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Treatment option of Chronic obstructive pulmonary disease

Diagnosis

Seek medical advice and have a thorough examination promptly if you have COPD symptoms, and are over 40 years old, in the high-risk group, and smoking or have smoked before. There is no cure for COPD. Early diagnosis and proper treatment can help control the conditions.

Physical examination

Patients with early COPD may wheeze when breathing; they may have an increased anteroposterior rib cage diameter; end stage patients may experience leg swelling due to heart failures.

Lung function test

A lung function test is an indispensable tool to diagnose COPD, to determine the severity, and to monitor and predict the development of the disease. A simple test of spirometry can help identify early COPD efficiently. The Forced Expiratory Volume in one second(FVE1) and Forced Vital Capacity(FVC) are indicators of the severity of the disease. If the rate is always below 70%, the condition will be diagnosed as COPD.

Arterial blood gas analysis

Arterial blood samples are taken to check the level of oxygen and carbon dioxide; the normal range for the former is PaO2 75 – 100mmHg and for the latter PaCO2 35 – 45mmHg. This type of intrusive examination is usually applied when the patient experiences a lack of oxygen, carbon dioxide detention or right-sided heart failure. It determines whether long-term oxygen therapy is required. 

A finger mounted pulse oximeter is also available. It measures the blood oxygen level on the skin surface. This method is quick and non-invasive, but does not provide any readings on carbon dioxide or other details.

Chest X-ray examination

This less sensitive method seldom reveals any abnormalities in patients with early or middle phase COPD but in end stage patients, it shows symptoms like an overinflated chest, enlarges alveoli, or a diaphragm that is pushed down. However, a chest X-ray examination will still be conducted to eliminate other possibilities like tuberculosis or lung cancers which have similar symptoms as COPD.

Treatment

Quit smoking

Since smoking is a main cause of COPD, the first and foremost treatment is to quit smoking. It benefits patients in all stages. Once smoking is stopped, the severity of cough and sputum production will improve within a week. It will also delay worsening of symptoms and prolong the life of patients.

Medication

There is no cure for COPD but proper medications can control the conditions, improve symptoms and enhance the quality of life.

  • Bronchodilators
    These inhalers are either in oral or aerosol form. The main substance containsβ2-agonists , anticholinergics and theophylline which relaxes the airway smooth muscle tissue, reduces the level of lung overinflation, and relieves breathing difficulty. Inhalers reach the airways directly, thus requiring a lower dose and having fewer side effects. But more skill is required when using these drugs. The elderly may find them difficult to use, but a spacer will help.
  • Steroids  Steroids suppress inflammation but are not very effective in treating COPD. Only 10 - 15% of stable COPD patients have their lung functions improved after using inhaled steroids.
  • Antibiotics
    Antibiotics are only used when there is a bacterial infection. They have no effect on COPD symptoms.
  • Expectorants
    These dilute and help the discharge of sputum.

Oxygen therapy

For severe cases experiencing a lack of oxygen, doctors may prescribe oxygen therapy, which may improve the physical ability of the patients. Doctors’ instructions must be followed for best results. Patients may place an oxygen delivery device at home and carry portable ones if approved by doctors and therapists.

Pulmonary rehabilitation programme

This treatment, provided by a professional medical team, includes physiotherapy and occupational therapy, education, aerobic training and conditioning, nutrition counselling and self-care skill training. It is widely approved as an effective option which relieves breathing difficulty, reduces hospital admission, improves lung capacity to take in more oxygen and enhances the quality of life.

Surgery

Some severe cases may need a surgical removal of alveoli or a lung volume reduction surgery to reduce pressure on lung tissues and the level of lung overinflation, and to improve lung functions and physical ability.