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| COPD (Chronic Obstructive Pulmonary Disease) |
Last updated: May 12, 2008 |
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COPD (Chronic Obstructive Pulmonary Disease) |
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations
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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.
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 Signs, symptoms & indicators of COPD (Chronic Obstructive Pulmonary Disease): | | | | | | Symptoms - General |  Fatigue on light exertion |
Symptoms - Respiratory |
Chronic productive cough
Easily being short of/always being short of breath or normal breathlessness
Air hunger |
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Conditions that suggest COPD (Chronic Obstructive Pulmonary Disease): | | | | | | Circulation |  Pulmonary Embolism |
Diet |
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] |
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Symptoms - Respiratory |
Counter-indicators:
 Not having COPD |
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Risk factors for COPD (Chronic Obstructive Pulmonary Disease):
COPD (Chronic Obstructive Pulmonary Disease) suggests the following may be present: | | | | | | Diet | 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] |
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Nutrients |
Antioxidant Requirement / Oxidative Stress |
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COPD (Chronic Obstructive Pulmonary Disease) can lead to:
Recommendations for COPD (Chronic Obstructive Pulmonary Disease): | | | | | | Amino Acid / Protein |  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] |
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Animal-based |
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] |
 Cetyl-myristoleate |
Botanical |
Red Clover (Trifolium pratense)| | Red Clover tincture has long been a treatment for whooping cough and bronchitis. |
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Diet |
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 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. |
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Digestion |
Bromelain| | Bromelain has been shown to reduce cough and thin mucus secretions for easier removal in chronic bronchitis, but probably not in acute bronchitis. |
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Environmental |
 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] |
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Extract |
Rye Grass Extract |
Habits |
Tobacco Avoidance| | Smoking is the primary cause of COPD. |
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Lab Tests/Rule-Outs |
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] |
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Mineral |
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. |
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Nutrient |
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]. |
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Oxygen / Oxidative Therapies |
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. |
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Physical Medicine |
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. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
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