Navigating COPD: Comprehensive Treatment Insights

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Treatment Options

Although there is currently no cure for COPD, there are many treatment options and lifestyle changes that can minimise symptoms and help the patients live a normal life of a good quality. Even for more severe stages there is effective therapy that can control the symptoms and reduce exacerbations. The goals of COPD treatment are to reduce hospitalisations, reduce and prevent exacerbations, decrease dyspnoea, improve quality of life, slow progression and reduce mortality.

LIFESTYLE CHANGES

COPD is a chronic disease therefore it requires major lifestyle changes in order to extend survival chances and provide the best quality of life possible, so it is always recommended to make lifestyle changes and form new habits.

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Since the lungs are weakened the patient should do anything to prevent exacerbations. A little exercise every day and a balanced diet consisting of nutritious foods are recommended, as well as maintaining a healthy weight. Also high fluid intake is recommended to help keep the mucus thinner so it is easier to cough it out.

The most important step that should be taken after diagnosis is to stop smoking. Although the damage already present in lungs cannot be reversed, quitting can prevent further damage. It is the only way to prevent COPD from getting worse.

However, quitting smoking especially for a heavy smoker is a very hard task, thus the doctor can recommend nicotine replacement products or other medications such a bupropion and varenicline that can help one other non-medicinal way are support groups. Evidence shows that smoking cessation reduces FEV1 decline rates and mortality.

Furthermore, in some cases diagnosed at early stages quitting smoking might be all the treatment needed. Furthermore, pulmonary rehabilitation is a program recommended to people with lung problems and includes exercise training, education about the disease, nutritional counselling and support. An analysis of 20 Randomised Control Trials has shown that patients attending this program had less dyspnoea and increased exercise ability and quality of life. However, it took at least six months to achieve benefits and usually the patients with severe or moderate COPD were the ones to benefit. Doctors usually prescribe pulmonary rehabilitation to symptomatic patients with less than 50% FEV1, but it should also be considered for patients which are considered symptomatic or exercise limited even if they have FEV1 over 50%.

MEDICATIONS

Furthermore, many medications have been developed in different forms to treat symptoms and complications of COPD, some of which are taken on a regular basis while others only when needed. Medications can reduce symptoms and exacerbations; however, it might take some time of trial and error to find the ideal medication and dosage for different patients. Bronchodilators are a first line of treatment drug for COPD. They are given as inhalers or nebulisers and help relax and widen the airways, relieving coughing and shortness of breath. Bronchodilators are further divided into short-acting and long-acting, and which one is prescribed depends on the severity of COPD.

Short-acting bronchodilators last four to six hours and are usually used when needed, like for example when the patient feels breathless, and should not be used more than four times in a day. Long-acting bronchodilators are prescribed to patients who experience symptoms regularly and last around 12 hours therefore can be used daily and only need to be taken once or twice a day. There are two classes of inhaled bronchodilators: І2 agonists and anticholinergics, both seem to improve quality of life and decrease FEV1 decline.

Inhaled corticosteroids are commonly prescribed to people who have frequent exacerbations or those who are taking long-acting bronchodilators but still feel breathless. Inhaled corticosteroids have been found to minimise annual FEV1 decline and exacerbations number, however an increased risk of pneumonia is observed therefore long-term monotherapy is not recommended and it is best combined with long-acting inhaled І2 agonists. Corticosteroids can also be given as tablets; however, they cannot be given for long as they cause serious side effects and increase risk of infection thus, they are only prescribed during exacerbations. Usually it is recommended to start the treatment with inhaled bronchodilators only and add an inhaled corticosteroid only if symptoms get worse and FEV1 falls below 50%.

Theophylline, tablet form, is a very inexpensive drug which belongs to a family of drugs called xanthines, and improves breathing by relaxing the muscles of the airways and prevents exacerbations by easing chest tightness and shortness of breath, however it still has some side effects which are usually dose related. In general, it is not a first line of treatment drug. Another medication given in tablet form that reduces inflammation and relaxes airway muscles is phosphodiesterase-4 inhibitors, but it is generally given for severe COPD with chronic bronchitis. It is a rather new type of medication and therefore seems to cause less side effects. In clinical trials only 28% of patients with moderate to severe COPD were found to have exacerbations when taking this drug while 35% of patients with the same stage of COPD taking a placebo had exacerbations. However, no improvement of symptoms was observed.

Another type of medication given as a tablet when the patient has a persistent cough with lots of thick mucus is mucolytic drugs which are usually prescribed to make the mucus thinner and easier to cough up. When experiencing severe symptoms or during exacerbation the patient may need additional treatment to prevent lung failure. Vaccines such as pneumococcal and whooping cough vaccine are recommended to prevent any lung infections that could cause exacerbations. Furthermore, antibiotics are usually given to patients to treat acute exacerbations due to infections although they are not generally recommended for prevention. Nebulised medication is used in severe COPD cases if inhalers have not worked and enables a large dose of medicine to be taken in one go by turning liquid medication into mist. Another therapy used when the patient has low oxygen level in blood is long-term oxygen therapy which can be done at home through nasal tubes or a mask. Although this is not a treatment for main symptoms this can help stop oxygen levels from becoming dangerously low.

This therapy should be used for at least 16 hours a day. Furthermore, some patients use it only during activities or while sleeping and it can improve quality of life and it is the only COPD therapy proven to extend life.SURGERY Surgery is reserved for severe COPD cases or when all other treatments have failed which is more likely when the patient has a severe form of emphysema. There are three main operations, which are major operations and have to be done under general anaesthetic and have a significant risk. One of the options is lung volume reduction surgery where the surgeon removes small wedges of the damaged lung tissue from the upper lobes, creating extra space in the chest cavity for the remaining healthier lung to expand and the diaphragm to work more efficiently, making breathing more comfortable. This surgery can improve some patients' quality of life and prolong life. Lung transplant is another option for specific people who meet certain criteria.

Although significant improvement is seen it is still a major operation and therefore has significant risks, such as organ rejection. Although very expensive and associated with high mortality both of the above options may be appropriate for patients with upper lobe predominant emphysema or low exercise capacity. In 54% of the patients with one of those signs lung volume surgery was associated with improved survival rate of five years compared to those who were only receiving medical therapy where 40% of the patients have an improved survival rate of over five years. A third surgical option is bullectomy, in which large bullae formed in the lungs when air sacks' walls are destroyed, are removed. These bullae can become very large and cause more severe breathing problems, removing them allows the lungs to work better and makes breathing more comfortable.

Conclusion

To conclude, as it was made apparent in this research COPD is not just one disease it is rather an umbrella that spreads and covers a number of untreatable obstructive diseases that, simply put, destruct the breathing cycle, especially during exhalation where forced expiratory volume is decreased without affecting the total lung capacity. What is rather interesting is the impact that smoking has and how tobacco exposure acts as a fuel to the development of these diseases, proving once again that smoking kills, although slowly, surely. Although a severe disease the early diagnosis of it, is quite hard since the early symptoms are usually mistaken for other disease or even a simple cold, however symptoms are usually presented at later stages.

What might be a contributing factor to the fact that a cure is not available, yet, is that the actual cause has not been identified yet, although major factors have been identified and tackled. Throughout history leaps where made on how to diagnose COPD, especially with the discovery of spirometer in the 1800s which is still being used today. Not only for diagnosis but to also grade and keep track of the development of the disease and it is still considered to be the most helpful tool, to date. However, spirometer is not a specific diagnostic tool for COPD and further investigations need to be carried out in order to have a definite diagnosis.