How to Treat COPD?

What does COPD treatment include?

COPD treatment has two main goals. The first is to reduce complaints and improve the quality of life, and the second is to slow down the progression of the disease. There is currently no treatment to eliminate COPD. However, the progression of the disease can be largely prevented by avoiding smoking and other risk factors.

• Ending smoking addiction and other harmful exposures that cause COPD. (It is impossible to be successful in treatment unless patients are removed from risk factors.)

• Drugs that open breath and reduce inflammation in the windpipe (They are generally used through the respiratory tract.)

• Expectant drugs

• Cough suppressant drugs

• Flu and pneumonia vaccines

• Regular exercise 

• Respiratory rehabilitation

• Oxygen therapy 

• Mechanical ventilation

• Alpha-1 antritrypsin

• Surgical treatment

Lung volume reducing surgery

Bullectomy

Lung transplantation

 

What are the aims of the treatment?

Increasing effort capacity.

Reducing complaints.

Improving quality of life.

Slowing down the progression of the disease.

Preventing exacerbations.

Unless COPD is detected at an early stage and patients are removed from risk factors, it is not possible to completely eliminate the negative effects of the disease on health. For this reason, people in the COPD risk group should have a breath test for early diagnosis.

In patients where smoking is the main reason for the development of the disease, "quitting smoking" forms the basis of COPD treatment. When smoking is stopped, the severity of deterioration in the windpipes and air sacs slows down. Cessation of other exposures such as smoking (biofuel, harmful gases and dust in the work environment, etc.) is also the basis of treatment. COPD medications It does not prevent the thread from moving forward. Medicines are used only to reduce shortness of breath.

Which drugs are used in the treatment?

Drugs used in the treatment of COPD, which widen the windpipes and reduce the inflammation that causes narrowing, are generally called " It is used by breathing, also called “inhalation”. In inhalation therapy, many different devices are used, with different working principles and shapes. The doses of drugs used by inhalation are very low. However, since the drugs reach the respiratory tract directly, their effects are very strong. Since the dose of the drugs is low and only a small portion of the dose used enters the blood, side effects are almost non-existent. Inhalation medications are not habit-forming and do not cause any harm to the teeth and lungs.

For inhalation therapy to be effective; It is necessary to choose the right device according to the patient and use the devices with the right technique and regularly. In order to use the devices with the correct technique, the patient must be trained by doctors and other healthcare professionals, and this training must be repeated over time.

When are expectorant drugs used?

In normal people, approximately 100 ml (about half of a glass of water) of mucus, called "mucus", is deposited in the windpipe a day. secretion is produced. This mucus layer, which covers the inside of the windpipes like plaster, protects the lungs from particles and microorganisms (viruses, bacteria) in the inhaled air. The mucous secretion is continuously transported towards the throat and swallowed together with saliva. Mucus secretion production increases abnormally for various reasons. The excessive amount of mucus that blocks the windpipes is coughed out in the form of sputum. Mucus that cannot be expelled can cause shortness of breath. In addition, mucus accumulated in the windpipes triggers more mucus production, causing infections.

Patients with COPD may sometimes have difficulty expelling sputum. Difficulty in expelling phlegm causes exhausting coughs and shortness of breath. In this case, medications that facilitate expectoration can be used. This group of drugs is called “mucolytics”.

Mucolytics cause thick phlegm. They can soften and liquefy the water and thus facilitate their excretion from the lungs by coughing. However, the use of mucolytics may not always have this effect. Therefore, if there is no benefit when used for the first time, it is unnecessary to continue using mucolytics.

It should not be forgotten that the most effective expectorant is to drink plenty of fluids. It is necessary to drink at least 7-8 glasses of water a day.

 

When are cough suppressants used?

Some COPD patients have difficulty expelling sputum even though mucus accumulates in their windpipes. Therefore, they have to cough strongly and very frequently to expel phlegm. Cough attacks make patients very tired, shorten their breathing and can prevent them from sleeping. During periods when coughing increases and is tiring, especially at night when it prevents sleep, a cough suppressant containing the substance "dextromethorphan", which is not very strong, can be used. However, when a stronger cough suppressant is needed, drugs containing codeine can be used. Cough suppressants are not medications to be used continuously and should only be used for short periods of time when coughs are very bothersome. Since codeine is a narcotic drug, it is often used in pain relief treatments and can cause addiction with continuous use. On the other hand, even if coughs are tiring, if phlegm is produced, cough suppressants should not be used.

When is alpha-1 antitrypsin used?

Alpha-1 antitrypsin (AAT) deficiency, a very rare genetic disease, can cause COPD. AAT treatment can be lifesaving in these patients. AAT is administered continuously as an intravenous infusion once a week.

When should the flu vaccine be administered?

Many different viruses cause flu epidemics in autumn and winter. Every year, viruses that may cause flu epidemics are identified and flu vaccines that will provide a protective effect against flu infections caused by these viruses are used. Flu vaccination may reduce the risk of severe respiratory infections and death in COPD patients requiring hospitalization. Flu vaccine features It shows its protective effect in elderly COPD patients. Side effects of the flu vaccine are usually mild and temporary. It is recommended that the vaccine be administered every year during the autumn and winter months, at the end of October at the earliest.

Which patients are given the pneumonia vaccine?

Pneumonia vaccines for people over 65 years of age. It is recommended for all COPD patients and above, as well as younger COPD patients who are accompanied by other diseases such as heart disease or are in severe stages. Pneumonia vaccines have been found effective in preventing severe pneumonia. Thus, the risk of severe exacerbations and death is reduced. Pneumonia vaccines are not repeated every year like the flu vaccine. The vaccination program should be implemented as recommended by your doctor.

What are the benefits of regular physical exercise?

COPD; It can cause serious limitation, inadequacy and obstruction in individuals' daily life activities. The disease causes inactivation, deconditioning and muscle weakness, thus reducing exercise capacity. Patients with reduced exercise capacity have difficulty performing basic care activities such as bathing and dressing.

There is no need for heavy exercises for adequate physical activity. Walking, an activity that everyone can do, can provide almost all the benefits of regular physical activity. Walking outdoors in cold or very hot weather and when there is air pollution will cause more harm than good. In this case, the alternative to walking is to use a stationary bike at home. To improve and maintain health, moderate-intensity physical activity (e.g. walking) for at least 30 minutes a day, at least five days a week, will be sufficient. You can also exercise for 10 minutes every morning. Exercise training programs for COPD should include upper and lower extremity strengthening training together. As the patients' ability to exercise increases, additions can be made to the exercises.

Benefits of regular exercise:

• Muscle strength increases

• Blood circulation and oxygen intake increases

• The workload of the heart and lungs decreases

• Weight decreases

• The feeling of weakness and fatigue decreases

• Sleep thirst decreases

• Morale and motivation increases

• Joints become stronger

• The immune system (the body's resistance system) becomes stronger

• The risk of heart diseases decreases

• Bones become stronger

• Osteoporosis is prevented

• Life expectancy is extended

 

What is respiratory rehabilitation?

In addition to drug treatment in COPD, rehabilitation such as regular exercise and physical activity, breathing exercises, application of airway cleaning techniques, proper nutrition and psychosocial support to protect and maintain a healthy lifestyle. approaches are needed. In respiratory rehabilitation centers, an organized program is implemented in which pulmonologists, physiotherapists, psychiatrists and dietitians work. The number of respiratory rehabilitation centers in our country is not sufficient. For this reason, the majority of our patients cannot receive this treatment opportunity.

 

What is oxygen therapy and how is it applied?

As COPD disease progresses, respiratory failure develops over the years and blood oxygenation is important even at rest. decreases at a rate. This condition is called “hypoxemia”. In case of hypoxemia, the oxygen necessary for life cannot be obtained. Most patients can tolerate mild to moderate hypoxemia. Hypoxemia can worsen over time and cause life-threatening damage to many systems and organs. Increased pressure in the vessels within the lungs, heart failure, kidney failure, deterioration in brain functions such as memory loss and speech disorders, blood clotting, high blood pressure, loss of muscle strength and decrease in exercise capacity are among the important effects of hypoxemia.

In patients who develop severe hypoxemia, oxygen therapy becomes mandatory in addition to COPD disease treatment medications. Oxygen therapy is applied for a long time only in hospitalizations due to exacerbations and in patients with severe hypoxemia, with oxygen being taken at home.

Industrial type oxygen cylinders cannot be used in long-term oxygen therapy at home as they will run out in a short time. Called "oxygen concentrator" for long-term oxygen therapy,

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