COPD (Chronic Obstructive
Pulmonary Disease)

COPD (Chronic Obstructive Pulmonary Disease): Overview

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.

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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 and Development; Contributing 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.

Signs, symptoms & indicators of COPD (Chronic Obstructive Pulmonary Disease):

Symptoms - General

Symptoms - Nails

Symptoms - Respiratory

(Intermittent) difficult exhalation

COPD causes the lungs to undergo permanent changes that affect one's ability to exhale properly.  These changes usually worsen over time.

Counter-indicators
Absence of difficult exhalation

COPD causes the lungs to undergo permanent changes that affect one's ability to exhale properly.  These changes usually worsen over time.

Conditions that suggest COPD (Chronic Obstructive Pulmonary Disease):

Circulation

Respiratory

Collapsed Lung

COPD increases the risk of a collapsed lung.

Pneumonia

Lung diseases – such as chronic bronchitis and emphysema – are risk factors for the development of pneumonia.

Symptoms - Respiratory

Counter-indicators

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.

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]

Lab Values - Scans

Counter-indicators

Symptoms - Muscular

Being lean or underweight or being very skinny

Slender, older women are more susceptible to various chronic lung problems such as bronchitis, pneumonia and asthma, according to a long series of studies.

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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]

COPD (Chronic Obstructive Pulmonary Disease) can lead to:

Respiratory

Recommendations for COPD (Chronic Obstructive Pulmonary Disease):

Amino Acid / Protein

Cysteine / N-Acetylcysteine (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.

Botanical

Red Clover

Red Clover tincture has long been a treatment for whooping cough and bronchitis.

Diet

Spicy Foods

Spicy foods are known expectorants, which help the body to expel phlegm.

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.

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.

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]

Habits

Tobacco Avoidance

Smoking is the primary cause of COPD.

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]

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].

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 bronchitisemphysema – 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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