Health Issue: COPD

There’s no cure for COPD, and you can’t undo the damage to your lungs. But COPD treatments can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Smoking cessation
The most essential step in any treatment plan for smokers with COPD is to stop all smoking. It’s the only way to keep COPD from getting worse — which can eventually result in losing your ability to breathe. But quitting smoking is never easy. And this task may seem particularly daunting if you’ve tried to quit before. Talk to your doctor about nicotine replacement products and medications that might help, as well as how you might handle relapses. It’s not known what role exposure to secondhand smoke plays in COPD, but avoid it whenever possible.

Medications
Doctors use several basic groups of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

• Bronchodilators. These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both.
• Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better. But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. They’re usually reserved for people with moderate or severe COPD.
• Antibiotics. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are only recommended when necessary.

Surgery
Surgery is an option for some people with some forms of severe emphysema who aren’t helped sufficiently by medications alone:

• Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue. This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently. The surgery has a number of risks, and long-term results may be no better than for nonsurgical approaches.
• Lung transplant. Single-lung transplantation may be an option for certain people with severe emphysema who meet specific criteria. Transplantation can improve your ability to breathe and be active, but it doesn’t appear to prolong life and you may have to wait for a long time to receive a donated organ. So the decision to undergo lung transplantation is complicated.

Other therapies
Doctors often use these additional therapies for people with moderate or severe COPD:

• Oxygen therapy. If there isn’t enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve heart function, exercise capacity, depression, mental clarity and quality of life. In some people, it may also extend life. Talk to your doctor about your needs and options.
• Pulmonary rehabilitation program. Comprehensive pulmonary rehabilitation may be able to decrease the length of any hospitalizations you require, increase your ability to participate in everyday activities and improve your quality of life. These programs typically combine education, exercise training, nutrition advice and counseling. If you are referred to a program, you’ll probably work with a range of health care professionals, including physical therapists, respiratory therapists, exercise specialists and dietitians. These specialists can tailor your rehabilitation program to meet your needs.

Managing exacerbations
Even with ongoing treatment, you may experience times when symptoms suddenly get worse. This is called an acute exacerbation, and it may cause lung failure if you don’t receive prompt treatment. Exacerbations may be caused by a respiratory infection or a change in temperature or air pollution. Whatever the cause, it’s important to seek prompt medical help if you notice more coughing, a change in your mucus or if you have a harder time breathing.

When exacerbations occur, you may need additional medications, supplemental oxygen or treatment in the hospital. Once symptoms improve, you’ll want to take measures to prevent future exacerbations. This may include quitting smoking, avoiding indoor and outdoor pollutants as much as possible, exercise and treatment for GERD.