Chronic Obstructive Pulmonary Disease (COPD) Treatment

What is COPD?

Chronic Obstructive Pulmonary disease (COPD) is a lung condition characterized by the breakdown of lung tissue and reduced lung function.  Air classically gets “trapped” in the lungs, making it difficult to breathe or blow air out.  The most common risk factor for COPD is smoking tobacco.  People often have recurrent episodes of shortness of breath and productive cough.

COPD may eventually lead to heart failure with the long-term requirement of oxygen supplementation.  It is one of the leading causes of death in the United States.

Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes COPD?

COPD is most often caused by cigarette smoking or second hand smoke exposure.  It can also be caused by:

  • Air pollution
  • Occupational exposures – beryllium, sand blasting, chemical exposures
  • Alpha-1-antitrypsin deficiency – a rare condition associated with lung and liver disease

Destruction of the normal lung tissue and architecture results in problems getting rid of air, as a result air gets trapped and the lungs become hyper-inflated.  They may also have trouble exchanging gas, taking in oxygen and removing carbon dioxide.  This can lead to low oxygen levels with physical exertion or at rest in severe cases.  The end result is stiffness in the blood vessels of the heart and lung leading to heart failure.

How common is COPD?

COPD is a very common condition that is frequently evaluated in the primary care clinic.  Severe or unusual cases may require referral to a pulmonologist (lung specialist).

The disease affects approximately 6.3% of Americans, which is equivalent to 15 million people in the United States.  More than 126,000 deaths are caused by COPD each year.  This makes it a leading cause of death.  Most cases of COPD are due to smoking.

What are the symptoms and signs of COPD?

The most common symptoms of COPD include:

  • Difficulty breathing – especially with exertion
  • Productive cough
  • Chest tightness
  • Wheezing
  • Fatigue & low energy
  • Weight loss

Your doctor will often evaluate for certain findings on your physical examination such as:

  • Oxygen saturation
  • Cyanosis – blue/purple discoloration of the lips or skin due to low oxygen
  • Rapid or abnormal breathing
  • Barrel chest – hyperinflation of the chest
  • Wheezing on lung examination
  • Signs of heart failure – swelling in the legs

How is COPD diagnosed?

COPD is diagnosed based on symptoms, physical examination, and confirmed with breathing tests (pulmonary function tests).  During this test, lung volumes are analyzed for abnormal patterns.  Your doctor will also usually order a chest x-ray to evaluate your lung anatomy and rule out other conditions that cause difficulty breathing such as pneumonia or heart failure.

Commonly ordered blood tests include a CMP (comprehensive metabolic panel), CBC (complete blood cell count).  They will also usually check your cholesterol levels and screen for diabetes.  If they suspect you have a rare form of COPD called alpha-1-antitrypsin deficiency, they will check for alpha-1-antitrypsin levels.  Your liver tests may also be abnormal in the setting of this condition.

Some doctors will obtain an EKG (electrocardiogram) and ultrasound of the heart (echocardiogram) if they are concerned about heart disease.

How is COPD treated?

The treatment of COPD involves smoking cessation, proper immunization, and treatment with various medications.  In fact, immunization is the only treatment in COPD associated with improved mortality benefit as it prolongs your life.

These include Pneumovax and Prevnar – pneumococcal pneumonia vaccines.  The annual influenza vaccine is also indicated in most patients.

The most commonly prescribed drugs include:

  • Rescue inhalers
  • Atrovent (ipratropium)
  • Combivent - a combination of albuterol and ipratropium

If your symptoms occur frequently and you use your rescue inhaler often, your doctor may prescribe an inhaled controller medication once or twice daily.  These medications may include:

  • Spiriva (tiotropium)
  • Advair, Symbicort - bronchodilator combined with an inhaled corticosteroid

They work by preventing airway constriction and reducing inflammation – two important features of COPD.  Note – Atrovent should not be taken with Spiriva.

Episodes of COPD exacerbations often require treatment with oral corticosteroids (eg, prednisone).  Your doctor may also prescribe antibiotics such as:

Mild to moderate COPD attacks are generally treated on an outpatient basis with rescue inhalers, inhaled controller medications, and oral corticosteroids (eg. prednisone) at times.

Severe COPD exacerbations (and some moderate exacerbations) usually require a visit to the emergency department and may warrant hospital admission.

Long-term, patients with COPD can benefit from pulmonary rehabilitation.  Many individuals with severe disease will require treatment with supplemental oxygen.  Lung transplantation is a last resort in patients that meet certain criteria such as life expectancy more than 10 years.

COPD Patient Summary:

  • COPD is a very common condition characterized by the breakdown of lung tissue and reduced lung function.
  • COPD is most often caused by cigarette smoking or second-hand smoke exposure.  It can also be caused by air pollution, occupational exposures (eg. beryllium, sand blasting, chemical exposures).
  • Rarely it is caused by alpha-1-antitrypsin deficiency – a condition associated with lung and liver disease.
  • The most common symptoms are difficulty breathing, productive cough, wheezing, chest tightness, fatigue & low energy.
  • COPD is diagnosed based on symptoms and physical examination - and confirmed with breathing tests (pulmonary function tests). 
  • Your doctor will also usually order a chest x-ray to evaluate your lung anatomy and rule out other conditions that cause difficulty breathing
  • Treatment typically consists of smoking cessation, proper immunization (Pneumovax, Prevnar, influenza vaccine), and treatment with various medications.
  • The most common medications include ProAir or Ventolin (albuterol), atrovent (ipratropium), Combivent (albuterol/ipratropium), Spiriva (tiotriopium), Advair, and Symbicort.
  • Moderate to severe COPD exacerbations are often treated with oral corticosteroids (e.g., prednisone) and antibiotics (e.g., Zpack, Tetracycline, Augmentin).
  • Some patients with COPD exacerbation require hospitalization.
  • Individuals with severe disease may benefit from pulmonary rehabilitation and long-term supplemental oxygen.
  • Lung transplantation may be considered in candidates that meet certain criteria.

References:

  1. Balkissoon R, Lommatzsch S, Carolan B, Make B. Chronic obstructive pulmonary disease: a concise review. Med Clin North Am. 2011 Nov;95(6):1125-41.
  2. Lee H, Kim J, Tagmazyan K. Treatment of stable chronic obstructive pulmonary disease: the GOLD guidelines. Am Fam Physician. 2013 Nov 15;88(10):655-63, 663B-F.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.