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Alternative Names: Known to many as chronic bronchitis or emphysema.
Chronic Obstructive Pulmonary Disease (COPD) is estimated to affect 32 million persons the United States, where it is also the fourth leading cause of death. COPD prevalence has increased dramatically in the past few decades and is one of the major causes of bed-confining disability.
COPD refers to a group of conditions that cause shortness of breath and are associated with obstruction of air flow within the lung. Patients typically have symptoms of both chronic bronchitis and emphysema, but the classic triad also includes asthma.
COPD is a mixture of 3 separate disease processes that together form the complete clinical picture. These processes are chronic bronchitis, emphysema and, to a lesser extent, asthma. While each case of COPD is unique in the blend of processes, two main types of the disease are recognized.
Chronic Bronchitis - "Blue Bloaters"
Chronic bronchitis plays the major role in this type and is defined by excessive mucus production with airway obstruction and notable enlargement of mucus-producing glands.
Damage to the airway lining impairs the miniature ciliary hairs located there which usually help clear bacteria and mucus. Inflammation and secretions provide the obstructive component of chronic bronchitis. In contrast to emphysema, chronic bronchitis is associated with a relatively undamaged pulmonary capillary bed. Emphysema is usually present to a variable degree.
As the disease progresses, these patients develop signs of right-sided heart failure and are known as "blue bloaters".
Emphysema - "Pink Puffers"
The second major type is that in which emphysema is the primary underlying process. The physiology of emphysema involves the gradual destruction of the small air sacs where gas diffusion takes place, and of the pulmonary capillary bed, leading to a decreased ability to oxygenate blood. The body compensates with lowered cardiac output and more rapid breathing. Eventually, these patients develop muscle wasting and weight loss and are identified as "pink puffers".
Incidence; Causes & Development; Risk Factors
Men are more likely to have COPD than women and COPD occurs predominantly in individuals over 40.
Most of the time COPD is secondary to tobacco abuse, but other more rare conditions, such a cystic fibrosis, may be contributing factors.
Being obese can aggravate COPD.
Complications
Patients with COPD are susceptible to many factors that can lead to an acute deterioration. Aggressive and prompt intervention may be the only action that prevents respiratory failure.
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Signs, symptoms & indicators of COPD (Chronic Obstructive Pulmonary Disease):
Conditions that suggest COPD (Chronic Obstructive Pulmonary Disease): | | | | | Circulation |  Pulmonary Embolism |
Diet |
Consequences of Poor Diet | Out of 50 consecutive COPD patients presented with acute respiratory failure upon admittance to a hospital, malnutrition was observed in 60% of all patients but only 39% of those whose body weight was equal to or above 90% of ideal body weight. These results suggest that assessment of nutritional status should be systemically performed for COPD patients with acute respiratory failure, especially those who are in need of mechanical ventilation. Aggressive, early nutritional support in acute illness might have beneficial effects on the weaning of patients off mechanical intervention. [Nutritional Status of Patients With COPD and Acute Respiratory Failure, Chest, May 1993;103(5): pp.1362-1368] |
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Respiratory |
Pneumonia |
Symptoms - Respiratory |
 COPD (confirmed)
Counter-indicators:
 Not having COPD (confirmed) |
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Risk factors for COPD (Chronic Obstructive Pulmonary Disease): | | | | | Addictions |  Cigarette Smoke Damage| | Smoking is the single most important risk factor in the development of COPD, contributing to 81.5% of all COPD deaths. People who smoke or have chronic bronchitis have an increased risk of emphysema. Chronic coughing and shortness of breath are symptoms of these diseases. Studies involving over one million men and women have shown that the death rate for chronic bronchitis and emphysema is six times as high for smokers as for non-smokers. |
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COPD (Chronic Obstructive Pulmonary Disease) suggests the following may be present: | | | | | Diet | Consequences of Poor Diet| | Out of 50 consecutive COPD patients presented with acute respiratory failure upon admittance to a hospital, malnutrition was observed in 60% of all patients but only 39% of those whose body weight was equal to or above 90% of ideal body weight. These results suggest that assessment of nutritional status should be systemically performed for COPD patients with acute respiratory failure, especially those who are in need of mechanical ventilation. Aggressive, early nutritional support in acute illness might have beneficial effects on the weaning of patients off mechanical intervention. [Nutritional Status of Patients With COPD and Acute Respiratory Failure, Chest, May 1993;103(5): pp.1362-1368] |
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Recommendations and treatments for COPD (Chronic Obstructive Pulmonary Disease): | | | | | Amino Acid / Protein |  Cysteine / N-Acetyl-Cysteine (NAC)| | NAC helps break down mucus. Double-blind research has found that NAC supplements improved symptoms and prevented recurrences in people with chronic bronchitis. NAC may also protect lung tissue through its antioxidant activity. |
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Botanical |
 Red Clover |
Diet |
 High/Increased Protein Diet| | Researchers from England state that chronic obstructive pulmonary disease may only worsen by eating a diet that contains an overabundance of high-carbohydrate foods. The results suggest that even small changes in the constitution of meals, especially in terms of less carbohydrate, may have significant effects on exercise tolerance and breathlessness amongst patients with COPD. [Diets Rich in Carbohydrates Worsens COPD, Medical Tribune, July 23, 1992; p.17] |
Increased Fruit/Vegetable Consumption| | A diet high in antioxidants may protect against the free-radical-damaging effect of environmental toxins or cigarette smoke. Studies comparing different populations have shown that increasing fruit consumption appears to reduce the risk of developing chronic bronchitis. |
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Digestion |
Bromelain| | Bromelain has been shown to reduce cough and thin mucus secretions for easier removal in chronic bronchitis, but probably not in acute bronchitis. |
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Environmental |
Particulate Matter Avoidance| | Long-term effects of particulate air pollution on the incidence of bronchitis, emphysema and asthma have been documented. There is an unexpectedly high COPD mortality found in small agricultural communities, which may be in part due to occupational dust exposure. The authors felt that prevention of COPD should start in childhood, with emphasis on infection prevention and the control of indoor pollution. [Environmental Factors and Chronic Obstructive Pulmonary Disease, European Respiratory Review, 1992;2:9; pp.144-148] |
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Habits |
Tobacco Avoidance| | Smoking is the primary cause of COPD. |
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Lab Tests/Rule-Outs |
Test Antioxidant Status| | Oxidative stress appears to play a role. Deficiencies of glutathione and vitamins E and C were found in patients with COPD. Increased lipid peroxidation is also a concern. [Oxidative Stress in Chronic Obstructive Pulmonary Disease, American Journal of Respiratory and Critical Care Medicine, 1997;156: pp.341-57] |
Test Magnesium Levels| | There is a possibility that magnesium deficiency contributes to pulmonary complications. The authors note during the past few years there has been an increase in calcium consumption in the U.S. but little change in magnesium intake, which may imbalance the calcium:magnesium ratio. Serum levels can be normal and yet there can be magnesium deficiency within cells. These authors believe pulmonary patients should be routinely monitored for magnesium deficiency. There have been noted benefits of magnesium for wheezing also.[Role of Magnesium in Regulation of Lung Function, The Journal of the American Dietetic Association, June 1993;93(6): pp.674-677] |
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Nutrient |
Essential Fatty Acids| | A high intake of omega-3 fatty acids may protect cigarette smokers against chronic obstructive pulmonary disease. Supplementing with omega-3 fatty acids may interfere with the inflammatory mediators triggered by cigarette smoking. Even small increments of omega-3 fatty acids may have a cumulative beneficial effect. [Dietary N-3 Polyunsaturated Fatty Acids in Smoking-Related Chronic Obstructive Pulmonary Disease, The New England Journal of Medicine, July 28, 1994;331(4): pp.228-233]. |
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Physical Medicine |
Calming / Stretching Exercises| | In an experiment conducted in Western Australia, 22 male patients aged 52 to 65 were selected for severe breathing problems such as chronic bronchitis - emphysema - that made normal breathing impossible.
Half of the men underwent standard treatment for 9 months: physiotherapy that included relaxation techniques, breathing exercises and general workouts to improve stamina. The other 11 men were given a yoga teacher instead of a physiotherapist. He taught them techniques of yoga breathing, which encouraged the use of all chest and abdominal muscles as well as ten yoga postures.
The difference between the two groups was striking. The men who had practiced yoga showed a significant improvement in their ability to exercise, but the physiotherapy group did not. Eight or more out of the 11 patients who underwent yoga declared that they had definitely increased tolerance for exertion and that they recovered more quickly after exertion. The physiotherapy group reported no similar improvement. A significantly greater number of patients reported that "with the help of yogic breathing exercises, they could control an attack of severe shortness of breath without having to seek medical help", according to the study.
Doctors analyzing the results from the study postulate that, after the training, the breathing pattern of the patients in the yoga group changed to a slower and deeper cycle, allowing them to tolerate higher work loads. Patients in the physiotherapy group continued in their shallow rapid breathing pattern. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Asthma (Asthmatic)
A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress. Extrinsic Asthma is triggered by pollen, chemicals or some other external agent; Intrinsic Asthma is triggered by boggy membranes, congested tissues, or other native causes… even adrenalin stress or exertion.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bronchitis
Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Capillary
Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.
Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Ciliary
Often Ciliary activity: Activity of the eyelashes or any hairlike processes (cilia).
Cystic Fibrosis
(CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.
Fatty Acids (Fatty Acid)
Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Glutathione
A natural sulfur-bearing peptide formed from the linking of three amino acids: glutamic acid, cysteine and glycine. Glutathione acts as an antioxidant and detoxicant and is involved with the selenium-containing enzyme glutathione peroxidase. Glutathione is also involved in amino acid transport across cell membranes and is a powerful free radical scavenger and antioxidant that removes unwanted substances from the body.
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Mediator (Mediate, Mediates, Mediators)
A substance or structure that helps bring about a specific response in a bodily tissue.
Mucus (Mucous)
The viscous, slippery substance that consists chiefly of mucin, water, cells, and inorganic salts and is secreted as a protective lubricant coating by cells and glands of the mucous membranes.
NAC
N-acetyl-l-cysteine. A sulfur compound that is a precursor of glutathione.
Peroxidation
A type of oxidation that results in the formation of peroxides in body tissues which contain high proportions of oxygen.
Pneumonia (Pneumonitis)
Inflammation, usually infectious, of the lungs. Unless the result of only moderate chemical or smoke irritation, it is a potentially life-threatening condition. There are so many defenses against an infection this deep in the body that the very presence of pneumonia signals a pathogen of great virulence or impaired or exhausted immunity, or all three. Pneumonitis: Inflammation of the lungs, from whatever cause. It may be concurrent with pneumonia or pleurisy.
Polyunsaturated Fatty Acid (Polyunsaturated Fatty Acids, PUFA, PUFAs)
A polyunsaturated fatty acid is one that is missing more than one pair of hydrogen atoms. Polyunsaturated fatty acids are mostly found in plant and sea foods. Safflower, sunflower, corn and soy oils are high in polyunsaturated fatty acids.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Tincture
An alcohol or water-alcohol solution, usually referring to a preparation from herbal materials.
Last updated: May 18, 2008
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