People with COPD signs and symptoms tend to decrease their physical activity as shortness of breath makes exertion more and more difficult. If your COPD prognosis is poor, you also may think you need to cut down on physical activity. However, decreased activity can start a vicious cycle of progressive deconditioning. This leads to a worsening of COPD symptoms and more breathlessness. COPD rehabilitation is aimed at breaking that cycle.

COPD Rehabilitation: Program Basics

COPD rehabilitation is more than an exercise program, although exercise is the most important component. According to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), pulmonary rehabilitation is tailored to the needs of individual patients, and is designed to optimize physical and social performance and autonomy.

A portable spirometer, called an “incentive” spirometer, challenges and recruits reluctant alveolae.

The AACPR lists the following core components for a COPD rehabilitation program:

• Exercise training and other therapeutic exercise (aerobic, strength, and flexibility training)
• Education and skills training (such as breathing retraining)
• Secretion clearance techniques
• Prevention and management of COPD exacerbations
• Control of irritants and allergens
• Instruction in proper use and safety of oxygen systems
• Nutritional assessment and intervention if necessary (Find out how a COPD diet might help you in our article on COPD home remedies.)
• Psychosocial assessment, support, panic control, and professional intervention, if necessary
• Help with smoking cessation if currently smoking
• Education about medication use
• Implementation of a home treatment program follow-up

COPD patients at all stages can benefit from a COPD rehabilitation program—in fact, one study found that patients in the earlier stages of COPD derived greater benefits than those in the later stages.

Although those with less advanced COPD had better results, those with severe COPD signs and symptoms also had improved ability to exercise, and less shortness of breath. This research suggests that when it comes to COPD rehabilitation, the earlier the better. However, all of the patients were helped by the program. Other studies have found that rehabilitation benefits are generally sustained for up to 18 months after the program ends, especially if the exercise training is maintained.

There are many COPD rehabilitation programs around the country. Your doctor can most likely refer you to one—alternately, the American Association for Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org) has a searchable online directory of rehabilitation programs. Health insurance may or may not cover COPD rehabilitation—you’ll need to check with your insurance carrier.

Medicare coverage of COPD rehabilitation can vary from state to state, so check with your doctor or provider to obtain the guidelines in your state.

See also these University Health News posts:

• “Lung Diseases and COPD Facts: Understanding the Breathing Process“
• “Lifestyle Changes Among the Keys to COPD Treatment“
• “Is There Such a Thing as a COPD Diet?“

Originally published in May 2016 and updated.

The post COPD Rehabilitation: Dealing with a Serious Lung Disorder appeared first on University Health News.

Almost every person with COPD will be prescribed a short-acting bronchodilator (either a beta-agonist, an anticholinergic, or a combination of both) to use as needed to relieve shortness of breath, coughing, wheezing, and other symptoms. Some people also will need long-acting bronchodilators and/or an anti-inflammatory drug. Your doctor will work with you to figure out the right drugs and combinations of drugs to relieve your symptoms, and you also should get immunized against influenza and pneumonia.

One thing you should avoid using is over-the-counter cough medications, such as guaifenesin (Robitussin, Mucinex), since there is little evidence to show that these are helpful for people with COPD. Although coughing can be bothersome, it has the important function of helping to clear mucus. This means that suppressing a cough may increase the risk of lung infection.

Mild COPD Treatment

For a person with mild COPD who has occasional symptoms, a short-acting bronchodilator alone may be sufficient to manage the condition. Two short-acting bronchodilators—a beta-agonist plus an anticholinergic—also may be prescribed. To simplify this regimen, a combination of a short-acting beta-agonist plus a short-acting anticholinergic is available in a single inhaler. If more symptoms develop over time, additional medications will likely be necessary.

Moderate-to-Severe COPD Treatment

For people with moderate-to-severe COPD who tend to experience symptoms more frequently, one or more long-acting bronchodilators will be added to the regimen. These drugs will be taken regularly every 12 or 24 hours. If acute episodes of breathlessness or coughing occur while taking these medications, a short-acting bronchodilator such as albuterol can be used to quell the episodes.

Inhaled corticosteroids are recommended for people with moderate-to- severe COPD who do not get sufficient relief from bronchodilators alone, or who experience frequent exacerbations of symptoms. Inhaled corticosteroids have been shown to reduce flare-ups. However, some studies have found that using inhaled corticosteroids, with or without a bronchodilator, increases the risk of developing pneumonia. Nevertheless, because inhaled corticosteroids may decrease the risk of dying, they often are added when bronchodilators alone are insufficient. Hopefully further research will clarify the role of inhaled steroids in COPD. Patients should discuss any concerns they have with their physician.

For people prescribed long-term use of both a long-acting bronchodilator and a corticosteroid, combinations of both in a single inhaler are available.

Severe COPD Treatment

For patients with more severe COPD, combinations of two long-acting bronchodilators are generally used. These often are combined in a single inhaler.

Immunizations

For people with obstructive airway diseases, flu or pneumonia can be very serious and even life threatening. Fortunately, vaccines are available to protect against influenza and some forms of pneumonia. It is extremely important that everyone with obstructive airway disease follow the recommended vaccination schedule, or their doctor’s advice.

Flu Vaccine

People with COPD or other lung problems should receive an influenza vaccination once a year. The ideal time to get a flu shot is in October or November, as flu season runs from November to March.

Pneumococcal Vaccine

The pneumococcal vaccine protects against the bacteria that is the most common cause of pneumonia, Streptococcus pneumoniae. There are now two forms of pneumococcal vaccine, the Pneumovax and the Prevnar 13. It is recommended that all adults over age 65 receive a pneumococcal vaccination. Unlike the flu shot, which must be given every year in the fall, pneumococcal vaccination provides protection for at least five years. It can be given at any time of the year.

The pneumococcal vaccine is advised for all people with COPD age 65 and older. It also may be given to people with COPD who are younger than age 65 and have severe or very severe disease (FEV1 less than 40 percent of predicted), and recommended for people with asthma who are younger than age 65.

Treating COPD Exacerbations

The most common cause of an exacerbation is a lung infection that may increase mucus production. In these cases, antibiotics may be used. Before prescribing an antibiotic, the doctor may send a sample of the sputum for analysis to determine whether the infection is bacterial or viral, since antibiotics are only effective against bacteria. Studies have shown that a short course (five days) of antibiotics is just as effective as taking antibiotics for longer than five days.

In 2017, the American Thoracic Society and European Respiratory Society issued joined guidelines on the management of COPD exacerbations. Their recommendations included:

• For ambulatory patients with an exacerbation of COPD, a short course of oral corticosteroids plus antibiotics.
• For patients hospitalized with an exacerbation, oral corticosteroids rather than intravenous corticosteroids, if possible.
• For patients hospitalized with an exacerbation causing respiratory failure, noninvasive mechanical ventilation.
• After being discharged for an exacerbation, pulmonary rehabilitation should begin within three weeks. It should not be started during hospitalization.

A recent study found that engaging in any amount of regular exercise following hospitalization for a COPD exacerbation actually reduces the risk of dying.

To learn about other COPD treatment regimens, purchase COPD, Asthma and Other Lung Disorders at UniversityHealthNews.com.

The post COPD Treatment Regimens appeared first on University Health News.

Propionate, an antimold agent that is added to foods such as bread, baked goods, and sausage, may increase the risk of diabetes and obesity, according to a study published in April in Science Translational Medicine.

Researchers gave healthy, normal-weight mice a dose of the preservative and found that it activated the sympathetic nervous system and increased the levels of the hormones glucagon and FABP4, which are normally elevated only when a person is fasting. This caused the liver to produce more glucose, leading to high insulin levels. For several weeks, the mice ate a serving size of propionate that was equivalent to what the average human would consume. In addition to the higher hormone levels, they had higher levels of insulin, insulin resistance, and fat mass.

The same effects were seen in 14 humans who ate a 500-calorie meal with either 1 gram of calcium propionate or a placebo for two weeks.

The study does not prove causation, but it adds more information to a broader examination of the contributors to the growing obesity and diabetes epidemics.

Low-Dose Antibiotic May Improve COPD Treatment

An extended, low-dose course of the antibiotic azithromycin could reduce treatment failure in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD), according to a new study published in May in the American Journal of Respiratory and Critical Care Medicine. In a multicenter trial, 301 COPD patients who were hospitalized with an acute COPD exacerbation were randomly assigned to receive either azithromycin (500 milligrams [mg] for three days, then 250 mg every other day for 90 days) or placebo within 48 hours of admission. Over the course of the study, fewer patients in the azithromycin group experienced treatment failure (49 percent vs. 60 percent), the need for intensified treatment within three months (47 percent vs. 60 percent), or step-up therapy (13 percent vs. 28 percent.) Patients in the azithromycin group had shorter hospital stays (11 days vs. 14) and less time in intensive care (three days vs. 11). After discontinuing the antibiotic, however, the benefits faded, suggesting that a longer-term treatment should be tested.

Malaria Drug Successfully Used for Diabetes in India

Hydroxychloroquine, a drug traditionally used to treat malaria, may be as beneficial for people with diabetes as the drug canagliflozin, according to a presentation at the American Association of Clinical Endocrinologists 2019 Annual Scientific & Clinical Congress.

Hydroxychloroquine is used in India as a secondary treatment for patients with type 2 diabetes who fail to meet glycemic targets with other oral glucose-lowering drugs. This study enrolled 87 such patients who had a mean glycated hemoglobin (HbA1c) of 8.4 percent. The patients were randomized to receive either 400 mg of hydroxychloroquine or 300 mg of canagliflozin daily. Both groups experienced similar results. HbA1c decreased in those taking hydroxychloroquine from 8.32 percent to 7.11 percent, while those taking canagliflozin went from 8.63 percent to 7.44 percent. Fasting plasma glucose was also similar in both groups. The drugs differed, however, when it came to body mass index (BMI). Those taking hydroxychloroquine saw significant decrease in BMI (27.2 to 25.7), while those taking canagliflozin maintained the same weight. A major barrier to the use of hydroxychloroquine for diabetes in the United States is that there is very little cardio-renal information available. DM

The post Internal Medicine Newsbriefs: Preservatives & Diabetes; Antibiotics & COPD; Malaria Drug for Diabetes appeared first on University Health News.

For those with COPD who are current smokers, the most important first step is to quit. Smoking cessation helps to slow down the disease, especially in its early stages. People with COPD should also reduce their exposure to secondhand smoke, occupational sources of lung irritants (like dust and chemicals), and indoor and outdoor air pollutants. When outdoor air quality is poor, people with significant COPD should stay indoors to help reduce their symptoms. Everyone with COPD should receive immunizations for influenza and pneumonia.

In people with COPD, the parts of the lungs damaged due to emphysema cannot be restored. Therefore, drug treatment is aimed at improving function in the parts of the lungs that are still working, and reducing inflammation in the lungs. Antibiotics may be added to the treatment regimen if exacerbations occur, while younger adults who inherited alpha-1 antitrypsin deficiency may be treated with alpha-1 antitrypsin augmentation therapy.

In addition to medications, regular physical activity is important for maintaining lung function. For patients with more severe disease, a specialized exercise program called pulmonary rehabilitation has been shown to improve the ability to exercise and engage in basic daily activities with less shortness of breath.

In severe disease, oxygen therapy is often required. Some people with advanced COPD may be candidates for lung volume reduction surgery, which may relieve symptoms and can improve quality of life, or lung transplantation.

Drugs to Treat Obstructive Airway Diseases

Drug therapy is part of the treatment for just about everyone with COPD or asthma. Drug regimens generally include two types of medicines:

• Bronchodilators to open narrowed airways
• Anti-inflammatory drugs (corticosteroids) to reduce inflammation in the lungs.

Various combinations of these medications often are used. Some people with COPD also may take a PDE4 inhibitor called  Roflumilast (Daliresp).

The preferred method for delivering COPD medications is inhalation. Using an inhaler device ensures that the drug quickly reaches the airway, where it is needed, and also minimizes the risk of drug side effects.

Bronchodilators

Bronchodilators expand the airways, making it easier to breathe and go about daily life. There are two main types of bronchodilators: beta-agonists and anticholinergics. Each is available in short-acting and long-acting formulas, and each can be taken orally, intravenously, or through inhalation. A third type of bronchodilator, theophylline, is an older drug that is used less frequently due to its side effects and potential interactions with other medications. 

Beta-Agonists

Beta-agonists activate a receptor on muscles surrounding the bronchial tubes, causing them to relax and allowing the airway to dilate. Short-acting beta-agonists start to work within minutes and last about four to six hours. Long-acting beta-agonists (LABAs) take longer to begin working (about 20 minutes), but last up to 24 hours.

Possible side effects of beta-agonists include headaches, nervousness, dizziness, and shakiness. If side effects occur, they often last only a short time and diminish or resolve completely once the medication is used regularly. If they persist, a different medication, or a lower dose may be prescribed. Some research suggests an initial heart attack risk from taking LABAs (see “Short-Term Heart Attack Risk with Long-Acting Beta-Agonists”).

Anticholinergics

Anticholinergics block a receptor in the lung to prevent the airways from constricting. The short-acting anticholinergic drug ipratropium (Atrovent) starts to work within 15 minutes, and lasts for six to eight hours. Long-acting anticholinergic drugs take 10 to 20 minutes to start working, and last 12 to 24 hours. Possible side effects of ipratropium include coughing, headaches, nausea, heartburn, diarrhea, urinary retention, and constipation, among others. However, they are generally not serious and diminish or go away completely if the medication is stopped. If any side effect is severe, or does not go away, a different medication may be needed.

Anti-Inflammatory Drugs

Corticosteroids are the most commonly used anti-inflammatory drugs in people with COPD or asthma, and reduce swelling in the bronchial tubes. They can be taken in tablet, liquid, injected, or inhaled form. The pill form acts faster than the inhaled version, but often causes many more side effects.

Oral Corticosteroids

Oral corticosteroids—most commonly prednisone (Deltasone) and predisolone (Medrol)—are generally reserved for treating acute exacerbations of COPD or asthma. Breathing becomes easier, coughing and wheezing subside, and mucus production lessens within a few hours or days after the medication is started.

Even though oral corticosteroids have pronounced effects, they are generally only used for a short period of time (a few days to a few weeks). This is because in addition to reducing inflammation, corticosteroids have other effects on the body that can cause unwanted and potentially severe consequences. Taken by mouth in moderate-to-high doses for months or years, corticosteroids can cause bruising of the skin, cataracts, bone thinning (osteoporosis), muscle weakness, hair loss, growth of facial hair in women, mood changes, and weight gain. Anyone who uses oral steroids for long periods of time also may be susceptible to developing high blood pressure and/or diabetes. Moreover, when oral steroids are used for more than a few weeks, the body becomes accustomed to the drug and it cannot be stopped abruptly without adverse effects. Therefore, anyone who takes an oral steroid for several weeks or more must taper off the drug.

Inhaled Corticosteroids

Most people with obstructive airway disease who take corticosteroids use the inhaled form. Using an inhaler device delivers the medication directly to the lungs. Very little medication travels through the bloodstream, which minimizes side effects. In commonly used doses, inhaled steroids are safe to use over the long term. Possible side effects include a cough, sore throat, hoarse voice, and a yeast infection in the mouth (oral candidiasis). Candidiasis can be avoided by rinsing your mouth with water after each use of the inhaler, or by using a spacer.

PDE4 Inhibitor

The PDE4 inhibitor roflumilast (Daliresp) works through an entirely different mechanism than bronchodilators and anti-inflammatory drugs. Roflumilast is taken once a day to reduce inflammation in the lungs. It also may promote smooth muscle relaxation, which may enhance airway dilation. Roflumilast has a limited benefit on lung function so it is generally only taken as part of a comprehensive COPD regimen.

Types of Inhalers

Inhalers deliver bronchodilators or corticosteroid medications as a spray, mist, or fine powder. Three types of devices are available to deliver inhaled medications: a metered dose inhaler (MDI), a dry powder inhaler (DPI), and a nebulizer.

Metered Dose Inhalers

An MDI is a small, pressurized canister with a mouthpiece and a metering valve that contains medication. The patient shakes the inhaler, places his or her mouth over the mouthpiece, and then inhales while pushing down on the top of the canister to deliver a precise dose of the medication. Proper inhaler technique is needed to ensure that the correct amount of drug is delivered. Poor technique can result in too little drug reaching the lungs, as well as more side effects due to the drug being deposited in the mouth or the back of the throat instead of the airway. Several common mistakes can interfere with drug delivery. For example, some people exhale before the end of the spray, or inhale after the medication is sprayed. Other mistakes include inhaling through the nose instead of the mouth, squeezing the canister twice but only inhaling once, or forgetting to take the cap off the mouthpiece.

Many people find it helpful to use a spacer device with their MDI to improve drug delivery. A spacer is a short tube that is placed between the mouthpiece of the inhaler and your mouth. The medicine enters the tube, and from there it can be inhaled more slowly and deeply. This results in more effective delivery of the medicine to the lungs.

The medication in the MDI canister is suspended in a mixture of substances. One of these is a propellant, which squirts the mixture out of the device and gives it enough momentum to get down into the lungs. The mix also contains preservatives, flavoring agents, and chemicals that help to disperse the drug throughout the lung.

Each inhaler has different directions for washing, drying the mouthpiece, and priming. It’s important to follow the instructions that come with the inhaler your doctor has prescribed.

Dry Powder Inhalers

DPIs are similar to MDIs, but they don’t contain a propellant. Using a DPI requires inhaling more deeply and quickly to suck the medicine out of the device and into the lungs. DPIs are easy to use, as they don’t require the coordination of taking a breath while actuating the device with your hand.

To use a DPI, simply place your mouth tightly over the mouthpiece and inhale quickly. Unlike an MDI, a DPI inhaler should not be shaken before being used, nor is a spacer needed.

Nebulizers

Inhaled medications like bronchodilators and corticosteroids also can be delivered via a nebulizer. A nebulizer is a machine that turns the liquid form of a drug into a fine mist that is then inhaled through a mouthpiece or facemask. Nebulizers are often used for treating very young children who have asthma. They also are used for older children and adults who have more severe lung disease, or who have difficulty using MDIs or dry powder inhalers.

The long-acting bronchodilator formoterol is available for use in a nebulizer. This drug is an alternative to MDI and DPI inhalers for COPD patients who may have difficulty using inhaler devices easily or correctly.

COPD Treatment Regimens

Almost every person with COPD will be prescribed a short-acting bronchodilator (either a beta-agonist, an anticholinergic, or a combination of both) to use as needed to relieve shortness of breath, coughing, wheezing, and other symptoms. Some people also will need long-acting bronchodilators and/or an anti-inflammatory drug. Your doctor will work with you to figure out the right drugs and combinations of drugs to relieve your symptoms, and you also should get immunized against influenza and pneumonia.

One thing you should avoid using is over-the-counter cough medications, such as guaifenesin (Robitussin, Mucinex), since there is little evidence to show that these are helpful for people with COPD. Although coughing can be bothersome, it has the important function of helping to clear mucus. This means that suppressing a cough may increase the risk of lung infection.

Mild COPD

For a person with mild COPD who has occasional symptoms, a short-acting bronchodilator alone may be sufficient to manage the condition. Two short-acting bronchodilators—a beta-agonist plus an anticholinergic—also may be prescribed. To simplify this regimen, a combination of a short-acting beta-agonist plus a short-acting anticholinergic is available in a single inhaler. If more symptoms develop over time, additional medications will likely be necessary.

Moderate-to-Severe COPD

For people with moderate-to-severe COPD who tend to experience symptoms more frequently, one or more long-acting bronchodilators will be added to the regimen. These drugs will be taken regularly every 12 or 24 hours. If acute episodes of breathlessness or coughing occur while taking these medications, a short-acting bronchodilator such as albuterol can be used to quell the episodes.

Inhaled corticosteroids are recommended for people with moderate-to- severe COPD who do not get sufficient relief from bronchodilators alone, or who experience frequent exacerbations of symptoms. Inhaled corticosteroids have been shown to reduce flare-ups. However, some studies have found that using inhaled corticosteroids, with or without a bronchodilator, increases the risk of developing pneumonia. Nevertheless, because inhaled corticosteroids may decrease the risk of dying, they often are added when bronchodilators alone are insufficient. Hopefully further research will clarify the role of inhaled steroids in COPD. Patients should discuss any concerns they have with their physician.

For people prescribed long-term use of both a long-acting bronchodilator and a corticosteroid, combinations of both in a single inhaler are available.

Severe COPD

For patients with more severe COPD, combinations of two long-acting bronchodilators are generally used. These often are combined in a single inhaler.

Immunizations

For people with obstructive airway diseases, flu or pneumonia can be very serious and even life threatening. Fortunately, vaccines are available to protect against influenza and some forms of pneumonia. It is extremely important that everyone with obstructive airway disease follow the recommended vaccination schedule, or their doctor’s advice.

Flu Vaccine

People with COPD or other lung problems should receive an influenza vaccination once a year. The ideal time to get a flu shot is in October or November, as flu season runs from November to March.

Pneumococcal Vaccine

The pneumococcal vaccine protects against the bacteria that is the most common cause of pneumonia, Streptococcus pneumoniae. There are now two forms of pneumococcal vaccine, the Pneumovax and the Prevnar 13. It is recommended that all adults over age 65 receive a pneumococcal vaccination. Unlike the flu shot, which must be given every year in the fall, pneumococcal vaccination provides protection for at least five years. It can be given at any time of the year.

The pneumococcal vaccine is advised for all people with COPD age 65 and older. It also may be given to people with COPD who are younger than age 65 and have severe or very severe disease (FEV1 less than 40 percent of predicted), and recommended for people with asthma who are younger than age 65.

Treating COPD Exacerbations

The most common cause of an exacerbation is a lung infection that may increase mucus production. In these cases, antibiotics may be used. Before prescribing an antibiotic, the doctor may send a sample of the sputum for analysis to determine whether the infection is bacterial or viral, since antibiotics are only effective against bacteria. Studies have shown that a short course (five days) of antibiotics is just as effective as taking antibiotics for longer than five days.

In 2017, the American Thoracic Society and European Respiratory Society issued joined guidelines on the management of COPD exacerbations. Their recommendations included:

• For ambulatory patients with an exacerbation of COPD, a short course of oral corticosteroids plus antibiotics.
• For patients hospitalized with an exacerbation, oral corticosteroids rather than intravenous corticosteroids, if possible.
• For patients hospitalized with an exacerbation causing respiratory failure, noninvasive mechanical ventilation.
• After being discharged for an exacerbation, pulmonary rehabilitation should begin within three weeks. It should not be started during hospitalization.

A recent study found that engaging in any amount of regular exercise following hospitalization for a COPD exacerbation actually reduces the risk of dying.

Alpha-1 Antitrypsin Therapy

Alpha-1 antitrypsin augmentation therapy involves using a concentrated form of this protein that has been removed from donated blood and purified. Augmentation therapy cannot reverse damage that has already been done to the lungs, but it can slow down any further decline in lung function. The therapy must be taken for life, and is very expensive. It must be administered by a health-care professional in a doctor’s office or hospital clinic, or through a home infusion service. The costs may be covered by private health insurance policies, but criteria for coverage can vary widely. Before beginning therapy, check with your insurance company. For people age 65 and older, Medicare covers at least part of the cost.

Pulmonary Rehabilitation

A very helpful addition to drug therapy for people at all stages of COPD is a specialized program called pulmonary rehabilitation. Pulmonary rehabilitation is a series of educational and structured exercises that enable people to make the most of their remaining lung capacity. People with COPD who engage in these programs have less shortness of breath, an increased ability to exercise, better quality of life, and less frequent hospitalizations than similar COPD patients who do not participate in pulmonary rehabilitation.

People with COPD tend to slow down their physical activity, since shortness of breath makes exertion increasingly difficult. Decreasing activity can start a vicious cycle of progressive deconditioning, and this leads to worsening of symptoms, more breathlessness, and less physical activity. Pulmonary rehabilitation is aimed at breaking that cycle.

A pulmonary rehabilitation program is more than an exercise program, although exercise is the most important component. In addition to exercise training, the program may include:

• Nutrition counseling
• Education about your condition
• Breathing strategies
• Energy-conserving techniques
• Help with smoking cessation
• Education about medications and how to take them

One study found that including music therapy in a pulmonary rehabilitation program provided added benefit. The participants, who attended six-week pulmonary rehab programs, also took part in weekly music therapy sessions that included playing wind instruments, and singing. They demonstrated greater improvements in symptoms such as shortness of breath, fatigue, and depression, compared with COPD patients who had standard pulmonary rehab. Another study found that adding angiotensin-converting enzyme (ACE) inhibitors, a common class of blood pressure-lowering drugs, significantly improved COPD patients’ muscle mass, strength, and walking speed in response to exercise training.

Most pulmonary rehabilitation programs last six weeks or longer. The exercises learned during the program should be continued at home once the program ends. Studies have found that pulmonary rehabilitation benefits are generally sustained after the program ends, especially if the exercise training is maintained.

One study found that people in the earlier stages of COPD derived greater benefits from pulmonary rehabilitation than those in later stages of the disease. Although patients with less-advanced COPD had better results, those with severe COPD had improved ability to exercise and less shortness of breath. This research suggests that when it comes to pulmonary rehabilitation, the earlier it is done the better. However, patients with any stage of COPD can benefit from the program.

There are many pulmonary rehabilitation programs around the country. Your physician can most likely refer you to one. As an alternative, contact the American Lung Association or the American Association of Cardiovascular and Pulmonary Rehabilitation, which has a searchable online directory of pulmonary rehabilitation programs (see the Resources section at the back of this report). Be sure to ask your insurance carrier whether it covers pulmonary rehabilitation. Medicare coverage varies from state to state, so check with your physician or pulmonary rehabilitation provider to obtain the guidelines in your state.

Oxygen Therapy

People with severe COPD may have low levels of oxygen in their blood (a condition called hypoxemia). This may cause increased difficulty breathing, and further impair the ability to exercise. Low oxygen levels also may cause fatigue, memory loss, morning headaches, depression, and confusion. Over time, chronically low oxygen levels also can cause heart failure.

Many people with COPD have few, if any, symptoms that can be specifically linked to hypoxemia. To determine whether someone has hypoxemia, a physician will perform either an arterial blood gas test or pulse oximetry. In pulse oximetry, a noninvasive probe is attached to the finger, ear, or forehead to measure the amount of oxygen in the blood. The test may be done both at rest and while walking, since the oxygen level in the blood is often low only during activity.

Oxygen therapy can ensure the delivery of adequate oxygen to preserve the function of vital organs. It usually is given only to people with very severe (stage IV) COPD. In stage IV COPD, airflow is severely limited, and the amount of air that can be blown out in one second (FEV1) is less than 30 percent of what would be expected in someone without lung disease. For these people, long-term use of supplemental oxygen for more than 15 hours each day can prolong life and improve quality of life. Oxygen therapy can reduce shortness of breath during exertion, which makes it easier to perform basic daily activities. Oxygen therapy also may improve mental functioning, reduce depression, and help the heart.

The normal air we breathe contains about 21 percent oxygen. Providing more pure oxygen can increase the amount of oxygen taken into the lungs. The physician will prescribe a specific amount of supplemental oxygen, and provide instructions on when and how long it should be used, as well as which delivery method will be used. Supplemental oxygen may be used continuously (24 hours) or periodically, such as only during exercise or overnight. There are three methods for delivering oxygen, as explained below. With each system, the oxygen is breathed in through a mask or a nasal tube (cannula).

Compressed Oxygen Gas

Compressed oxygen gas is contained in tanks or cylinders. Large stationary tanks are used inside the home, while smaller, more portable tanks can be used on trips outside the home (they usually contain enough oxygen to last a few hours).

Liquid Oxygen

Cooling oxygen gas creates a liquid form of oxygen. When the liquid is warmed, it turns back into a gas that can be inhaled. Like compressed oxygen gas, liquid oxygen systems include a large tank for use in the home, and a small portable canister for use outside the home. This canister is filled with liquid oxygen from the indoor tank. One disadvantage of liquid oxygen systems is the tendency for the liquid to evaporate over time.

Oxygen Concentrator

An oxygen concentrator is an electric device that takes air from the room and separates the oxygen from other gases. The oxygen is then made available for inhaling through a mask or nasal cannula. This system does not require tanks of liquid or gaseous oxygen to be continuously refilled. The supply of oxygen is unlimited, and the device is small enough to be moved from room to room. Most oxygen concentrators require a continuous electrical source, and must be plugged into an electrical outlet. However there are portable oxygen concentrators that operate on battery power and may be used for exercise or travel.

COPD Surgery

Selected patients with advanced COPD may be candidates for surgical treatment that removes the damaged parts of the lung, or lung transplantation.

Lung Volume Reduction Surgery

Lung volume reduction surgery can ease the effort of breathing and make walking and other daily activities more feasible for people with severe COPD. During the procedure, the parts of the lung that are most heavily damaged are removed.

As described previously, the destruction of alveoli in emphysema causes air to get trapped in the lungs. As a result, the lungs become enlarged (hyperinflated). Enlarged lungs can crowd the chest cavity and flatten the diaphragm, making it more difficult to breathe. Removing the hyperinflated portions of the lungs has the effect of improving lung function and quality of life.

Lung volume reduction surgery doesn’t cure emphysema, but it helps to relieve symptoms and may prolong life in some patients. However, the surgery is only effective in a minority of patients with emphysema. For this reason, it is very important that prospective patients be carefully evaluated by a surgeon with experience in this highly specialized procedure.

Historically, lung volume reduction surgery involved opening the chest with an incision through the breastbone to gain access to the lungs. Today, it is more often done through several small incisions. A thin tube with a video camera on the end is inserted through one of the incisions so the surgeon can see inside the body on a video monitor. Surgical instruments are inserted through the other incisions to remove the hyperinflated lung. Regardless of the procedure used, the operation requires a hospital stay of five to 10 days. A less invasive option involves implantable valves but is not yet widely available (see “A Less-Invasive Treatment for Emphysema Is Now Available”).

Medicare covers traditional lung volume reduction surgery for people who meet certain criteria, and requires that anyone contemplating the surgery first complete a certified pulmonary rehabilitation program.

Due to the risks of surgery, there has been interest in developing a method of reducing lung volume using bronchoscopy. This minimally invasive technique allows the surgeon to access the airways through a thin instrument called a bronchoscope. In 2018, the U.S. Food and Drug Administration approved a technique that uses a valve placed in the lungs with a bronchoscope to restrict airflow to a section of the lungs. It is the first less-invasive alternative to lung volume reduction surgery. At this time, however, the treatment is only available in specialized centers.

Lung Transplantation

Lung transplantation may be considered for people with severe COPD who are otherwise healthy. This procedure is generally reserved for people with end-stage lung disease, but no other significant health problems. The criteria generally include an FEV1 of less than 20 percent of what would be predicted in someone without lung disease, as well as very low oxygen levels or very high carbon dioxide levels.

For patients with emphysema, either one or both lungs may be transplanted. The procedure generally results in improved lung function and better quality of life. However, there are risks involved in the surgery, and lung transplant recipients must take drugs to suppress their immune system for the remainder of their lives. These drugs are necessary to prevent the body from rejecting the new organ.

Smoking Cessation

Quitting smoking is an essential step for preventing and treating COPD but—as anyone who has quit smoking or tried to quit smoking can attest—is not so easy to accomplish. People with obstructive lung disease have a powerful incentive to quit smoking, yet many continue to light up. A study from the Centers for Disease Control and Prevention found that 46 percent of adults age 40 and older who have asthma or COPD still smoke.

Cigarette smoking is a powerful addiction, and simply knowing the laundry list of its effects is rarely enough to make smokers quit the habit. About 70 percent of adult smokers report that they want to quit completely, but very few people succeed in permanently quitting on their first attempt. First and foremost, quitting smoking requires motivation. It also requires understanding what you’re up against, and getting the right type of help.

Nicotine Addiction

Nicotine is an addictive substance that acts on regions of the brain that produce pleasurable effects.

Nicotine is carried in cigarette smoke into the lungs, where it is absorbed from the alveoli into the bloodstream. From there, it reaches the brain within about seven seconds and binds to receptors called nicotinic acetylcholine receptors, resulting in a release of brain chemicals called neurotransmitters. The primary neurotransmitter released from intake of nicotine is dopamine, which is believed to be linked to the region of the brain responsible for pleasurable feelings.

Other neurotransmitters released when nicotine binds to nicotinic receptors also produce effects that reinforce tobacco use. These include stimulation, arousal, improved memory and attention, reduced stress, relaxation, improved mood, faster reaction time, and appetite suppression. Many smokers come to depend on smoking to produce these effects. However, because nicotine levels don’t stay elevated in the blood for very long, the effects are short-lived and more cigarettes are needed to achieve them.

Upon quitting, many smokers report withdrawal symptoms, such as depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite or weight gain. These are relieved with smoking, making it especially difficult to quit.

The physiologic addiction to nicotine is only part of the story: There also is a large psychological and behavioral component. Smoking becomes a habit, and as such, smokers often associate smoking with certain activities or moods. For example, some people smoke a cigarette after a meal or with a drink, when they feel stressed, or to perk themselves up when they feel down. Smokers also come to associate the pleasurable effects of smoking with the ritual of smoking. They may enjoy just holding a cigarette, the act of lighting it, or the smell and taste of the smoke.

Getting Help to Quit

Because smoking is associated with physiological, behavioral, and psychological factors, all three must be addressed when attempting to quit. Studies have shown that some combination of counseling, social support, and pharmacologic therapies usually is necessary. It usually takes more than one try to quit for good—the average is seven attempts—but the benefits are worth it.

It all starts with the decision to quit. Guidelines published by the Agency for Healthcare Research and Quality recommend beginning by setting a firm quit date, preferably within two weeks. Enlisting the support of family and friends is essential. Some form of counseling—either an individual or group-counseling program—is advised. Internet-based chat rooms also can be helpful. Quit lines have been set up in many states (www.smokefree.gov; 1-800-QUITNOW) to connect smokers to relevant resources. Some smokers have found acupuncture or hypnosis helpful. For people age 65 and older who smoke and have a disease or adverse health effects linked to tobacco use, Medicare Part B will cover smoking cessation counseling. Two smoking cessation attempts are allowed each year, and for each attempt, Medicare will pay for up to four counseling sessions.

Breaking the smoking habit will most likely require coming up with new problem-solving and stress-reducing techniques to replace smoking. For example, it can be helpful to identify situations or activities that increase your risk for smoking, and discuss new types of coping skills with a counselor or fellow smokers who are quitting. Also try to minimize time spent with smokers, to reduce temptation.

Medications That Can Help You Quit

Several types of pharmacologic therapies are available to relieve nicotine withdrawal symptoms:

Nicotine Replacement Therapies

These are available as skin patches, gums, lozenges, inhalers, and as a nasal spray. The patch, gum, and lozenges can be obtained without a prescription. Nicotine gum is not chewed like regular gum—for the nicotine to be absorbed, the gum must be chewed a few times and then held between the cheek and gum.

The nicotine patch maintains a steady blood level of nicotine. This avoids the ups and downs of nicotine levels during smoking, and disrupts the “crave-and-reward” cycle. A step-down program is usually recommended when using the nicotine patch. This program starts with a higher dose of 21 milligrams (mg) per day, which is reduced to a moderate dose (14 mg/day), and finally a low dose (7 mg/day).

E-cigarettes contain nicotine, and some smokers switch to these vapor-producing devices to help them quit tobacco cigarettes. The effectiveness of nicotine replacement therapies such as the gum and patch are established. E-cigarettes are still being studied as an aid to quitting, and two questions remain unanswered: First, are e-cigarettes safe? Second, are they an effective tool for quitting? One study found that smokers who used e-cigarettes were actually less likely to quit smoking than those who never used them.

Bupropion (Zyban)

The antidepressant bupropion (Zyban), which requires a doctor’s prescription, has been shown to help eliminate withdrawal symptoms. It appears that the drug works best when used in conjunction with one of the nicotine replacement therapies.

Varenicline (Chantix)

This is another drug available by prescription only. Varenicline works by binding to some of the nicotinic receptors, thereby blocking nicotine from binding to these receptors. This results in a reduction in the craving for nicotine, and decreases the pleasurable effects of smoking.

Studies have shown varenicline to be generally effective at helping people quit smoking. However, some people who take the drug experience dramatic changes in mood and behavior. The manufacturer advises stopping the drug and contacting a health-care provider immediately if agitation, depressed mood, changes in behavior, or suicidal thoughts or behavior occur. Some people who use varenicline have a decreased tolerance to alcohol, and get drunk more easily—therefore, people who use the drug are advised to decrease the amount of alcohol they consume.

There are numerous resources to help people quit smoking. Some of these are listed in the Resources section at the end of this book. If you try and fail, don’t be discouraged: You are not alone. Perhaps you just need to try a different technique until you find one that works for you.

Health Benefits of Smoking Cessation

The benefits of quitting occur relatively quickly and continue for 10 years or more. Soon after quitting, blood circulation and lung function begin to improve. Within one to two years, the risk for heart disease decreases. The risk for developing cancer declines with the number of years of smoking cessation.

A large study of more than 104,000 women quantified some of the risk reduction with smoking cessation:

• Those who quit smoking had a 13 percent lower risk of dying from any cause within the first five years of quitting, compared with women who continued to smoke.
• The excess risk of death from any cause reached the level of never-smokers 20 years after quitting.
• Much of the reduction in the risk of dying from heart disease was realized within the first five years.
• Five to 10 years after quitting, death from any type of lung disease was reduced by 18 percent. After 20 years, it reached the level of never-smokers.
• About 64 percent of deaths among current smokers and 28 percent of deaths among former smokers were attributable to cigarette smoking.
• Lung cancer mortality was reduced 21 percent within five years of smoking cessation. It took 30 years to completely eliminate the excess risk.

Lifestyle Tips to Help Maintain Lung Function

In addition to quitting smoking and taking prescribed medications, people with COPD can take steps to improve their health and possibly slow down the damage caused by the disease. Strategies include eating a healthy diet, exercising regularly, learning special breathing techniques, and making changes in day-to-day life, among others. Even staying cool can have important benefits: One study found that high indoor and outdoor temperatures were linked to more symptoms. Being in hot indoor environments also worsened lung function.

Eat Right

Your body needs the energy provided by food to function, and that includes breathing. In fact, oxygen is a necessary part of the process of breaking down food into energy (called metabolism). Energy, in turn, is needed for the process of breathing.

For people with COPD, difficulty breathing may make it difficult to eat properly, creating a downward cycle that can lead to malnourishment and even greater breathing problems. About one-third of people with COPD—typically those with more severe COPD—are malnourished and experience weight loss. Malnutrition can worsen lung function, making additional weight loss more likely. This can lead to a vicious downward spiral. Malnutrition also compromises the immune system, which can render a person with COPD susceptible to infections and other illnesses. But just as being underweight is dangerous for people with COPD, being obese can be harmful too.

If You Are Underweight

It is extremely important for people with COPD to consume the recommended number of daily calories and maintain a healthy weight. If you are underweight, it means your body has fewer stores of energy to draw from. Once weight loss occurs, it is difficult for COPD patients to gain weight. A well-balanced diet that provides an adequate number of calories is necessary for good health. The recommended caloric intake varies by age and level of activity, but keep in mind that people with COPD expend extra energy in the simple act of breathing. For a person with COPD, the act of breathing may burn 10 times as many calories as it does for someone without lung disease. This means that even more calories may be required to maintain proper weight.

If breathing problems make eating difficult, try eating four to six small meals a day, rather than three large ones. You also might try eating the largest meal early in the day, so that you have more energy for the rest of the day. Take your time preparing meals, and choose foods that are easy to prepare. You don’t want to expend too much energy making a meal, only to have little energy left to eat it. Eat slowly, in a relaxed setting. Digestion requires energy, so wait an hour or more after eating before engaging in activities.

If You Are Overweight

There is some evidence that being slightly overweight may benefit people with COPD (see “A Little Extra Weight Benefits COPD Patients”). However, obesity—which is defined as a body mass index of 30 or greater—can be harmful. The more obese a COPD patient is, the greater the difficulty they will have in breathing and walking. Their risk for exacerbations increases, too, leading to a worsening quality of life.

If you are obese, you might want to check the U.S. Department of Agriculture (USDA) nutrition guidelines (see the Resources section at the back of this report). You also might consider consulting a registered dietitian who specializes in COPD and can work with you to develop an individualized food plan.

Foods to Prioritize

The USDA recommends consuming foods and beverages that are rich in nutrients and come from the basic food groups. Your diet should emphasize fruits, vegetables, whole grains, and dairy products. The diet should also include protein from lean meats, poultry, and fish, along with beans, eggs, and nuts. Try to avoid foods with little nutritional value that supply only empty calories, as this can cause you to become obese, yet malnourished. This means limiting your consumption of saturated fats, trans fats, cholesterol, salt (sodium), and sugar. Sodium is particularly problematic because it can cause fluid retention that may interfere with breathing.

One study found that people with COPD who ate a healthy diet that included fish, grapefruit, bananas, and cheese had better lung function and fewer symptoms than those who did not eat these foods. The researchers noted that these particular foods may not by themselves be the key to improved health—rather, eating them indicates the person most likely eats an overall healthy diet that includes fish, fruit, and dairy products. Other data suggests that former smokers may benefit from certain foods (see “Tomatoes and Fruit May Help Repair Lung Damage in Ex-Smokers”).

Foods to Avoid

Avoid foods that cause gas or bloating, as these can make breathing more difficult. Gas-producing foods include broccoli, cauliflower, beans, and carbonated beverages.

Stay Hydrated

Drink plenty of fluids, which help to thin mucus and make it easier to cough up. Try for six to eight glasses (eight fluid ounces each) per day. Water, milk, and fruit juice are the best sources, but coffee, tea, and sugar-free soft drinks also count. Alcoholic beverages, such as wine and beer, contribute to fluid intake, but should be consumed only in limited amounts (a maximum of one drink a day for women and two for men).

Exercise Regularly

People in all stages of COPD experience a decline in their ability to engage in physical activity as the disease worsens. Although it may seem difficult to exercise when breathing is a problem, regular exercise can actually improve lung function. It also keeps muscles strong, and improves overall health. A recent study of people with COPD found that those who got no exercise at all were less able to be physically active and had weaker muscle strength compared with people who were at least somewhat physically active.

If you feel daunted by the idea of exercising, keep in mind that the level of exertion required is relative to your health and ability. You don’t need to be an athlete to benefit from exercise—in fact, you should begin by having a discussion with your doctor to determine the most appropriate type of exercise and level of intensity.

If you’ve been in a pulmonary rehabilitation program, continue the exercises on your own after finishing the program. If you haven’t been in one of these programs, be sure to increase your physical activity slowly from your present level. Walking is a good way to get exercise without overexerting yourself. Try to walk a little farther and for longer periods each day, working up to 20 to 30 minutes of physical activity three to five times a week. The key is to do it on a regular basis (daily, or at least several times each week). Research has shown that increasing physical activity decreases hospitalizations due to exacerbations of COPD. One study found that people with COPD who engaged in any regular exercise were about one-third less likely to be readmitted to the hospital within 30 days of being discharged. The benefit was greatest for those who exercised 150 minutes or more a week.

Before beginning an exercise, warm up your muscles by doing some stretches. If walking is your chosen activity, start at a slow pace and gradually walk faster. It may help to walk or exercise with friends, making it a social occasion. Be sure to go at your own pace, and don’t compare yourself to anyone else. Keep a diary to record your exercise goals and track your progress.

Control Your Breathing

Breathing techniques, such as pursed-lip breathing and diaphragmatic breathing, can help to make the most of every breath you take. Talk to your physician or respiratory therapist about these techniques to find out if they might be useful for you.

Pursed-lip breathing slows the pace of breathing and increases air pressure in the lungs, which helps your airways stay open. If you feel short of breath from exertion, stop for a few minutes and practice pursed-lip breathing to get fresh air flowing into your lungs. Diaphragmatic breathing facilitates deeper breathing. The diaphragm is a dome-shaped muscle in the abdomen that is involved in the mechanical process of breathing. In people with COPD, the diaphragm and other muscles involved in breathing can weaken. Using a diaphragmatic breathing technique can strengthen these muscles, slow down your breathing rate, increase your blood oxygen levels, and allow you to use less effort to breathe.

Breathe Clean Air

Keep the air in your home as clear of irritants as possible. For example:

• Don’t smoke, and don’t allow anyone else to smoke in the house.
• Keep all fumes and strong smells out. This includes air fresheners, scented candles, and fragrant cleaning products.
• If you must have painting done, stay out of the house until it is finished.
• Avoid smoke from wood fires.

Travel Comfortably

Having a chronic lung disease like COPD may require making special arrangements for traveling, particularly by airplane. Those who require oxygen therapy will first need to obtain permission from their physician to fly. They also must notify the airline in advance of travel to arrange for using oxygen during the flight. Keep in mind that even if you don’t require oxygen therapy at home, you may need supplemental oxygen while flying. This is because the air pressure inside an airplane cabin is lower than it is on the ground, especially during take-off and landing. Low air pressure decreases the amount of oxygen in the air. People without lung disease can adapt to the changes in air pressure, but for a person with severe COPD, even a small change in air pressure may cause an exacerbation of symptoms.

Always discuss air travel plans with your physician. Blood oxygen measurements will likely be needed to determine whether supplemental oxygen will be required. The doctor also will need to provide a letter to the airline. During the flight, the oxygen will be provided by the airline (likely at a fee). Passengers are not allowed to bring their own liquid or gas oxygen canisters on board an airplane. However, many airlines allow patients to use their own portable concentrators during flights. Empty cylinders and equipment likely are allowed only as checked baggage.

Information about which airlines allow use of oxygen on flights, along with their policies, is available from the Airline Oxygen Council of America (see the Resources section at the back of this report).

Relax and Take Care of Yourself

Anxiety, stress, and fatigue are common in everyday life and can lead to health problems even for otherwise healthy people. For people with COPD, they can exacerbate the condition, leading to worsened lung function, infections, and other health problems.

Coping with COPD may feel overwhelming at times. Sharing feelings and concerns with loved ones and asking for their help may ease some of the burden. Joining a support group for people with COPD may be even more helpful. The American Lung Association (see Resources) has contact details for local support groups.

The post 4. Treating COPD appeared first on University Health News.

To make a COPD diagnosis, a doctor will perform a physical examination and evaluate the patient with spirometry, which can diagnose COPD by measuring FEV1 even before COPD signs and symptoms become apparent. Spirometry also is used for COPD staging, and to monitor the progression of the disease for a COPD prognosis.

GOLD COPD Stages: What They Mean

People with COPD have a decrease in FEV1 (the amount of air that can be blown out in one second). As the disease gets worse, the FVC (the total amount of air that can be exhaled after inhalation) also deteriorates compared with people of the same age who have normal lung function.

For the GOLD guidelines, COPD is divided into four stages: mild, moderate, severe, and very severe. (See also “COPD Stages: How Chronic Obstructive Pulmonary Disease Advances.”) These classifications are based on increasing severity of airflow restriction and symptoms. The spirometry reading for FEV1 is generally used to determine the severity classification, which can provide information as to your life expectancy with COPD.

• COPD Stage 1: Mild COPD. Spirometry shows mild limitation in airflow (FEV1 greater than 80 percent of predicted). Chronic cough and sputum production may be present. At this stage, the person is often unaware of impaired lung function.
• COPD Stage 2: Moderate COPD. Spirometry shows limitation in airflow that is worse than in mild COPD (FEV1 less than 80 percent but greater than 50 percent of predicted). Shortness of breath typically occurs with exertion. Cough and sputum production are more likely than in mild COPD. At this stage, the person may first become aware of a problem with breathing, and seek medical advice.
• Stage 3 COPD: Severe COPD. Airflow limitation becomes progressively worse (FEV1 less than 50 percent but greater than 30 percent of predicted). Shortness of breath will increase, even with even a small amount of exertion, and the person will likely feel fatigued. Quality of life often diminishes.
• Stage 4 COPD: Very severe COPD. Among COPD stages, this level is the one also known as COPD end stage. Airflow is severely compromised (FEV1 less than 30 percent of predicted or less than 50 percent of predicted, plus the person has chronic respiratory failure). This may lead to heart problems, such as heart failure. Quality of life is markedly impaired. Exacerbations of the disease may be life-threatening.

What Is the Difference Between Asthma and COPD?

COPD signs and symptoms can be similar to asthma, especially in the early stages of COPD. COPD and asthma also can coexist. Therefore, for some patients (especially those who smoke), it may be difficult to make an accurate diagnosis. However, there are some distinguishing characteristics between the two afflictions. The following two lists summarize the difference between asthma and COPD.

COPD

• Usually begins after age 40.
• Symptoms get worse with advancing age.
• Occurs in people with a history of smoking.
• Results in a limitation in airflow that is non-reversible.

Asthma

• Usually begins early in life (often in childhood).
• Symptoms can vary from day to day.
• Symptoms often occur at night or in the early morning.
• Allergy, rhinitis, and/or eczema are usually present.
• Family history of asthma
• Limitation in airflow is largely reversible with medication.

One major difference between asthma and COPD relates to the reversibility of the condition. Is COPD reversible? No—the damage to the airways is permanent, and gets progressively worse. The airway narrowing in asthma, on the other hand, is usually reversible.

In addition an asthma attack generally is sparked by a trigger, such as an allergic reaction, exposure to the cold, or exercise. Doctors can simulate an asthma trigger with an inhaled drug called methacholine. This drug causes the airways to spasm, which will be detected on a test of breathing function (spirometry). A positive result of this test indicates asthma is probably the cause of the patient’s symptoms. However, this is not 100 percent accurate because a person with chronic bronchitis also may have a positive result on this test.

People with asthma (especially those who smoke) can develop a chronic cough, and could develop COPD. In some cases, it may not be possible to make a clear distinction between asthma and COPD. Current medical treatment guidelines state that for patients with both asthma and COPD, treatment should be similar to that for asthma. But each patient is different—therefore, treatment will likely be individualized.

For further reading, see these University Health News posts:

• “What Does COPD Stand For?“
• “Extra Help for COPD Signs and Symptoms“
• “Lifestyle Changes Among the Keys to COPD Treatment“

Originally published in 2016 and updated.

The post GOLD COPD Guidelines for Lung Disease Treatment appeared first on University Health News.

Statistics afforded by COPD ICD 9 and other ICD 9 codes help governments decide how to budget for preventive health and treatment programs.

The International Classification of Diseases codes used in the United States are based on version 9 of the ICD—so your health records, and any documents you receive from your health insurer, will have a “COPD ICD 9” number. They also will have another code called a CPT.

CPT stands for Current Procedural Terminology, but it doesn’t relate to your diagnosis—it relates to whatever treatment you were given or procedure you had at your medical appointment.

COPD ICD 9 Codes: What They Mean

The United States still uses the ICD 9 codes even though ICD 10 is more up to date, because most healthcare providers have not yet transitioned over to ICD 10. At some point in the future, your COPD ICD 9 code will be circumvented by a COPD ICD 10 code. Until then, the COPD ICD 9 codes include diseases that are characterized by irreversible airflow limitation, and are as follows:

• ICD 9 code 490: bronchitis (not specified as acute or chronic)
• ICD 9 code 491: chronic bronchitis
• ICD-9 code 492: emphysema
• ICD-9 code 494: bronchiectasis
• ICD-9 code 496: chronic airway obstruction

Some authorities also include:

• ICD-9 code 493: asthma
• ICD-9 code 495: hypersensitivity pneumonitis

For further reading on COPD symptoms and treatment, see these University Health News posts:

• • “What Does COPD Stand For?“
  • “Extra Help for COPD Signs and Symptoms“
  • “COPD Exacerbations: These Lung Condition Flare-Ups Can Be Serious“
  • “Lifestyle Changes Among the Keys to COPD Treatment“

Originally published in 2016, this post is regularly updated.

The post COPD ICD 9: What It Means appeared first on University Health News.

Nicotine is an addictive substance that acts on regions of the brain that produce pleasurable effects, and it produces these effects very quickly. Many smokers come to depend on smoking to reliably produce these effects. However, because nicotine levels don’t stay elevated in the blood for very long, the effects are short-lived, and more cigarettes are needed to achieve them.

COPD treatment guidelines urge smokers to quit, and with good reason: It can make a big difference when it comes to helping you avoid COPD complications. But many smokers, when they try to quit, report withdrawal symptoms such as depression, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite or weight gain. These are relieved with smoking, making it especially difficult to quit even though it can help ease COPD signs and symptoms.

The physiologic addiction to nicotine is only part of the story: There also is a large psychological and behavioral component. Smoking becomes a habit, and as such, smokers often associate smoking with certain activities or moods. For example, some people smoke a cigarette after a meal or with a drink, when they feel stressed, or to perk themselves up when they feel down.

Smokers also come to associate the pleasurable effects of smoking with the ritual of smoking. They may enjoy just holding a cigarette, the act of lighting it, or the smell and taste of the smoke.

Get Help to Quit and Increase Your Life Expectancy with COPD

Because smoking is associated with physiological, behavioral, and psychological factors, all three must be addressed when attempting to quit.

For people who want to quit in order to increase life expectancy with COPD, studies have shown that some combination of counseling, social support, and pharmacologic therapies usually is necessary. It will probably take more than one try to quit for good, but the benefits are worth it. These strategies may help you succeed, especially if you remember that your life expectancy with COPD may increase if you no longer smoke:

• Set a quit date.
• Remove all cigarettes and ashtrays from your home, car, and place of work.
• Tell your family and friends, and ask for their support.
• Use some form of nicotine replacement (patch, gum, or lozenge).
• Talk to your doctor about medications that may help you.
• Call 1-800-QUIT NOW (784-8669) to find the quit line in your state. You can also access the service online at https://smokefree.gov/talk-to-an-expert.
• Find counseling (individual, group, or telephone) that you are comfortable with.
• If you don’t succeed the first time, try again.

Enlisting the support of family and friends is essential. Some form of counseling—either an individual or group counseling program—is advised, and Internet-based chat rooms can also be a helpful source of support. Some smokers have been helped to quit with acupuncture or hypnosis.

For some people age 65 and older, Medicare Part B will cover smoking cessation counseling. The coverage is limited to those who smoke and have a disease or adverse health effects linked to tobacco use. Two smoking cessation attempts are allowed every year; for each attempt, Medicare will pay for up to four counseling sessions.

Breaking the smoking habit to increase life expectancy with COPD will most likely require coming up with new problem-solving and stress-reducing techniques to replace smoking. For example, it can be helpful to identify situations or activities that increase your risk for smoking, and discuss new types of coping skills with a counselor or fellow smokers who are quitting. Also try to minimize time spent with smokers, to reduce temptation.

Medications That Can Help You Quit

None of the drugs on the COPD medications list will help you quit smoking—but other drugs can relieve withdrawal symptoms. Many of these products are nicotine replacement therapies. These are available in skin patches, gums, lozenges, inhalers, and a nasal spray. The patch, gum, and lozenges can be obtained without a prescription. Nicotine gum is not chewed like regular gum—in order for the nicotine to be absorbed, the gum must be chewed a few times, and then placed and held between the cheek and gum.

Nicotine patches are designed to disrupt the “crave and reward” cycle of smoking cigarettes.

The nicotine patch maintains a steady blood level of nicotine, which avoids the ups and downs of nicotine levels during smoking, and disrupts the “crave and reward” cycle. A step-down program is usually recommended when using the nicotine patch. This program starts with a higher dose (21 mg/day), which is reduced to a moderate dose (14 mg/day), and finally a low dose (7 mg/day).

E-cigarettes contain nicotine, and some smokers switch to these vapor-producing devices to help them quit tobacco cigarettes. While the effectiveness of nicotine replacement therapies such as the gum and patch are established; e-cigarettes are still being studied as an aid to quitting. One recent study found that smokers who used e-cigarettes were actually less likely to quit smoking than those who never used them.

Another drug that is sometimes used for smoking cessation is bupropion (Zyban), which requires a doctor’s prescription. Zyban has been shown to help eliminate withdrawal symptoms, but it appears that the drug works best when used in conjunction with one of the nicotine replacement therapies.

Varenicline (Chantix) is another drug available by prescription only. This drug works by binding to some of the nicotinic receptors, which blocks nicotine from binding to these receptors. This results in a reduction in the craving for nicotine, and decreases the pleasurable effects of smoking.

Studies have shown varenicline to be generally effective at helping people to quit smoking; however, some people who take the drug experience severe changes in mood and behavior. The manufacturer advises stopping the drug and contacting a healthcare provider immediately if agitation, depressed mood, changes in behavior, or suicidal thoughts or behavior occur.

Some people who use varenicline have a decreased tolerance to alcohol, and get drunk more easily—therefore, people who use the drug are advised to decrease the amount of alcohol they consume.

Within two to three months of your last cigarette, your lung function improves and your risk for heart attack decreases.

Health Benefits of Smoking Cessation

You can definitely increase life expectancy with COPD if you quit smoking. But that isn’t all.

Within 20 minutes of your last cigarette, for example, your heart rate drops, while the carbon monoxide level in your blood drops to normal after about 12 hours. By two to three months after your last cigarette, your lung function begins to improve, and your heart attack risk begins to fall.

Within one to two years, the risk for heart disease decreases. The risk for developing cancer also declines with the number of years of smoking cessation.

Originally published in May 2016 and updated.

The post Quit Smoking: Increase Your Life Expectancy with COPD appeared first on University Health News.

These classifications are based on increasing severity of airflow restriction and symptoms, and they help doctors determine an individual’s COPD treatment guidelines and life expectancy.

Accessing COPD Stages

A COPD test called spirometry is generally used to determine which of the COPD stages you’re in. A spirometry test involves taking a deep breath in and then exhaling as hard and as long as possible into a hose connected to a machine called a spirometer. The machine measures how fast air is blown out of the lungs, as well as the total amount of air inhaled and exhaled.

The spirometer can be used to take several types of measurements. Some common ones used in the diagnosis and management of obstructive lung diseases are as follows:

• Forced vital capacity (FVC): The total amount of air you can forcibly blow out after inhaling.
• Forced expiratory volume in 1 second (FEV1): The amount of air you can blow out in one second.
• The ratio of FEV1 to FVC (FEV1/FVC): In healthy adults, this should be 75 to 80 percent.
• Peak expiratory flow (PEF): The speed of air moving out of your lungs at the beginning of an exhalation.

COPD Stages: Defining Each Level

Doctors use four COPD stages to gauge patients with the condition.

• COPD Stage 1: Your spirometry test shows mild limitation in airflow (FEV1 greater than 80 percent of predicted for a person of the same age with no lung disease). At this early stage, your COPD signs and symptoms may be barely noticeable. It is likely you are unaware that your lung function is impaired, although you may have a chronic cough, with sputum production.
• COPD Stage 2: Your spirometry test shows limitation in airflow that is worse than in mild COPD (FEV1 less than 80 percent but greater than 50 percent of predicted for a person of the same age with no lung disease). Your COPD signs and symptoms are becoming more obvious—you may notice that you are experiencing shortness of breath when you exert yourself, and a cough and sputum production are more likely than in Stage 1 COPD. Your growing awareness of your breathing problems may lead you to seek medical attention.
• COPD Stage 3: This is severe COPD. Your airflow limitation will have become progressively worse (FEV1 less than 50 percent but greater than 30 percent of predicted for a person of the same age with no lung disease). Your shortness of breath will increase, especially with even a small amount of exertion, and you will likely feel fatigued. Quality of life often diminishes during this stage.
• COPD Stage 4: This is very severe COPD; it means your airflow is severely compromised (FEV1 less than 30 percent predicted or less than 50 percent of predicted for a person of the same age with no lung disease). You also may have chronic respiratory failure that may lead to heart problems, such as heart failure. Your quality of life is markedly impaired, and COPD exacerbations may be life- threatening.

Originally published in 2016 and regularly updated.

The post COPD Stages: How Chronic Obstructive Pulmonary Disease Advances appeared first on University Health News.

COPD Diet

For people with COPD, difficulty breathing may make it difficult to eat properly, creating a downward cycle that can lead to malnourishment and even greater breathing problems. This can particularly affect those with Stage 3 COPD or Stage 4 COPD (according to the GOLD COPD guidelines).

About one-third of people with COPD are malnourished and experience COPD weight loss. (See our post “Is There Such a Thing as a COPD Diet?“) Malnutrition can worsen lung function and also compromise the immune system. A compromised immune system can render a person with COPD susceptible to infections and other illnesses.

COPD Home Remedies: Food Choice Is Key

So in the area of COPD “home remedies,” it’s extremely important for people with COPD to consume the recommended number of calories and try to maintain a healthy weight. If you’re underweight, it means your body has fewer stores of energy to draw from. Being overweight also can be problematic, since carrying extra weight means the heart has to work harder, which makes breathing more difficult.

If your lung problem symptoms (for example, breathlessness) make eating difficult, try eating four to six small meals a day rather than three large ones. You might also try eating the largest meal early in the day, so that you have more energy for the rest of the day.

Foods to prioritize: Focus on foods and beverages that are rich in nutrients and come from the basic food groups. Try to avoid foods with little nutritional value that supply only empty calories. Emphasize fruits, vegetables, whole grains, and dairy products. The diet should also include protein from lean meats, poultry, and fish, along with beans, eggs, and nuts.

Try to limit the amount of saturated fats, trans-fats, cholesterol, salt (sodium), and sugar. Sodium is particularly problematic because it can cause fluid retention, which can interfere with breathing.

Drink plenty of fluids, which help to thin mucus and thus make it easier to cough up. Try for six to eight glasses (eight fluid ounces each) per day. Water, milk, and fruit juice are the best sources, but coffee, tea, and soft drinks also count.

Foods to avoid: Stay away from foods that cause gas or bloating, as this can make breathing more difficult.

Exercise Regularly

People at all stages of COPD experience a decline in their ability to engage in physical activity over time as the disease worsens. But COPD treatment guidelines recommend exercise, and while it may seem difficult to exercise when breathing is a problem, it can actually improve lung function. It also keeps muscles strong, and improves overall health.

Research also has shown that increasing physical activity is another of the COPD home remedies that can be vital. You don’t need to be an athlete to benefit from exercise—in fact, you should begin by having a discussion with your doctor to determine the most appropriate type of exercise and level of intensity.

If you’ve been in a pulmonary rehabilitation program, continue the exercises on your own after finishing the program. If you haven’t been in one of these programs, be sure to increase your physical activity slowly from your present level.

Walking is a good way to get exercise without overexerting yourself—try to walk a little farther and for longer periods each day, with the aim of working up to 20–30 minutes of physical activity three to five times a week. The key is to do it at your own pace, on a regular basis (daily, or at least several times each week).

Breathing Exercises for COPD

Another among several COPD home remedies to consider: breathing techniques. Pursed-lip breathing and diaphragmatic breathing may help to make the most of every breath you take. The basics:

Pursed-lip breathing: If you feel short of breath from exertion, stop for a few minutes and practice pursed-lip breathing to get fresh air flowing into your lungs:

• Sit comfortably with your feet on the floor, and relax.
• Breathe in through your nose.
• Breathe out slowly and evenly through pursed lips (lips mostly closed, with a small opening in the center, as if you are about to whistle). Breathing out should take twice as long as inhaling.
• Repeat the technique several times until shortness of breath diminishes.

Diaphragmatic breathing: Using this technique to slow down your breathing rate, increase your COPD oxygen levels, and allow you to use less effort to breathe:

• Lie comfortably on your back.
• Place one hand on your upper chest and one on your stomach.
• Breathe normally for a minute, and notice whether your chest or stomach rises with each intake of breath. If your chest expands, try to focus on breathing with your diaphragm (which would cause your stomach to rise).
• Inhale slowly through your nose.
• Slowly exhale through pursed lips.
• Rest and repeat. Continue for five to 10 minutes.

Breathe Clean Air

Keep the air in your home as clear of irritants as possible. For example:

• Don’t smoke, and don’t allow anyone else to smoke in the house.
• Keep all fumes and strong smells out.
• If you must have painting done, stay out of the house until it is finished.
• Avoid smoke from wood fires.

Also avoid outdoor air pollutants as much as you can, by staying indoors when outdoor air quality is poor.

Travel Comfortably

Having a chronic lung disease such as COPD may require making special arrangements for traveling, especially travel by airplane. Those who require oxygen therapy will first need to obtain permission to fly from their physician. They must also notify the airline well in advance of travel, to arrange for use of oxygen during the flight.

Always discuss air travel plans with your physician. Lung function tests will likely be needed to determine whether supplemental oxygen will be required. The doctor will also need to provide a letter to the airline.

During the flight, the oxygen will be provided by the airline (there will likely be a fee for this service). Passengers are not allowed to bring their own oxygen canisters on board an airplane, but some airlines will allow patients to use their own portable concentrators during flights. Empty cylinders and equipment likely are allowed only as checked baggage.

Information about which airlines allow use of oxygen on flights, along with their policies, is available from the Airline Oxygen Council of America.

Originally published in July 2016 and updated.

The post COPD Home Remedies: How to Ease Symptoms appeared first on University Health News.

The Global Initiative for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease (GOLD) released revised and updated recommendations for assessing COPD, therapies, nonpharmacologic therapies and COPD and common comorbidities, its third revision since 2001. Highlights of the report include recommendations to 1) separate spirometric values from the “ABCD” grouping of patients by symptoms and risk of exacerbations, thus individualizing patient care; 2) include specific escalation and de-escalation strategies for medication treatment, depending on whether a patient’s symptoms remain persistent or lessen; 3) review non-pharmacologic treatment, such as pulmonary rehabilitation, exercise training, oxygen therapy, vaccines, bronchoscopy, surgery, and end-of-life/palliative care; and, 4) acknowledge and treat comorbidities and minimize treatment with multiple drugs. (American Journal of Respiratory and Critical Care Medicine, online, Jan 30, 2017.)

New Treatment for Severe Intestinal Infection.

Researchers led by Mark Wilcox, MD, Professor of Microbiology at the University of Leeds, UK, have found a stronger drug to add to current treatments that combat Clostridium difficile (C. diff.), a severe, and sometimes life-threatening, intestinal bacterium. C. diff can occur following treatment with antibiotics for illnesses such as bronchitis, and acts by destroying the “good” gut bacteria, leaving the patient susceptible to C. diff toxins. The infection can be particularly dangerous for the elderly or people with weakened immune systems, and occurs frequently in community-dwelling situations, such as hospitals or long-term care facilities. Treatment to date is generally with an even stronger antibiotic than prescribed for the initial illness, such as metronidazole, vancomycin, or fidaxomicin. But researchers found that adding a drug called bezlotoxumab (Zinplava) to standard treatment can reduce risk of infection by up to 37 percent. The drug works by neutralizing a C. diff toxin that damages the gut wall. Symptoms of mild C. diff infection include watery diarrhea three or more times a day for two or more days, and mild abdominal cramping and tenderness; severe infection is characterized by watery diarrhea 10 to 15 times a day, severe abdominal cramping and pain, fever, dehydration, loss of appetite, and nausea, among others. It is important to see a doctor if you experience any of these symptoms. (New England Journal of Medicine, Jan. 26, 2017.)

The post Newsbriefs: COPD Treatment; Intestinal Infection Treatment appeared first on University Health News.