Treatment and management of COPD

The goals of COPD treatment are to:

• Relieve your symptoms

• Slow the progress of the disease

• Improve your exercise tolerance (your ability to stay active)
  

• Prevent and treat complications

• Improve your overall health

Treatment and management

• Smoking cessation

• Medicines

1. Bronchodilators
2. Inhaled steroids
3. Antibiotics
   

• Bronchodilators

-Relax the muscles around your airways. This helps open your airways and makes breathing easier.
-Depending on how severe your disease is, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4 to 6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.
-Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go right to your lungs. Not all inhalers are used the same way.
-If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may only use the medicine when symptoms occur.
-If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.

• Inhaled steroids

- Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better.
- But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
- They're usually reserved for people with moderate or severe COPD.

• Antibiotics

- Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms.
- Antibiotics can help fight bacterial infections, but are only recommended when necessary.

• Vaccine

1. Flu Shots

The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk for the flu. Should be given once a year.

2. Pneumococcal Vaccine

This vaccine lowers your risk for pneumococcal pneumonia. People who have COPD are at higher
risk for pneumonia than people who don't have COPD.

• Pulmonary rehabilitation program

-The goals are to reduce symptoms, improve quality of life, and increase participation in everyday life
-Rehabilitation programs should include, at a minimum:

1. Exercise training
2. Nutrition counseling
   
3. Education

-The minimum length of an effective rehabilitation is 6 weeks. The longer the programs continue the more effective the results.
Benefits does wane after rehabilitation ends, but if exercise is maintained at home the patient’s health status remains above pre-rehabilitation level.

• Oxygen therapy

- If there isn't enough oxygen in your blood, you may need supplemental oxygen.
- There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town.
- Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time.
- Oxygen therapy can improve heart function, exercise capacity, depression, mental clarity and quality of life. In some people, it may also extend life.

• Surgery

- Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone
- Types of surgery done:

1. Bullectomy
2. Lung volume reduction surgery
3. Lung transplant

• Bullectomy

-When the walls of the air sacs are destroyed, larger air spaces called bullae form.
- These air spaces can become so large that they interfere with breathing.
- In a bullectomy, doctors remove one or more very large bullae from the lungs.

• Lung volume reduction surgery

- In this surgery, your surgeon removes small wedges of damaged lung tissue.
- This creates extra space in your chest cavity so that the remaining lung tissue and the diaphragm work more efficiently.

- The surgery has a number of risks, and long-term results may be no better than for nonsurgical approaches.
- Major risks associated with this procedure are:

1. Prolonged air leakage is the most common complication after LVRS. Approximately 40% of patients will have this problem. Some patients will actually go home with a chest drain in place for a few days to help manage this.
2. Pneumonia (15%) can occur in emphysema patients, especially in patients who have a history of recurrent bouts
3. Bleeding (2-5%)
4. Stroke (<1%)
5. Heart attack (1%)
6. Death: The chance of dying after LVRS is approximately 3-8%
   

• Lung transplant
  

-During a lung transplant, the damaged lung is removed and replaced with a healthy lung from a deceased donor
-Transplantation can improve your ability to breathe and be active, but it doesn't appear to prolong life and you may have to wait for a long time to receive a donated organ.
-However, lung transplants have a high risk of complications. These include infections and death due to the body rejecting the transplanted lung