much longer.
Because many people who have reached this stage in their illness don’t want aggressive treatment, such as invasive ventilation, which may prolong the dying process, Home Healthcare Nurse suggests that treatment guidelines be based on your values, goals, and needs.
Many end-stage COPD patients receive palliative care, or comfort care, from a hospice or home health program. Comfort measures often include providing a hospital bed so that you can sit up to make breathing easier, helping you regulate the temperature of your home so that it’s not too hot or too cold, and starting opioids (narcotic pain medications like Roxanol) to treat the frightening sensation of “air hunger” or not being able to breathe.
Although COPD isn’t curable, following recommended treatment guidelines can help slow the course of your disease, ease nerve-wracking exacerbations, improve your mobility, and enhance your ability to care for yourself.