COPD - Chronic Obstructive Pulmonary Disease
Bad News: COPD is a progressive disease with no known cure and is the third leading cause of death in the United States.
Good News: COPD is preventable and the progression of COPD can be slowed and treatments are available to improve symptoms.



What is COPD?


Watch the following video for a better understanding:


COPD is a disease that presents itself by altering the lung tissue and makes breathing difficult.

COPD presents itself in 2 ways: Chronic Bronchitis and/or Chronic Emphysema [1]
Chronic Bronchitis: long-term cough along with mucus (productive cough)
Chronic Emphysema: destruction of the lung tissue and structure over time


When air is inhaled it flows through the trachea and then branches off into smaller and smaller branches until it reaches the alveoli. Alveoli are the functional units of the lung and are similar to a balloon; they expand when air is inhaled and deflate during exhale. Capillaries surround the alveolar walls which allow carbon dioxide to pass into the alveolar passage way to be exhaled and oxygen into the capillary blood to supply the body tissues.


In COPD, less air flows in and out of the airways because of one or more of the following [2]:
  • The airways and air sacs lose their elastic quality.
  • The walls between many of the air sacs are destroyed.
  • The walls of the airways become thick and inflamed.
  • The airways make more mucus than usual, which tends to clog them.


Thus, when this tissue is damaged carbon dioxide may stay in the blood damaging tissue and enough oxygen may not reach the tissue to allow proper function!


external image copd_2010.jpg
http://www.nhlbi.nih.gov/health/health-topics/topics/copd/

In Figure A, healthy lungs, open passageways allow maximum air flow to the small compartmental alveoli.
In Figure B, COPD affected lungs, the passageways are constricted and clogged with mucus. Also, note that the walls between the alveoli have been destroyed minimizing the capillary/alevolar ratio. The fewer alveoli that exist the less oxygen getting into the lungs and carbon dioxide getting out.




What causes COPD?


COPD is caused by long-term exposure to irritants [3, 4].
  • Tobacco smoke from cigarettes, pipes, hookah, and cigar (95% of COPD cases)
  • Chemical fumes and pollution (5%)
  • Genetics and chronic respiratory infections (1%)


Tobacco: smoke contains tar which gets into the lung passageways. The immune systems responds by sending cells to destroy the tar but become damaged as well. These damaged cells die and release chemicals that cause the alveoli to lose elasticity and destroy the walls separating them. In response, the lungs become inflamed and release mucus and decrease the amount of air that can enter and exit the lungs [LS].

Chemical fumes/pollution: similar to tobacco, the chemicals cause irritation to the lung tissue which becomes inflamed and release mucus that decreases the amount of air that can enter and exit the lungs.

Genetics: An AAT, alpha-1 antitrypsin, deficiency can cause COPD to develop when exposed to lung irritants such as tobacco smoke, allergens, and chemical fumes [AAT]. This is a rare disease that is caused by the liver's inability to produce the AAT protein.

Age: since COPD is a progressive disease, symptoms are seen primarily in those over age 40.




COPD Signs and Symptoms

Contact your doctor immediately if you suddenly have significantly increased difficulty breathing or chest tightness, severe coughing, changes in the color or volume of phlegm being produced, or fever.

Typical COPD Symptoms:
  • chronic cough
  • excessive production of mucus or phlegm
  • dyspnea (i.e. shortness of breath) during physical activity
  • chest tightness
  • wheezing
  • fatigue
Frequent colds or influenza may also occur in people with COPD. Symptoms are often ignored at first because they can be chalked up to having "a smoker's cough" or being out of shape. Many people with COPD have most, or even all, of these symptoms. However, some people with COPD don't experience any of these symptoms. If you are unsure, it's always a good idea to let your medical provider know about your concerns.

COPD is a progressive disease. Symptoms may first go unnoticed, but over time they become more severe. Smoking will also increase the rate of COPD progression. Often mild COPD sufferers will simply change their daily routines in order to avoid feeling the symptoms. It is best not to ignore the symptoms and to see a doctor as early as possible in order to have the best possible outcome.

Severe COPD, symptoms may include:
  • swelling of the ankles, feet, or legs
  • lips with a bluish tint (due to the low oxygen levels in the blood)
  • shortness of breath
  • weight loss
  • decreased muscle endurance

Symptoms, Diagnosis and Treatment of COPD





Medical Treatment of COPD


There is no cure for COPD, but there are treatments that help patients to live as actively as possible, reduce their COPD symptoms and slow the progression of the disease.

The #1 step of treatment is to stop smoking. Many products and programs are available to help you quit smoking. Ask your doctor for a recommendation of a method that is right for you. Also, ask for your family's and friend's support and avoid secondhand smoke.

Other treatments include:
  • Medications
    • Bronchodilators: act to make breathing easier by relaxing the airways and allowing them to open and allow for easier air flow in and out of the lungs
      • delivered using an inhaler
      • available in short-acting (4-6 hours) and long-acting (12+ hours)
    • Inhaled Glucocorticosteroids: reduce inflammation in the airways which allows air to move more freely in an
      out of the lungs
      • delivered using an inhaler

  • Vaccines
    • Flu Shots: helps reduce the risk of contracting the flu virus
      • influenza may be a serious threat to those with COPD
    • Pneumococcal Vaccine: helps reduce the risk of contracting pneumonia
      • people with COPD are at increased risk for pneumonia
        *Ask your doctor if he/she would recommend these vaccines for you.

  • Pulmonary Rehabilitation
    • A supervised program meant to improve the health, daily function and quality of life of those with lung problems.
    • The program may include: an exercise program, disease management education, nutrition counseling and psychological counseling.


  • Oxygen Therapy
    • Oxygen therapy may help individuals with severe COPD who have low blood oxygen levels.
    • Oxygen delivery may be via nasal prongs or a mask.
    • The additional oxygen may be used intermittently or continuously depending on the patient's needs.

  • Surgery (needed in rare cases)
    • Bullectomy: removal of one or more very large bullae (air pockets resulting from damaged lung tissue that make breathing difficult)
    • Lung Volume Reduction Surgery: removal of damaged lung tissue which may improve breathing and quality of life in certain patients
    • Lung Transplant: replacement of a severely damaged lung with a healthy lung from a donor
      * Patients who undergo lung transplant have high risk for problems such as infection and death.



Dietary Treatment for COPD


Dietary treatment for COPD varies by patient and should be highly individualized to their specific needs. Things such as age, gender, medical history, current medications, past and present state of nutrition, living facilities (home or hospital), oxygen saturation, sense of smell and taste, and anthropometric measurements can all attribute to the dietary needs for COPD. Generally, with COPD energy expenditure is increased. This increase in expenditure is in large part due to the work of breathing.

Complications also affecting energy expenditure include:
  • Gas diffusing capacity
  • Co2 retention
  • Respiratory inflammation

Malnutrition is common among COPD patients and occurs in about 25-35% of patients with moderate to severe COPD. This can be due to dyspnea, fatigue, and early satiety.

Feeding Strategies
Some suggestions for successful nutritional intake for COPD patients is to have smaller, more frequent meals to help from bloating and fullness. Lessening the time spent eating can also decrease fatigue during meal. It is also suggested that if the patient is preparing food for themselves to have them rest before meals. Enteral feeding can also be suggested to increase caloric intake.

Energy
Energy requirements for COPD should be determined by the individuals needs after assessment but 25-30kcal/kg body weight seems to be appropriate.

Fluids
Consuming enough fluids is important in dietary management for COPD. Fluids will help increase the thinning and clearance of pulmonary secretions in the lungs. Also, supplemental oxygen therapy can dry mucus membranes and cause irritation. Fluids help keep these membranes hydrated. A guideline for fluid intake with COPD patients is about 8 to 12 cups of caffeine-free liquids per day

Macronutrients
A patient with stable COPD should have macronutrients determined by underlying lung disease, oxygen therapy, medications and possible interactions with foods, weight, and fluid fluctuations. A main goal of balancing these macronutrients is to maintain a satisfactory RQ. (RQ: Respiratory Quotient is a measurement that shows which substrate is being utilized (fat or carbohydrates), by measuring CO2 and O2. RQ should have a value of about 0.8)
external image RQ-explanation.jpg

  • Protein should meet requirements that maintain or restore lung and muscle strength, and also to promote immune function as to avoid infections. 1.2-1.7g/kg of dry body weight seems to be sufficient.
  • Fat intake should be about 30%-45% of total kcal
  • Carbohydrate intake should be about 40%-55% of total kcal

One of the hallmarks of adequate dietary treatment for COPD is to replete but not over feed.






















Resources


1. Chronic obstructive pulmonary disease. Pub Med Health.2. What is COPD?. NHLBI.3. COPD. John Hopkins Health Alerts.4. COPD:Causes. National Jewish Health.5. What Does Smoking Tobacco do to Lungs?. LiveStrong.6. What Is Alpha-1 Antitrypsin Deficiency?. NHLBI.7. How a Low Carb Diet Affected My Athletic Performance. The War On Insulin.
8. COPD Diet Guidelines: Protein, Calcium, Reducing Sodium, and More. WebMD.
9. What are the signs and symptoms of COPD?10. NHLBI COPD Signs and Symptoms11. NHLBI COPD Treatment