Treatment

 

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What can you do if you have Chronic Obstructive Pulmonary Disease (COPD)?
 
Certainly you should change any behavior that can make it worse. The single most important thing you can do for yourself is to stop smoking. In fact, if you don't stop smoking, none of your other efforts will be as effective as they could be, and your COPD will get worse.
 
 
As a COPD patient—
  • You need clean air. Therefore, you should also avoid being around smokers and fume-laden air. During fog or smog, try to stay indoors with windows closed. If possible, use fumeless appliances for heating.
  • Polluted air also can irritate your lungs. Try not to go out when the air quality is rated poor. But if you cannot avoid excessive air pollution, protect your mouth and nose with a mask.
  • You should see your doctor on a regular basis - especially if you have a chest cold or any time you cough up mucus.
  • It is also important to guard against catching the flu by getting an influenza vaccine each fall, well before winter starts. A pneumonia vaccine should also be given to anyone over age 60, and all persons with COPD.
There are many different types of treatments that can help you cope with COPD and live your life to the fullest. Keep reading to find out more about COPD treatment – but remember that your primary care provider is the best person to direct your care and should be the one to select the treatment that will be most helpful to you...
 
 
Clearing Your Lungs
 
Coughing has an important "cleaning action" and is something you should practice every day – especially in the morning, when mucus may have settled in your lungs as you slept. You must learn to cough in such a way that you can clear your lungs of mucus with two or three coughs. Your doctor or the respiratory therapist will teach you the way that is best for your particular problem.
 
As an aid to this cleaning, your doctor may recommend breathing moist or humid air, and drinking plenty of fluids every day. Doing this may help thin out the mucus so that you can cough it up more easily.
 
Your primary care provider may also recommend that you use inhaled bronchodilating drugs or anti-inflammatory drugs to open your airways and help increase the normal flow of mucus out of your lungs (Keep reading to find out more about these drugs.)
 
 
Breathing Techniques
 
Learning to breathe properly is another very important lesson for people with COPD. If you have COPD, you usually work very hard to breathe. However, because you are not breathing properly, your hard work does not make you feel better and you become tired easily.
 
There are several things you can do to improve your breathing:
  • Relax. Being tense makes it harder to breathe.
  • Breathe out through pursed lips, like when whistling. This slows down your breathing and makes each breath do more good for you...
  • Lean forward while exercising. This also helps control shortness of breath.
  • "Belly breathing" may also help shortness of breath. This is done by allowing your belly to stick out while breathing in and then pulling your belly in while breathing out. Remember to purse your lips when breathing out!
 
Physical Activity
 
Often people make the mistake of believing that if they try to avoid becoming short of breath, they will protect their lungs and heart. THIS IS NOT TRUE! Remaining physically active will improve your breathing ability and help you feel better and enjoy life more.
 
You can exercise even if you have COPD. As we all know, muscles will become weak if we don't use them. This is true for the muscles of your chest, which are important in breathing, as well. Strengthening these muscles will help decrease shortness of breath.
 
Don't let COPD change your normal attitudes about exercise. You should walk every day, trying to do a little more than you did the day before. Start by walking in your house, then try walking out of doors (but not when there is poor air quality) — walking longer distances each time.
 
Your primary care provider will help you find the exercises that are best for you. Ask if there is a local pulmonary rehabilitation program, where you can learn more about your COPD and get advice and support to learn the best ways to exercise and control your COPD symptoms.
 
 
Oxygen
 
Supplemental oxygen is a very helpful treatment that enables many patients with severe COPD lead a more normal and productive life.
 
Your primary care provider may order an oxygen test (by taking blood from an artery or by using an oximeter) – and if your oxygen level is low, the doctor will prescribe it for you. Portable devices will allow you to carry oxygen with you, or your doctor might tell you to use oxygen only at night during sleep when your oxygen level may drop because of shallow breathing. Liquid portable oxygen now comes in a very light device, making it the most practical ambulatory system. Your primary care provider will order the proper oxygen system which can benefit you the most. The device supplier (often called a durable medical equipment company or DME) must follow your doctor’s prescription exactly as it is written. The DME will also instruct you in how to use your oxygen equipment safely. A respiratory therapist may also be called in to help you learn more about using supplemental oxygen. Follow the directions you are given carefully, as you would for any medication that is prescribed, and be sure to ask questions if you do not fully understand how to use your equipment!
 
 
Medications
 
Many different medications are used as treatment COPD. Your primary care provider will decide which medicine is best for you based on your medical history, breathing tests, and other laboratory tests.
 
To help you breathe easier, your doctor may give you bronchodilator drugs. Bronchodilators relax the muscles that surround the breathing tubes and widen them, letting air travel in and out more easily.
 
Your primary care provider may also prescribe drugs called corticosteroids, which reduce the swelling in your breathing tubes. If you have an infection in your lungs, your primary care provider may prescribe antibiotics. Remember that is never good to take an antibiotic as a protection against future infections – but when prescribed, take ALL of the medication exactly as directed by the primary care provider. If you have any questions about your medications and how they work, ask the primary care provider or your pharmacist!
 
Lung medications are available in many forms. In addition to pills or syrups that your swallow, your primary care provider may prescribe medication to be delivered through a metered-dose inhaler (MDI) or a dry powder inhaler (DPI), both of which deliver the medication in a “puff” that you breathe in. Liquid medications are delivered using a nebulizer which turns the liquid into a mist that you breathe in. Directions for measuring your liquid medication and for using the cup and tubing that attach to the nebulizer should be given to you in written form (with pictures) by a respiratory therapist and/or the company that provides the nebulizer.
 
In order to get the maximum benefit from any medication, it is important to take it properly. This is especially true for medications that are inhaled.
 
Regardless of the type of medication your are taking, follow your primary care provider's directions carefully. Reread these instructions or the medication package insert often to make sure you are taking your medication the right way. Do not exceed the dose prescribed by your primary care provider. If you continue to have difficulty breathing, contact your primary care provider immediately.
 
 
Nebulizer Treatment
 
This type of treatment, which must also be prescribed by your primary care provider, delivers a mist of medication to your lungs by blowing air into the medication (liquid) in a cup attached to a small piece of tubing. When taking this treatment, here are some points to remember:
  • Be sure you know the amount of medication and solution to use as well as the length and timing of your treatment. Follow your primary care provider's or respiratory therapist's instructions carefully about when each treatment should be scheduled and the length of time that it should be done.
  • Relax and sit in a comfortable chair in an upright position.
  • Make sure the tubing is not bent or dented, and that the liquid cup is level with your mouth.
  • Put the mouthpiece in front of your teeth and keep your mouth slightly open.
  • Take a deep, slow breath, activating the air control (if your machine has one). Your machine may make a mist constantly. Whichever type of machine you have, relax and take in slow deep breaths to allow the mist fill your lungs. Hold your breath for about two seconds before exhaling. Remember to exhale slowly and completely each time.
If your mouth becomes dry during your treatment, don't be afraid to stop and drink some water. Also -- and this is very important -- if you bring up mucus during the treatment, turn your machine off and stop and cough it up. These treatments are helpful in eliminating mucus.

If you experience any discomfort after treatment, notify your primary care provider.
 
 
New Developments
 
Progress is continually being made in the treatment of COPD.

Beta agonists and anticholinergics are both bronchodilator medications. Many come in pill, liquid (for the nebulizer) or as MDIs or DPIs. Because these medications work in the lungs in different way, they are often prescribed for use at the same time. Many are now available mixed together in the same MDI or DPI – meaning that you only need to use one device to get both medications if they are prescribedthat way by your doctor.

A new treatment that may be effective in a rare hereditary form of emphysema is being tested on volunteers. A replacement for the inherited deficiency of alpha antitrypsin is commercially available. Although it restores a protective material in the lungs, its effectiveness in preventing the progress of emphysema remains to be proven.
 
Surgical approaches to improving dyspnea by removing areas of major lung damage from emphysema are called lung volume reduction surgery, (LVRS).

In selected patients, this operation can improve shortness of breath and quality of life. The mechanisms behind this improvement are complex. They include a restoration of the curvature of the diaphragm through a reduction in overinflation of diseased parts of the lung. These regions of excessive destruction are often in the upper parts of the lung, (apices). These areas contribute little to lung function, but they take up a lot of space for expansion of the rest of the lung, which is relatively normal. Extensive evaluations must be done through scans and tests of heart function to determine where the damaged parts of the lungs are and if you are a good candidate for this surgery.

Based on the results of a research study funded by Medicare, there is some reimbursement for this surgery. The study contrasted the results from surgery following a period of pulmonary rehabilitation compared to pulmonary rehabilitation alone. The study, called the National Emphysema Therapy Trial, (NETT), showed that only a small number of people with COPD will benefit from this surgery, which most will benefit from a full program of pulmonary rehabilitation (PR). Ask your doctor if there is a PR program in your area.