COPD is among the leading causes of death in industrialized countries, and new pharmacological treatments are being developed to help patients with this disease. But a spectrum of non-pharmacological ways of treating COPD are also available and important, ranging from actions a patient could take or oxygen use to a lung transplant. Here is a list of some of these options.

Smoking cessation

Quitting smoking is the most essential first step that COPD patients are advised to take. Smoking is among the leading risk factors for developing COPD, and it is known to worsen disease morbidity and accelerate airflow obstruction.

According to a 2014 report from the U.S. Surgeon General, “smoking is the dominant cause of chronic obstructive pulmonary disease (COPD) in men and women in the United States. Smoking causes all elements of the COPD phenotype, including emphysema and damage to the airways of the lung.”

Options to help people “kick the habit” include nicotine replacement therapies — such as  patches, gums, lozenges and sprays — and medications, including bupropion, varenicline and cytisine. More information on stopping tobacco smoking is available on the smokefree.gov website.

Disease management and comprehensive care plans

COPD management demands a close doctor-patient relationship, working together to discuss a patient’s interests and abilities in managing the disease, and in setting therapeutic goals. These plans typically involve multidisciplinary healthcare teams, and require patient education on such issues as treating disease flares, handling follow-up, and a support system for follow-up care and health checks. Usually, there are four parts to an effective management program: patient self-management, streamlining access to healthcare, decision support, and covering categories of clinical information. Supported by regular phone calls or other contact to ensure that necessary medications and the like are adhered to, individualized management plans can result in better quality of life and fewer COPD-related hospitalizations.

Telemedicine, an electronic platform to connect patients with healthcare specialists, can be of use in these action plans.

Long-term oxygen therapy

Long-term oxygen therapy is often defined as oxygen use for at least 15 hours a day. It is commonly given to COPD patients with low-blood oxygen levels to improve breathing difficulties, exercise tolerance, and survival.

Two studies, involving about 300 people with COPD and very low concentrations of oxygen in the bloodstream, showed that long-term oxygen therapy was of benefit. The first, a Phase 3 study called the Nocturnal Oxygen Therapy Trial or NOTT (NCT00000564), included 203 COPD patients at six U.S. centers and compared the effects of 12 hours of nocturnal oxygen therapy — thought to be easier on patients — with continuous low-flow oxygen therapy in terms of mortality rates, lung function, and exercise capacity after 12 months. The treatment groups were “not well-matched,” researchers found, and the study’s results possibly less than conclusive. In general, continuous oxygen therapy was found to have a lower mortality rate and lead to better improvement in lung function than nocturnal oxygen therapy.  A correlation was also found between the first six month of long-term oxygen therapy and improved pulmonary artery pressure, and with survival at an eight-year follow-up.

The other, a UK Medical Research Council domiciliary oxygen study, included 87 patients with severe COPD given 15 hours of daily oxygen therapy, or no oxygen therapy, and followed for five years. Improved survival was seen in the treated patient group at five years.

According to the British Thoracic Society guidelines for home oxygen use in adults, subsequent studies have also shown a survival benefit with long-term oxygen use (15 hours daily) in COPD patients with chronic low-blood oxygen levels, but not in those with moderate hypoxemia.

Noninvasive Ventilation

Treatment of COPD with noninvasive ventilation (NIV) is effective in acute flares, in helping in pulmonary rehabilitation, and in managing high levels of carbon dioxide. According to the GOLD Guidelines, the use of NIV is preferred over intubation and positive pressure ventilation as a first ventilation treatment of respiratory failure in acute flares of COPD. Studies show a success rate of 80–85%, with NIV improving oxygenation and decreasing carbon dioxide levels, as well s slowing the respiratory rate and easing severity of breathlessness. It also helps to avoid such complications such as pneumonia, related to ventilator use and length of hospital stay.

Interventional bronchoscopy and surgery

A common COPD condition is emphysema, which destroys the bronchi walls, creating less and larger bronchi instead of many tiny ones, reducing the amount of gas exchanged in the lungs and leaving large spaces filled with air even upon exhalation. The GOLD Guidelines recommend that lung volume reduction surgery be considered in patients with severe breathlessness and enlarged lungs, where emphysema has diminished the ability of non-affected lung areas to work well. The goal of lung volume reduction surgery is to remove the least functional parts of the lungs to improve airflow, gas exchange (oxygen and carbon dioxide) and create more room for lung mechanics in its remaining portions.

Intra bronchial valves placement may be a less invasive and more cost-effective option for some people with severe COPD, leading to an improved quality of life and better lung function. These valves are designed to limit airflow to more damaged and hyper-inflated portions of the lung, gradually collapsing these portions, so as to make space for the healthy parts of the lung to “breathe.”

Lung transplant

Lung transplants have been used to treat people with COPD for decades, with the first lung transplant performed in a cancer patient in 1963. But it was not until the 2000s, with better surgical techniques and immunosuppressives, that this option has come more into practice for people with severe disease. A lung transplant is a therapeutic option for end-stage COPD patients with the capacity to undergo rehabilitation, and survival rates are now 89% at one-year post-transplant and 50% at five years. A transplant is usually only considered after all other treatments options have failed, and then only if professionals think the procedure will benefit the patient. Lung transplants are a limited option because of a shortage of donor organs and the risk of complications, such as organ rejection and severe infections. COPD patients who continue to smoke are generally not candidates for lung transplants.

 

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