Chronic Obstructive Pulmonary Disease

Treatment

Mayo Clinic provides comprehensive treatment for Chronic Obstructive Pulmonary Disease (COPD). This includes maintenance therapy, prevention and treatment of acute cases and treatments for the most severe cases, including surgery.

Treatment for COPD is based on the patient's general medical condition and severity of the disease. Options usually include a combination of the following treatments. For some people, participation in a clinical trial is beneficial.

Proper treatment of COPD can result in improvements in exercise capacity, activity levels, quality of life, less hospitalization, and longer survival.

Stop smoking

By far, the most important and effective treatment for COPD is smoking cessation, which results in improvement in lung function during the first year after quitting and a return to a normal rate of change in lung function thereafter. The benefits of quitting smoking apply regardless of age, amount smoked or severity of COPD. Quitting smoking also reduces the risk of sudden cardiac death, heart attacks, strokes and lung cancer. People with COPD live longer and have a better quality of life if they stop smoking.

Despite the best efforts to stop smoking, many patients do not succeed in quitting. Many doctors are reluctant to prescribe treatment for patients with COPD who continue to smoke. That is unwarranted. There is good evidence that bronchodilators and inhaled corticosteroids are as beneficial for smokers as for nonsmokers.

The other treatment that improves survival of patients with severe COPD is oxygen therapy.

Medications

1. Short-acting bronchodilators, both beta agonists and anticholinergics, are the mainstay of therapy for COPD.
2. Long-acting bronchodilators are indicated for moderate to severe COPD. Currently two beta agonists are available. A long-acting anticholinergic is under consideration for approval by the U.S. Food and Drug Administration.
3. Inhaled corticosteroids are recommended for patients with moderate to severe COPD with frequent exacerbations (incidents which worsen symptoms).
4. Systemic corticosteroids (IV or pills) are beneficial for treatment of severe exacerbations.
5. Antibiotics may be beneficial for treatment of exacerbations.
6. Theophylline in low doses may reduce frequency of exacerbations in patients who tolerate it (it has many side effects).

Home oxygen therapy

Supplemental oxygen is prescribed to correct hypoxemia (low blood oxygen) to improve the physical and mental functioning of patients. Several studies have shown greater long-term survival in patients with severe COPD who received oxygen therapy.

Pulmonary rehabilitation

For those who have difficulty completing daily tasks, pulmonary rehabilitation may be very beneficial. Mayo Clinic in Rochester offers a Pulmonary Rehabilitation Program for people with chronic pulmonary disease and their families. The program can improve exercise capacity, reduce the hospitalization rate and improve overall quality of life for patients. It is conducted by a multidisciplinary team of specialists, including pulmonary physicians, respiratory therapists, physical therapists, occupational therapists and dietitians with expertise in the care of people with chronic pulmonary diseases. The comprehensive evaluation, educational and exercise components are covered on an outpatient or inpatient basis.

The typical length of a Pulmonary Rehabilitation program is six to 10 weeks, but for those not able to stay that long in Rochester, Mayo Clinic offers the Quick Start option. Quick Start is a two-day program that includes the educational components of the full program and a minimum of two aerobic training sessions. People are then referred to a health facility in or near their home where they can complete the remainder of the required exercise training sessions.

Surgery

Lung transplants are sometimes performed in severe cases of COPD.

Another option is lung volume reduction surgery (LVRS). In LVRS the surgeon removes small wedges of damaged tissue, usually 20 to 30 percent of each lung. Removing some damaged air sacs reduces the size of the lungs. As a result, the diaphragm contracts and relaxes more effectively and efficiently, and air exchange improves.

Results of a large clinical trial, called the National Emphysema Treatment Trial (in which Mayo Clinic participated), showed that LVRS can improve the lung function of many people with emphysema. The findings of the five-year trial were published in the May 22, 2003, edition of the New England Journal of Medicine.

The success of LVRS varied widely in the study:

• In people whose emphysema occurred primarily in the upper lobes of their lungs and whose exercise capacity was still low after they had undergone several weeks of pulmonary rehabilitation, survival rates were longer and lung function was better after they underwent LVRS compared with people with similar preoperative findings who did not have the surgery.
• However, for people who did not have emphysema in the upper lobes of their lungs and who had a greater exercise capacity after pulmonary rehabilitation, the surgery lowered survival rates and did not result in higher lung function.

Mayo pulmonary specialists and surgeons are very experienced in LVRS and in determining who receives the most benefit from either surgical or medical therapy for emphysema.