Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United State.
1. Emphysema, a type of Chronic obstructive pulmonary disease
(COPD), is defined as a long term and progressive condition cause of
shortness of breath but depending to the stage of lung function as a
result of damage to tissues of the air sacs (alveoli) in the lungs. In
the study of 63 patients with stable COPD (spirometric GOLD stages 2–4)
and 17 age- and comorbidity-matched controls, researchers found that in
contrast to asthma, COPD is characterised by elevated concentrations of
both BDNF and TGF-beta1 in serum. The stage-dependent association with
lung function supports the hypothesis that these platelet mediators may
play a role in the pathogenesis of COPD(1). In some cases, but rarely,
Emphysema is caused by Alpha-1 antitrypsin deficiency emphysema.
2. Chronic bronchitis
Chronic bronchitis is a chronic inflammation of the lung’s bronchi cause
of the increased production of mucus in the lung of that leading to
difficult breathing.
F. Treatments
F.1. In conventional medicine perspective
F1.1. Therapies
1. Incentive spirometry
In the study of a total of 27 consecutive patients (mean age, 68.4 +/-
7.9 years; 26 males) admitted for COPD exacerbations, found that the use
of IS appears to improve arterial blood gases and health-related
quality of life in patients with COPD exacerbations, although it does
not alter pulmonary function parameters(36).
2. Oxygen therapy
Majority of patients in Oxygen therapy have chronic obstructive
pulmonary disease (COPD). The multicenter Nocturnal Oxygen Therapy Trial
and the smaller Medical Research Council study identified LTOT as an
intervention that improved survival in patients with COPD or chronic
respiratory failure, approximately doubling survival at 19 months in
patients who were adherent to oxygen(37).
3. Bronchodilators
The aim of Bronchodilators is to decrease the resistance in the respiratory airway and increase airflow to the lungs
a. Short-acting bronchodilators
In the study to clarify the additive efficacy of short-acting
β(2)-agonists (SABA) or muscarinic antagonists (SAMA) on dynamic
hyperinflation and exercise tolerance in patients with chronic
obstructive pulmonary disease (COPD) who had been treated with
long-acting bronchodilators, showed that he additive efficacy of the two
drugs was analyzed. Inhalation of SABA and SAMA improved airflow
limitation and dynamic hyperinflation in stable COPD patients who had
been treated with LAMA. Inhalation of SABA decreased respiratory
resistance and the difference in respiratory resistance at 5 Hz and
20 Hz. On the whole, the additive efficacy of SABA on airflow limitation
and dynamic hyperinflation was superior to that of SAMA(38).
b. Long-acting bronchodilators
In an overview of the clinical studies evaluating the safety and
efficacy of inhaled aclidinium bromide, a novel long-acting
anticholinergic bronchodilator, for the treatment of COPD, showed that
clidinium bromide has effects on relevant COPD outcome measures,
including level of FEV(1), similar to other long-acting bronchodilators,
and therefore seems to have the potential for a significant role in the
future management of moderate to severe COPD(35).
c. Side effects of Bronchodilators medicine are not limit to headache, Nervousness, Trembling and shaking, Etc., depending to types of medicine.
5. Phosphodiesterase-4 (PDE4) inhibitors
a. Phosphodiesterases (PDE) are a family of enzymes responsible
for the metabolism of the intracellular second messengers cyclic AMP and
cyclic GMP. According to the study by GKT School of Biomedical Science,
King’s College London, Targeting PDE with selective inhibitors may
offer novel therapeutic strategies in the treatment of various
conditions, and in the context of respiratory disease these include
asthma and chronic obstructive pulmonary disease (COPD)(39). Other study
indicated that While there is a wide distribution of these enzymes
throughout the body, it is of interest that inflammatory cells thought
to participate in the pathogenesis of inflammatory diseases including
asthma and chronic obstructive pulmonary disease (COPD), preferentially
express PDE4(40).
b. Side effects are not limit to Nausea, Emesis, and related general intestinal problems.
6. Corticosteroids are most frequent used sontrollers in preventing inflammaory airways in asthma patients and COPD.
a. Inhaled corticosteroids
According to the study by University of Nevada School of Medicine, in
the review of review is to compare and contrast the newer inhaled
corticosteroid (ICS) ciclesonide with older ICSs, showed that once-daily
administration of ICSs is generally not as effective as twice-daily.
Continuous administration of ICSs does not change the natural history of
asthma in either children or adults. Long-term administration of medium
dose ICSs does not increase the risk of cataracts or osteopenia in
children and young adults(41). Others in the study of Dry powder
inhaler (DPI) devices to assess the proportion of patients with asthma
or chronic obstructive pulmonary disease (COPD) with significant
bronchoobstruction who do not have inspiratory flows necessary for the
adequate use of dry powder inhaler (DPI) devices Diskus and Turbuhaler.
showed that significant proportion of patients with asthma or COPD with
significant bronchoobstruction do not exhibit satisfactory inspiratory
flows for the use of dry powder inhaler (DPI) devices (Diskus <
Turbuhaler)(42).
b. Oral or intravenous corticosteroids
In the study of 47 patients, 30 females, 17 male, 24 received oral
prednisolone and 23 received IV hydrocortisone. At baseline the oral and
IV groups were similar (mean, SD) in age (38.3, 12.8 vs 37.3, 12.9,
P=0.80) and initial percent predicted (PP) PEF (61, 16.7 vs 69, 13.0,
P=0.11). After 72 h both groups had similar improvements in PEF (27%, 26
vs 27%, 19, P=0.96), researchers at the Department of Respiratory and
Sleep Disorders Medicine, Western Hospital, found that Corticosteroids
administered orally and IV had similar efficacy in the treatment of
adults hospitalised with acute asthma(43).
c. Side effects
a.1. psychiatric side effects include mania, depression and mood
disturbances within the first two weeks of corticosteroid therapy(44).
2. Short side effects include cutaneous effects, electrolyte
abnormalities, hypertension, hyperglycemia, pancreatitis, hematologic,
immunologic, and neuropsychologic effects. and Long-term corticosteroid
use may be associated with more serious sequel, including osteoporosis,
aseptic joint necrosis, adrenal insufficiency, gastrointestinal,
hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression,
and possible congenital malformations(45).
7. Other medication
7.1. Expectorants
a. Expectorants is the types of medicine used to assist the
clearance of mucus from the airways, lungs, bronchi, and trachea. In the
study to to determine if treatment with mucolytics reduces the
frequency of exacerbations, days of disability, or both, in participants
with chronic bronchitis or chronic obstructive pulmonary disease, or
both.Secondary objectives: to determine if mucolytics lead to an
improvement in lung function or quality of life and to determine the
frequency of adverse effects associated with mucolytics, showed that in
participants with chronic bronchitis or COPD, treatment with a mucolytic
may produce a small reduction in acute exacerbations, but may have
little or no effect on the overall quality of life. The effects on
exacerbations shown in early trials were larger than those found in the
more recent studies(46).Others in the study of group 1 ascoril (10 ml
tid), group 2 salbutamol (200 mcg two inhalations tid) plus bromhexin (8
mg tid) for 10 days.indicated that ascoril is most efficacious and safe
for the treatment of mild or moderately severe COPD and elimination of
its exacerbation. The early prescription of this therapy permits to
avoid hospitalization and expensive therapy(47).
b. Side effects are not limit to Nausea, Gastrointestinal Distress, Sleep Complications,Drowsiness, Etc.
7.2. Methylxanthines
a. Methylxanthines represent a unique class of drugs for the treatment
of asthma. At lower serum concentrations, theophylline is a weak
bronchodilator but retains its capacity as an immunomodulator,
anti-inflammatory, and bronchoprotective drug(48). In the study to
evaluate the addition of methylxanthines to standard treatments in
patients presenting with acute exacerbations of chronic obstructive
pulmonary disease (COPD), researchers at the indicated that the
available data do not support the use of methylxanthines for the
treatment of exacerbations of chronic obstructive pulmonary disease.
Potential benefits of methylxanthines for lung function and symptoms
were generally not confirmed at standard levels of significance(49).
b, Side effects are not limit to nausea and vomiting, and non-significant increases in tremor, palpitations, and arrhythmias, etc.
F.1.2. Surgery
Surgeries may be the only options for the patient with end-stage COPD, and suffering severe symptoms
1. Lung volume reduction surgery
In the study to to evaluate whether favorable short-term results in term
of functional outcome and survival following lung volume reduction
surgery persist for longer periods, showed that LVRS can lead to a very
long survival (10 years or more) in a small subgroup of patients, with
improvement of pulmonary functional data. Some preoperative data (upper
lobe distribution of emphysema and pulmonary arterial pressure) appear
to predict survival. Lung transplantation can be offered to these
patients, showing a trend to improved life expectancy(50).
2. Bullectomy
Bullectomy is the surgical removal of a bullae (greater than 1
cm) which is an air pocket in the lung with an aim to help COPD patients
breathe better. A bullectomy may be considered for giant bullae,
defined by a volume greater than a third of a hemithorax(51).
3. Lung Transplantation
Patients who are less than 65 years old with end-stage COPD but
suffering severe symptoms with no other significant disease may be
considered for lung transplant. It offers the greatest functional
benefits but also involves considerable risks(51)
According to the study Washington University, St Louis, Missouri, unfortunately, most emphysema patients are poor candidates for
any surgical intervention. A meticulous selection process is favoured
in which indications and contraindications are considered and the best
solution is devised for each patient. Patients with giant bullae filling half the thoracic volume and compressing relatively normal adjacent parenchyma are offered bullectomy;
those with hyperinflation, heterogeneous distribution of destruction,
forced expiratory volume in 1 second (FEV(1)) >20%, and a normal
carbon dioxide tension (PCO(2)) are offered LVRS; and patients with diffuse disease, lower FEV(1), hypercapnia, and associated pulmonary hypertension are directed towards transplantation. Using these criteria, few patients are serious candidates for surgical procedures. Combinations of LVRS and lung transplantation, either simultaneously or sequentially, are possible but rarely necessary(52).
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Sources
(1) http://respiratory-research.com/content/13/1/116/abstract
(36) http://www.ncbi.nlm.nih.gov/pubmed/15955148
(37) http://www.ncbi.nlm.nih.gov/pubmed/23229070
(38) http://www.ncbi.nlm.nih.gov/pubmed/23245993
(39) http://www.ncbi.nlm.nih.gov/pubmed/14636078
(40) http://www.ncbi.nlm.nih.gov/pubmed/11249575
(41) http://www.ncbi.nlm.nih.gov/pubmed/21720220
(42) http://www.ncbi.nlm.nih.gov/pubmed/22768682
(43) http://www.ncbi.nlm.nih.gov/pubmed/15707855
(44) http://www.ncbi.nlm.nih.gov/pubmed/10619339
(45) http://www.ncbi.nlm.nih.gov/pubmed/11588541
(46) http://www.ncbi.nlm.nih.gov/pubmed/22895919
(47) http://www.ncbi.nlm.nih.gov/pubmed/22690572
(48) http://www.ncbi.nlm.nih.gov/pubmed/20859807
(49) http://www.ncbi.nlm.nih.gov/pubmed/14500434
(50) http://www.ncbi.nlm.nih.gov/pubmed/23207566
(51) http://www.ncbi.nlm.nih.gov/pubmed/16088435
(52) http://www.ncbi.nlm.nih.gov/pubmed/12832685
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