Known to many as chronic bronchitis or emphysema, Chronic Obstructive Pulmonary Disease (COPD) is estimated to affect 32 million persons the United States – it is also the fourth leading cause of death there. Patients typically have symptoms of both chronic bronchitis and emphysema, but the classic triad also includes asthma. Most of the time COPD is secondary to tobacco abuse, but other more rare conditions, such a cystic fibrosis, may be contributing factors. Men are more likely to have COPD than women and COPD occurs predominantly in individuals over 40.
COPD is a mixture of 3 separate disease processes that together form the complete clinical picture. These processes are chronic bronchitis, emphysema and, to a lesser extent, asthma. While each case of COPD is unique in the blend of processes, two main types of the disease are recognized.
Chronic Bronchitis – “Blue Bloaters”
Chronic bronchitis plays the major role in this type and is defined by excessive mucus production with airway obstruction and notable enlargement of mucus-producing glands.
Damage to the airway lining impairs the miniature ciliary hairs located there which usually help clear bacteria and mucus. Inflammation and secretions provide the obstructive component of chronic bronchitis. In contrast to emphysema, chronic bronchitis is associated with a relatively undamaged pulmonary capillary bed. Emphysema is usually present to a variable degree.
As the disease progresses, these patients develop signs of right-sided heart failure and are known as “blue bloaters”.
Emphysema – “Pink Puffers”
The second major type is that in which emphysema is the primary underlying process. The physiology of emphysema involves the gradual destruction of the small air sacs where gas diffusion takes place, and of the pulmonary capillary bed, leading to a decreased ability to oxygenate blood. The body compensates with lowered cardiac output and more rapid breathing. Eventually, these patients develop muscle wasting and weight loss and are identified as “pink puffers”.
Patients with COPD are susceptible to many factors that can lead to an acute deterioration. Aggressive and prompt intervention may be the only action that prevents respiratory failure. Being obese can aggravate COPD.
Signs, symptoms & indicators of COPD (Chronic Obstructive Pulmonary Disease)
Fatigue on light exertion
Chronic productive cough
Easily being short of/always being short of breath or normal breathlessness
Air hunger
Conditions that suggest COPD (Chronic Obstructive Pulmonary Disease)
Need for Dietary Improvement
Out of 50 consecutive COPD patients presented with acute respiratory failure upon admittance to a hospital, malnutrition was observed in 60% of all patients but only 39% of those whose body weight was equal to or above 90% of ideal body weight. These results suggest that assessment of nutritional status should be systemically performed for COPD patients with acute respiratory failure, especially those who are in need of mechanical ventilation. Aggressive, early nutritional support in acute illness might have beneficial effects on the weaning of patients off mechanical intervention. [Nutritional Status of Patients With COPD and Acute Respiratory Failure, Chest, May 1993;103(5): pp.1362-1368]
COPD
Counter Indicators
Not having COPD
Risk factors for COPD (Chronic Obstructive Pulmonary Disease)
Cigarette Smoke Damage
People who smoke or have chronic bronchitis have an increased risk of emphysema.
COPD (Chronic Obstructive Pulmonary Disease) suggests the following may be present
Need for Dietary Improvement
Out of 50 consecutive COPD patients presented with acute respiratory failure upon admittance to a hospital, malnutrition was observed in 60% of all patients but only 39% of those whose body weight was equal to or above 90% of ideal body weight. These results suggest that assessment of nutritional status should be systemically performed for COPD patients with acute respiratory failure, especially those who are in need of mechanical ventilation. Aggressive, early nutritional support in acute illness might have beneficial effects on the weaning of patients off mechanical intervention. [Nutritional Status of Patients With COPD and Acute Respiratory Failure, Chest, May 1993;103(5): pp.1362-1368]
COPD (Chronic Obstructive Pulmonary Disease) can lead to
Dupuytren's Contracture
See the link between Diabetes II and Dupuytren’s Contracture.
Recommendations for COPD (Chronic Obstructive Pulmonary Disease)
Cysteine / N-acetyl-cysteine (NAC)
Oxidative stress is closely linked to inflammation. The inflammatory process in patients with stable COPD is dominated by macrophages, CD8+ T-lymphocytes and neutrophils, and to a lesser extent mast cells, in the bronchial submucosa and alveoli 5. Increased production of mediators, such as interleukin (IL)-8, tumour necrosis factor- (TNF-) and leukotriene B4, which both attract inflammatory cells and increase oxidant production by these cells, has been found.
Attenuation of oxidative stress would be expected to result in reduced pulmonary damage and a decrease in local infections, contributing to attenuation of the progression of COPD. At present the only antioxidant widely available for the treatment of patients with COPD is N-acetylcysteine (NAC).
An open clinical trial including 1,392 patients demonstrated the efficacy of NAC at a dose of 600mg·day in reducing the viscosity of expectorations, promoting expectoration and reducing the severity of cough. After 2 months of treatment with NAC, the viscosity of expectorations improved in 80% of cases, the nature of the expectorations improved in 59%, difficulty in expectorating improved in 74% and the severity of cough improved in 71%. [J Int Med Res 1983;11:279–284]
Improvement in clinical symptoms as a result of treatment with NAC has been shown in a long-term double-blind trial with parallel groups conducted in several centres to which 744 patients with chronic bronchitis were recruited. Patients were randomly divided into two groups, one treated with NAC and the other with placebo. The results confirmed the efficacy of NAC regarding the parameters related to bronchial hypersecretion. [Eur J Respir Dis 1980;61: Suppl. 111, 93–108]
Microdose DNA
“We looked at the COPD patients characterized by dry cough, little or no sputum production, and severely impaired pulmonary function, where their forced expiratory volume was in the vicinity of about 25% and with evidence of non-reversible disease. The microdose DNA demonstrated increased sputum production with improvement in COPD symptoms, especially shortness of breath. There was obvious improvement in forced expiratory volume, and also in the carbon monoxide coefficient of diffusion. There was significant increase in distance traveled during 6 minute walks, and a corresponding increase in their oxygenation, and again, with an excellent safety profile.” [Allan Lieberman, MD – Natural Microdose DNA AAEM Presentation, October 2004, Hilton Head, South Carolina]
Red Clover (Trifolium pratense)
Red Clover tincture has long been a treatment for whooping cough and bronchitis.
High/Increased Protein Diet
Researchers from England state that chronic obstructive pulmonary disease may only worsen by eating a diet that
contains an overabundance of high-carbohydrate foods. The results suggest that even small changes in the constitution of meals, especially in terms of less carbohydrate, may have significant effects on exercise tolerance and breathlessness amongst patients with COPD. [Diets Rich in Carbohydrates Worsens COPD, Medical Tribune, July 23, 1992; p.17]
Grain-free / Low Starch Diet
Please see the link between COPD and High/Increased Protein Diet.
Increased Fruit/Vegetable Consumption
A diet high in antioxidants may protect against the free-radical-damaging effect of environmental toxins or cigarette smoke. Studies comparing different populations have shown that increasing fruit consumption appears to reduce the risk of developing chronic bronchitis.
Bromelain
Bromelain has been shown to reduce cough and thin mucus secretions for easier removal in chronic bronchitis, but probably not in acute bronchitis.
Particulate Avoidance
Long-term effects of particulate air pollution on the incidence of bronchitis, emphysema and asthma have been documented. There is an unexpectedly high COPD mortality found in small agricultural communities, which may be in part due to occupational dust exposure. The authors felt that prevention of COPD should start in childhood, with emphasis on infection prevention and the control of indoor pollution. [Environmental Factors and Chronic Obstructive Pulmonary Disease, European Respiratory Review, 1992;2:9; pp.144-148]
Tobacco Avoidance
Smoking is the primary cause of COPD.
Test Antioxidant Status
Oxidative stress appears to play a role. Deficiencies of glutathione and vitamins E and C were found in patients with COPD. Increased lipid peroxidation is also a concern. [Oxidative Stress in Chronic Obstructive Pulmonary Disease, American Journal of Respiratory and Critical Care Medicine, 1997;156: pp.341-357]
Test Magnesium Levels
There is a possibility that magnesium deficiency contributes to pulmonary complications. The authors note during the past few years there has been an increase in calcium consumption in the U.S. but little change in magnesium intake, which may imbalance the calcium:magnesium ratio. Serum levels can be normal and yet there can be magnesium deficiency within cells. These authors believe pulmonary patients should be routinely monitored for magnesium deficiency. There have been noted benefits of magnesium for wheezing also.[Role of Magnesium in Regulation of Lung Function, The Journal of the American Dietetic Association, June 1993;93(6): pp.674-677]
Iodine
If you have chronic bronchitis and or emphysema (“COPD”, “COLD”) SSKI is an invaluable tool. SSKI “gets into” all body secretions, including often thick and hard to cough up bronchial secretions, which get infected very easily. SSKI takes care of both of these problems. It “loosens” secretions remarkably, making them much easier to “clear”, and it prevents micro-organisms from growing easily. With regular SSKI use, bronchial infection is a much less frequent happening. Depending on the severity of COPD, I recommend 3 to 6 drops of SSKI taken in water once daily. As COPD is usually a chronic condition, SSKI use will usually be indefinite, so make sure to monitor your thyroid function! (See the August 2002 Nutrition & Healing for a more complete discussion of natural COPD treatment – Jonathon Wright, MD.) [Taken from http://www.tahoma-clinic.com/iodide.shtml]
MSM (Methyl Sulfonyl Methane)
In a study of 7subjects with respiratory deficiency, all were given MSM to take orally. Five had emphysema, and two had lung tumors plus fluid accumulation. At two-week intervals, before and during the MSM supplementation, the five subjects with emphysema were tested for their ability to walk a specific distance. After one month, all emphysema sufferers had at least doubled their walking distance. The two subjects with lung tumors were assessed by attending physicians, nurses and their family as being more alert and with an improved attitude. The lung fluid disappeared during the first months of the test period.
Essential Fatty Acids
A high intake of omega-3 fatty acids may protect cigarette smokers against chronic obstructive pulmonary disease. Supplementing with omega-3 fatty acids may interfere with the inflammatory mediators triggered by cigarette smoking. Even small increments of omega-3 fatty acids may have a cumulative beneficial effect. [Dietary N-3 Polyunsaturated Fatty Acids in Smoking-Related Chronic Obstructive Pulmonary Disease, The New England Journal of Medicine, July 28, 1994;331(4): pp.228-233].
Oxygen
Not everyone with COPD needs oxygen therapy, but it can make a huge difference in the lives of those who do. Oxygen therapy can lead to a longer life expectancy. More importantly, it can improve the quality of everyday life for those who need oxygen therapy and use it properly.
Calming / Stretching Exercises
In an experiment conducted in Western Australia, 22 male patients aged 52 to 65 were selected for severe breathing problems such as chronic bronchitis – emphysema – that made normal breathing impossible.
Half of the men underwent standard treatment for 9 months: physiotherapy, that included relaxation techniques, breathing exercises and general workouts to improve stamina. The other 11 men were given a yoga teacher instead of a physiotherapist. He taught them techniques of yoga breathing, which encouraged the use of all chest and abdominal muscles as well as ten yoga postures.
The difference between the two groups was striking. The men who had practiced yoga showed a significant improvement in their ability to exercise, but the physiotherapy group did not. Eight or more out of the 11 patients who underwent yoga declared that they had definitely increased tolerance for exertion and that they recovered more quickly after exertion. The physiotherapy group reported no similar improvement. A significantly greater number of patients reported that “with the help of yogic breathing exercises, they could control an attack of severe shortness of breath without having to seek medical help,” according to the study.
Doctors analyzing the results from the study postulate that, after the training, the breathing pattern of the patients in the yoga group changed to a slower and deeper cycle, allowing them to tolerate higher work loads. Patients in the physiotherapy group continued in their shallow rapid breathing pattern.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Bronchitis
Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.
Pulmonary
Pertaining to the lungs.
Asthma
A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.
Cystic Fibrosis
(CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.
Ciliary
Often Ciliary activity: Activity of the eyelashes or any hairlike processes (cilia).
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Capillary
Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Contracture
An abnormal, often permanent shortening, as of muscle or scar tissue, that results in distortion or deformity, especially of a joint of the body.