COPD
(Chronic obstructive pulmonary disease)
COPD is a term that is used for two closely related diseases of the respiratory system: chronic bronchitis and emphysema. In many patients these diseases occur together, although there may be more symptoms of one than the other. Most patients with these diseases have a long history of heavy cigarette smoking.
| Cigarette smoking is the most important risk factor for COPD. |
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COPD gets gradually worse over time. At first there may be only a mild shortness of breath and occasional coughing. Then a chronic cough develops with clear, colorless sputum. As the disease progresses, the cough becomes more frequent and more and more effort is needed to get air into and out of the lungs. In later stages of the disease, the heart may be affected. Eventually death occurs when the function of the lungs and heart is no longer adequate to deliver oxygen to the body's organs and tissues.
Cigarette smoking is the most important risk factor for COPD; it would probably be a minor health problem if people did not smoke. Other risk factors include age, heredity, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections. Living in low socioeconomic conditions also seems to be a contributing factor. More than 13.5 million Americans are thought to have COPD. It is the fifth leading cause of death in the United States. Between 1980 and 1990, the total death rate from COPD increased by 22 percent. In 1990, it was estimated that there were 84,000 deaths due to COPD, approximately 34 per 100,000 people. Although COPD is still much more common in men than women, the greatest increase in the COPD death rate between 1979 and 1989 occurred in females, particularly in black females (117.6 percent for black females vs. 93 percent for white females). These increases reflect the increased number of women who smoke cigarettes.
| Between 1979 and 1989, COPD death rate increased more in females than in males, particularly in black females. |
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COPD attacks people at the height of their productive years, disabling them with constant shortness of breath. It destroys their ability to earn a living, causes frequent use of the health care system, and disrupts the lives of the victims' family members for as long as 20 years before death occurs. In 1990, COPD was the cause of approximately 16.2 million office visits to doctors and 1.9 million hospital days. The economic costs of this disease are enormous. In 1989, an estimated $7 billion was spent for care of persons with COPD and another $8 billion was lost to the economy by lost productivity due to morbidity and mortality from COPD.
How
Can Patients With Chronic Obstructive Pulmonary Disease Cope Best
With Their Illness?
In most instances of COPD, some irreversible damage has already occurred by the time the doctor diagnoses the disease. At this point, the patient and the family should learn as much as possible about the disease and how to live with it. The goals, limitations, and techniques of treatment must be understood by the patient so that symptoms can be kept under control, and daily living can proceed as normally as possible. The doctor and other health care providers are good sources of information about COPD education programs. Patients and family members can usually take part in educational programs offered at a hospital or by a local branch of the American Lung Association. Patients with COPD can help themselves in many ways. They can:
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Stop smoking. Many programs are available to help smokers quit smoking and to stay off tobacco. Some programs are based on behavior modification techniques; others combine these methods with nicotine gum or nicotine patches as aids to help smokers gradually overcome their dependence on nicotine.
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Avoid work-related exposures to dusts and fumes.
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Avoid air pollution, including cigarette smoke, and curtail physical activities during air pollution alerts.
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Refrain from intimate contact with people who have respiratory infections such as colds or the flu and get a one-time pneumonia vaccination (polyvalent pneumococcal vaccination) and yearly influenza shots.
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Avoid excessive heat, cold, and very high altitudes. (Note: Commercial aircraft cruise at high altitudes and maintain a cabin pressure equal to that of an elevation of 5,000 to 10,000 feet. This can result in hypoxemia for some COPD patients. However, with supplemental oxygen, most COPD patients can travel on commercial airlines.)
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Drink a lot of fluids. This is a good way to keep sputum loose so that it can be brought up by coughing.
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Maintain good nutrition. Usually a high protein diet, taken as many small feedings, is recommended.
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Consider "allergy shots." COPD patients often also have allergies or asthma which complicate COPD.
Of all the avoidable risk factors for COPD, smoking is by far the most significant. Cessation of smoking is the best way to decrease one's risk of developing COPD.DIETARY MEASURES
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A diet high in fruit and fish seems to be associated with lower mortality from COPD.
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A wasting syndrome associated with advanced emphysema requires increased caloric intake. Higher caloric intake alone does not appear to reverse the weight loss and malnutrition seen in advanced emphysema.
ALTERNATIVE THERAPIES FOR COPD
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Acupuncture has been shown to decrease breathlessness, increase walking distance and improve lung function in COPD. Acupuncture may also help patients quit smoking.
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Aromatherapy may be of some benefit in patients with emphysema
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Exercise has been repeatedly been shown to improve quality of life, endurance and lung function in patients with emphysema-especially when combined with inspiratory muscle training
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Ionized air has been recommended for chronic lung disease based on very limited observations
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Massage, in a very small study, has been associated with measurable improvements in lung function in COPD patients.
NUTRITIONAL SUPPLEMENTS
Antioxidants may help reduce oxidative damage that occurs during flare ups of emphysema. Elevated levels of vitamin C seem to be associated with a lower incidence of bronchitis. Elevated dietary levels of vitamin E and beta carotene are associated with a decreased incidence of chronic bronchitis but studies using vitamin E and beta carotene to prevent bronchitis have had mixed results. Vitamin C and vitamin E have both been shown to prevent the oxidative damage caused by exposure to smoke and air pollution .
Essential fatty acids tend to be low in emphysema patients who also have low immunity. The essential fatty acids in fish oil may reduce airway irritability and help with a variety of chronic lung diseases.