Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) causes severe shortness of breath, which can result from chronic bronchitis, emphysema, or both. Chronic bronchitis is defined as a constant cough and excessive mucus production that lasts for at least three months for more than two consecutive years. Emphysema is characterized by damage to the lungs, which causes them to lose their elasticity. COPD is the fifth leading cause of death in the United States.

Signs and Symptoms

	Cough (often with phlegm that is hard to "bring up")
	Shortness of breath during exertion (and eventually, at rest)
	Excessive mucus production and impaired mucus elimination
	Wheezing
	Recurrent respiratory infections

What Causes It?

Smoking is the number one cause of COPD. It can also be caused be exposure to pollutants. One rare form is inherited.

What to Expect at Your Provider's Office

Your health care provider will listen to your chest for wheezes, crackles, and decreased breath sounds. If your symptoms are severe, your provider will order a chest X-ray and lung-function tests. He or she will measure levels of blood gases in your arteries to determine if your condition might be hereditary. He or she will urge you to quit smoking immediately.

Treatment Options

Treatment Plan

Not smoking is the key to preventing COPD or to stop it from getting worse. Drug treatment varies depending on the severity of the disease. Your health care provider may talk with you about lifestyle changes you can make to help relieve the symptoms of COPD. These include exercising and eating a healthy diet. Support groups or therapy can help make it easier to live with the condition.

Drug Therapies

Prescription

	Alpha1-antitrypsin—this is a protein found in the plasma of blood; it is depleted when you have emphysema and may need to be replaced
	Bronchodilators—increase airflow and help to make it easier to breathe
	Corticosteroids—reduce inflammation; taken by inhaler
	Antibiotics—used to treat COPD when symptoms worsen
	Magnesium—given intravenously to relieve symptoms

Over the Counter

N/A

Complementary and Alternative Therapies

Complementary and alternative therapies can help decrease your symptoms and prevent infections. Some also can help you quit smoking.

Nutrition

	Dairy products and bananas increase mucus buildup and should be avoided. Garlic, onions, and horseradish may actually decrease mucus production.
	Some essential fatty acids: as an anti-inflammatory, dose is 1,000 to 2,000 IU, mixed omega-3 and omega-6 oils (flaxseed, fish, borage, and evening primrose oil; avoid vegetable oils and saturated fats)
	Coenzyme Q10 , makes it easier for you to exercise without getting short of breath. Dose is 10 to 50 mg three times a day.
	Other important antioxidants: selenium (200 mcg per day), vitamin E (400 IU per day), vitamin C (1,000 mg three times per day), L-carnitine (750 mg twice a day). Note that beta-carotene may increase the risk of lung cancer in smokers.
	Bromelain helps reduce mucus production (250 to 500 mg three times per day, on an empty stomach). You may be sensitive to this if you are allergic to pineapple. Bromelain may also aggravate gastritis.
	N-acetyl cysteine reduces mucus (400 mg three times a day).
	Magnesium promotes muscle relaxation in your lungs and blood vessels (100 to 500 mg twice a day). Magnesium may cause diarrhea if you are sensitive to it. An intravenous infusion of magnesium can also be very helpful, but must be done by a health care provider).

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

	Mullein (Verbascum thaspis): brings up phlegm, soothes irritation
	Ginger (Zingiber officinalis): dissolves secretions, relieves bronchial spasms
	Fennel (Foeniculum fructus): dissolves secretions, mild anti-spasmodic, calming digestive stimulant
	Coltsfoot (Tussilago farfara): soothes and reduces inflammation. Prolonged use may cause liver damage due to pyrrolizidine alkaloids.
	Licorice (Glycyrrhiza glabra): antiviral, antidepressant, soothing, reduces swelling. Do not take if you have high blood pressure.
	Hawthorne (Cretaegus oxycanthus): protects blood vessels.

Mix equal parts of herb, or tincture of four to six of the above herbs. Dose is 1 cup tea three times per day, or 30 to 60 drops tincture three times per day.

Essential oils: eucalyptus, thyme, rosemary, and lavender: place 3 to 5 drops in 2 cups of water in a humidifier to prevent infection.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results use for three consecutive days in one week. When placed over the lungs, castor oil packs decrease inflammation and stimulate drainage.

Postural drainage, yogic breathing, and pulmonary rehabilitation programs may all be helpful.

Acupuncture

Has been shown to have great benefit in smoking cessation.

Following Up

Your health care provider will want you to come back once or twice a year to monitor your lung function; however, if your symptoms become more severe, you should see your provider immediately so that life-threatening respiratory failure does not occur.

Special Considerations

If you have COPD, you are prone to respiratory infections. Your health care provider will most likely tell you to get a flu shot every year.

Supporting Research

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:423, 468.

Bordow RA, Moser KM. Manual of Clinical Problems in Pulmonary Medicine. 4th ed. Boston, Mass:Little, Brown; 1996:212–215.

Celli BR. Pulmonary rehabilitation in patients with COPD. Am J Respir Crit Care Med. 1995;152:861–864.

Duke JA. The Green Pharmacy. Emmaus, Pa: Rodale Press; 1997:93–95, 179–183.

Fauci AS, Braunwald E, Isselbacher KJ et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1451–1457.

Ferguson GT, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 1993;328:1017–1022.

Snider GL. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. Washington Crossing, Pa: Scientific Frontiers; l996:1–12.

Woodley M, Whelan A. Manual of Medical Therapeutics. 27th ed. Boston, Mass: Little, Brown; 1992:200–202.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.