Treatment of Chronic Obstructive Pulmonary Disease

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The cornerstone of COPD treatment is giving up smoking and taking up general healthy habits, such as a balanced diet and regular physical exercise. It is also important to avoid environments that can cause irritation of the airways, like smoking areas, particularly in passive smoker situations, contamination, low temperatures, etc.

The main aims of COPD treatment are summarised in:

  • reducing the chronic symptoms of the disease;
  • decreasing the frequency and severity of exacerbations;
  • improving the prognosis.

The short-term benefits (control of the disease), as well as the medium and long-term ones (reduction in the risk of exacerbations, the accelerated drop in lung function or death) must be achieved.

Bullectomy, lung volume reduction, and lung transplant are the three surgical interventions that may be performed in very select patients with COPD. These treatments may lead to improvement in some cases, including functional capacity and quality of life.

Bullectomy, lung intervention

Bullectomy. It is a surgical procedure indicated for years for bullous emphysema. One of the consequences of COPD is “air trapping”. The difficulties in the movement of air during the exhalation phase causes the lung not to empty properly and leaves the remains of air that, under normal conditions, would be exhaled. This air is “trapped”. “Air trapping” is usually diffuse. However, in some cases this trapping is irregular and in some areas it is greater than in others. This phenomenon explains the bullae (or “bubbles” of trapped air).

In extreme cases, a type of valve system is produced in some bullae that allows air to enter with inhalation, but not escape during exhaling. These bullae can become very large.

Currently, there is evidence that shows that bullectomy can be beneficial in patients with severe COPD and giant bullae. Resecting a giant bulla decompresses the adjacent lung parenchyma and helps reduce the breathlessness and shortness of breath (dyspnoea) and improve lung function.

Pulmonary surgery, lung operation, Lung reduction

Lung volume reduction surgery. Once the medical treatment is optimised, lung volume reduction surgery may be a treatment option in selected patients with COPD and a predominance of emphysema. The best candidates for volume reduction surgery are those with emphysema mainly in the upper lobes and with a low exercise capacity. The results of a large study of over more than 1200 patients with severe emphysema showed volume reduction surgery had a significant although temporary effect on the level of the symptoms or the worsening of the quality of life, which indicates that it mainly has a palliative role.

surgery scalpel

Lung transplant. Lung transplant has been performed for more than 30 years in patients with end-stage COPD. COPD is the main indication for lung transplant. But although this intervention has shown to have a clear positive impact on lung function in patients with COPD, exercise capacity and quality of life, the benefit in terms of increase in survival is uncertain. However, indirect and convincing evidence shows that when appropriate patient selection criteria for transplant are applied, the quality of life, as well as the survival, improves after transplant.

Lung transplant may be indicated in patients less than 65 years-old and with advanced COPD. The criteria that the lung transplant patient candidate must meet, according to International Guidelines are a BODE (Body-mass index, airflow Obstruction, Dyspnoea, and Exercise) index from 7 to 10, or any of the following: history of hospital admissions due to decompensations and acute respiratory failure, pulmonary hypertension, and low lung capacity.

Man with respiratory support

Home Oxygen. There is scientific evidence that demonstrates that the administration of oxygen more than 15 hours a day improves survival of patients with COPD who have chronic respiratory failure (with low values of oxygen in arterial blood -PaO2-).

take part in regular physical exercise

Rehabilitation. Regular physical activity is one of the pillars of COPD treatment. The patient with COPD must change their habits and avoid sedentarism. There are studies that show that rehabilitation programs that include multiple elements (exercise training, therapeutic education, etc.) and multidisciplinary interventions improve the symptoms and the quality of life, and have an impact on hospital admissions.

There are no studies that show how to scale these programs so that they could be extended to whole COPD patient population. On the other hand, the patients that have done the training start losing the benefits obtained over time, leading to a need to take part in booster programs.

Rehabilitation programs are very important for selected patient groups, such as candidates for lung transplant, or relatively young patients with a poor response to treatment. In some cases, home rehabilitation programmes have been established.

Substantiated information by:
Núria SeijasNurse — Hospital at HomeNéstor SolerPneumologist — Pneumology Department

Published: 20 February 2018
Updated: 20 February 2018

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