Chronic Obstructive Pulmonary Disease (COPD)
How is it treated?
Treatment of COPD is based on the severity of the disease. To measure disease severity, pulmonary function tests (PFT's) are often performed to measure how well air can move in and out of the lungs. The most common PFT is spirometry. The results from this test as well as others allow doctors to stage an individual properly and thus provide the most appropriate treatment. The most common value looked at by a doctor is the amount of air a person can exhale in one second which is known as FEV1.
The stages of COPD are:
- Stage 0 (at risk): A person may have one or more symptoms such as a chronic cough, breathlessness, or sputum production. This category also would include people that have been exposed to the risk factors mentioned previously. However, people in this stage generally have normal lung function.
- Stage I (Mild): FEV1 lung function is less than or equal to 80 percent of predicted normal lung function. There is minimal impact on health-related quality of life. Patients at this stage may not even be aware they have the disease. Some patients have symptoms while others do not at this stage.
- Stage II (Moderate): FEV1 lung function is 50 to 80 percent of predicted normal lung function. Typically, patients experience shortness of breath upon exertion, and symptoms have a significant impact on health-related quality of life. It is this stage that patients most often begin to seek medical attention.
- Stage III (Severe): FEV1 lung function is 30 to 50 percent of predicted normal lung function, and there is a profound impact on health-related quality of life. At this stage, the patient will most likely experience repeated attacks of shortness of breath often requiring medical help.
- Stage IV (Very Severe): FEV1 less than 30 percent predicted or respiratory failure (unable to breathe without assistance) is present. These patients may need consistent help from healthcare professionals and may die from respiratory failure at this stage.
Once the stage of COPD is identified, appropriate treatment can begin. The main goal of treatment is to prevent or minimize disease progression. Additional treatment goals include symptom relief, improvement in exercise tolerance, improvement of overall health, prevention of exacerbations, prevention of complications, reduction of the negative effects COPD may have on a person's daily living, and lastly, prevention of death. Treatment approaches are described below.
For individuals who are at risk for COPD, the most important treatment is to avoid risk factors that can cause COPD. These individuals should also get a flu vaccine annually and stay current with their pneumonia vaccination.
For individuals with mild COPD, treatment should start with identification and avoidance of risk factors. Drug treatment should begin with a short acting inhaled bronchodilator such as albuterol (a beta-agonist) or ipratropium (an anticholinergic) if symptoms cannot be controlled by eliminating risk factors. Combination inhaled products such as Combivent (which contains an ipratroprium and albuterol) are sometime prescribed. Flu and pneumonia vaccines are also needed since these illnesses can negatively impact COPD by causing sudden periods of COPD disease worsening known as "exacerbations".
Individuals with moderate COPD are typically also treated with one or more long-acting bronchodilators in addition to the treatment used for mild disease. Long acting bronchodilators include salmeterol or formoterol (long-acting beta-agonists) and tiotropium (a long-acting anticholinergic). These long acting bronchodilators provide sustained effects to the lungs and airways that are needed by individuals who experience symptoms on a more continual basis. Another medication sometimes used due to its prolonged effect is theophylline SR; however use of this medicine requires careful monitoring by a doctor.
Individuals with severe COPD, in addition to receiving therapies described in both mild COPD and moderate COPD, typically also receive inhaled glucocorticosteroids such as fluticasone or budesonide. Inhaled steroids can help reduce inflammation in the lungs and airways that can limit a persons breathing. Steroids are also useful in reducing the number of exacerbations a person may have.
Individuals with very severe COPD in addition to receiving the therapies described for mild COPD, moderate COPD, and severe COPD, may also be treated with oxygen or even surgery. The use of oxygen should be reserved for patients with respiratory failure, very severe COPD or for individuals who are still symptomatic despite taking beta-agonists, theophylline, and corticosteroids. The major surgical procedures include:
- Bullectomy- removing a part of the lung which is damaged.
- Lung Volume Reduction Surgery- parts of the lung are removed to stop the lung from overly increasing in size. This procedure has limited effectiveness and is not widely used.
- Lung Transplantation- replacing a damaged lung or lungs with healthy donor lungs.
In addition to the standard treatments for COPD, many people with COPD often complain of chronic thick mucus. This can be treated with a mucolytic (or mucus thinner) such as guaifenesin, which will thin the mucus and may decrease cough. Increasing water intake can also help thin the mucus. While agents such as these may help some individuals, there is a lack of evidence supporting their continual use.
CFC's in Inhalers and Depletion of the Ozone
The production of substances that damage the earth's ozone layer is being phased out world wide under the terms of an international agreement called the Montreal Protocol on Substances that Deplete the Ozone Layer. Since many of the metered-dose inhalers (MDIs) available in the United States for the treatment of COPD contained ozone-damaging chlorofluorocarbons (CFCs), many of these MDIs are being reformulated to no longer use CFCs. Many products will be reformulated with the propellant hydrofluoroalkane (HFA), which carries medicine into the lungs with no known ozone-depleting chemicals. The reformulation effort is underway and several non-CFC products are currently approved and/or marketed for a range of different drugs (including non-CFC MDI versions for albuterol, beclomethasone, fluticasone, and ipratropium, as well as dry powder inhaler (DPI) versions of fluticasone, formoterol, and salmeterol.) Several more non-CFC products are currently being developed.
Do not be concerned that the medicines you need to treat your COPD will be removed from the market. CFC-containing MDIs will not be removed by the FDA until sufficient alternative medicines exist to serve the needs of patients. The reformulation effort should be complete by December 31, 2008, when all production and sale of MDIs that contain CFCs must stop.
Drug classes used to treat Chronic Obstructive Pulmonary Disease (COPD) Anticholinergics Combination Inhalers Corticosteroids Inhaled Beta-2 Agonists Inhaled Corticosteroids Mukolytics Oral Beta-2 Agonists Theophyllines
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How is it treated?
