By Elisa Brown, PA-C

COPD is the 4th leading cause of death among adults worldwide and the 3rd leading cause of death in the USA. COPD is caused mostly by smoking but non-smokers are also susceptible to this condition. Being exposed to smoke with family members who smoked in the home, working in an environment with second-hand smoke, environmental or industrial inhalant exposure as well as having a genetic component of alpha-1-antitripsyn deficiency are also risk factors. People suffering from Asthma will also be at a higher risk.  Smoking cessation has been proven to be beneficial if you have COPD. Also avoiding areas where people smoke like inside a casino can reduce your risks. The disorder often occurs in older patients.

The clinical presentation begins when the patient has chronic bronchitis or a persistent cough with phlegm production for over 3 months.  Patients will also have shortness of breath, reduced exercise tolerance, general fatigue and difficulty breathing.  Your provider will have you perform a breathing test called a Pulmonary Function Test in the office to officially diagnose the disorder.  COPD can also be seen on Chest X-rays or Chest CT scans and can be found incidentally on Spinal X-rays. There are three components to COPD and they are chronic inflammation that leads to narrowing of the airways, emphysema and loss of lung elastic recoil and chronic or recurrent bronchitis.

Diet tips include eating smaller meals as larger meals fill you up and make it harder to breathe, drinking at least 6-8 glasses of water per day to thin the mucus out, eat healthy meals that give you enough  energy needed to breathe in and out, lose weight if you can to reduce the effort of your lungs to supply the body mass with oxygen.

Exercise is always recommended even in COPD patients and can help build strength to breathe easier, even if it is just walking around the block every day.  It is recommended that COPD patients get a minimum of 15 minutes of exercise per day. Meditation and breathing exercises have also been shown to decrease the number of exacerbations.  Try to have a good sleep routine that includes shutting off electronics and maybe a warm bath each night to relax the body.  Reducing anxiety is also very important in controlling exacerbations.  Depression can also cause reduced energy and low self esteem that also contribute to more hospital visits for COPD flares. Try to avoid people or situations that can worsen exacerbations by causing anxiety or stress.

Medications prescribed by your practitioner can also help relax the muscles in the airways, reduce swelling and help the lungs perform better. Most patients are familiar with Beta-agonist rescue inhalers such as Proventil, Ventolin or Xopenex that allow better oxygen exchange between the lungs and blood by dilating or opening the airways and are used with acute flares.  Inhaled Corticosteroids may also be prescribed such as Qvar, Asmanex, Pulmicort that help to reduce inflammation. Combination inhalers with corticosteroid and Long Acting Beta Agonist like Advair, Symbicort and Breo are more commonly used for COPD patients. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend Long-Acting Beta Agonist (LABA) in combination with Long Acting Muscarinic Antagonist (LAMA) as first line treatment for stable COPD such as Anoro, Bevespi and Stiolto. Trelegy is the only FDA approved inhaler that combines all three components of a corticosteroid, a LAMA and a LABA.  These inhalers are used 1-2 times per day for COPD control and maintenance.

Flares are treated more aggressively usually with an oral Corticosteroid and Azithromycin antibiotics to reduce inflammation and possible bacterial etiology of symptoms.  If COPD flares happen more frequently and inhalers are no longer controlling symptoms, it may be necessary to start on home oxygen therapy.

Having a diagnosis of COPD does not mean that you can’t enjoy life, it just means that adjustments need to be made to control COPD in order to have a better quality of life with this disorder.