Chronic Obstructive Pulmonary Disease (COPD)

Quitting smoking is the single most important step people with COPD can take to improve their health. It is one of the only ways to prolong life for those with chronic lung disease.

We offer individual sessions with pulmonary physicians to:

• Discuss smoking cessation strategies
• Initiate medication therapies to aid in smoking cessation
• Help patients enroll in smoking cessation programs

Patients and doctors can also obtain free nicotine patches and counseling from a Massachusetts program called Quitworks.

We offer a comprehensive physical therapy program for people with COPD and other lung diseases whose daily activities are limited because of shortness of breath. Walking and climbing stairs, for example, can be very difficult if you cannot catch your breath.

Our pulmonary rehabilitation program will help you:

• Learn more efficient breathing strategies during activities such as stair climbing
• Manage chronic sputum production
• Begin a supervised exercise program that includes aerobic training such as walking or cycling, along with strength and flexibility exercises
• Increase endurance to perform daily activities at home and in the community

Covered by most insurances, the program is typically six to eight weeks long with small classes and individualized attention.

Please note that if distance prevents you from attending pulmonary rehabilitation at BIDMC, we can make arrangements to provide the rehab in a local institution, with oversight from our BIDMC team.

There are a number of different medications, in different forms, to treat COPD: pills, liquids or inhaled medicine delivered directly to the lungs.

You may need medication on a regular basis or only when you have a flare-up of symptoms.

• Bronchodilators, the backbone of any COPD treatment regimen, open the airways
• Anti-inflammatory medicines reduce inflammation (swelling) in the lung airways
• Antibiotics treat lung infections
• Phosphodiesterase-4 (PDE-4) inhibitors reduce inflammation (swelling) and promote smooth muscle bronchodilatation (relaxing the smooth muscle surrounding the lungs helps widen the airways)

Our COPD Clinic can review your medicines to be sure you are taking the right type and dose, and advise about any new medications that may be available.

Our clinic will also provide instruction on correct use of inhalers and an "Action Plan" for what steps to take when an exacerbation of chronic bronchitis occurs, including whether antibiotics or anti-inflammatory medications are appropriate.

Vaccines to guard against flu and pneumonia are also an important treatment step. Immunization can lower the risk of a respiratory infection. Respiratory infections can be especially serious for those with COPD. You may also need a booster vaccine for pertussis (whooping cough).

There are also medical treatments available if you have alpha-1 antitrypsin (AAT) deficiency. This inherited disorder can lead to lung diseases such as emphysema. AAT is a protein made in the liver that helps protect the lungs and other body organs.

People who have emphysema because of low AAT levels may benefit from infusions of the AAT protein. Over time, these infusions may slow the progression of emphysema and hopefully reduce symptoms associated with emphysema.

When your lungs cannot deliver enough oxygen into your blood, oxygen therapy may be helpful. It may improve breathing and energy, and help people with COPD live longer.

You may need oxygen only for specific activities, or throughout the day. Portable oxygen systems use a facemask or nose prongs (a nasal cannula). Some patients may benefit from a transtracheal oxygen catheter. Doctors insert a small, flexible tube (catheter) into the windpipe to deliver oxygen directly into the lungs.

Endobronchial Valves

Using a bronchoscope inserted through the mouth under anesthesia, doctors place small, umbrella-shaped, one-way valves inside the airways that lead to the most diseased part of the lung.

The valve stops inflow and allows escape of the trapped air in the diseased tissue so the healthier areas of the lung can breathe easier.

By deflating the overblown portion of the lung, the valve helps reduce the volume (size) of the diseased and over-inflated lung. Healthier lung tissue can expand and function more normally.

Some patients with advanced COPD/emphysema may benefit from lung surgery: bullectomy, lung volume reduction surgery (LVRS), or lung transplantation.

Bullectomy

Emphysema damages the air sacs of the lung, causing them to over-inflate and enlarge. Very large air sacs are called bullae. If these large sacs are concentrated together, and not spread throughout the lung, then surgeons can perform a bullectomy to remove them.

Once removed, the large sacs are no longer pressing on the healthy lung, so the remaining healthy tissue functions better for easier breathing.

Lung Volume Reduction Surgery

Emphysema destroys lung tissue. The hyperinflated (enlarged) portion of the lung compresses the relatively normal parts of the organ and limits its function. Lung volume reduction surgery (LVRS) removes the hyperinflated portion of one or both lungs, most of which is non-working tissue.

This gives the remaining healthier lung(s) and breathing muscles (the diaphragm and muscles in between the ribs) more room to expand in the chest cavity for easier breathing.

Lung Transplantation

A small percentage of patients with COPD may be candidates to replace one or both lungs from an organ donor. Although COPD affects approximately 30 million Americans, only a few hundred will undergo lung transplantation in the United States.

Our multidisciplinary team can determine whether patients might be eligible to undergo lung transplantation and assist in referring patients to one of two experienced local lung transplantation centers in Boston.

We can also provide follow-up care once you have had a lung transplant. Patients who are likely to benefit most from a lung transplant include those with:

• Severe chronic obstructive pulmonary disease (COPD)
• Pulmonary fibrosis (IPF), when tissue deep in the lungs becomes scarred over time (fibrosis) and cannot exchange oxygen
• Cystic fibrosis (CF), an inherited disease that causes a build-up of mucus (and bacteria) in the lungs and other organs
• Certain kinds of emphysema
• Pulmonary arterial hypertension (IPAH), increased pressure in the pulmonary arteries that causes shortness of breath, chest pain and other symptoms that may eventually limit all physical activity

Palliative care is specialized medical care for people with serious illness, focusing on providing patients with relief from the symptoms, pain and stress of a serious illness — whatever the diagnosis. The goal is to improve quality of life for both you and your family.

Palliative care offers expertise in:

• Pain and symptom management
• Assistance in complex medical decision-making
• Psychosocial and spiritual support

You and your family may benefit from seeing the palliative care team if you:

• Are struggling to cope with a new serious diagnosis or with the changes of advancing illness
• Have symptoms, such as pain or difficulty breathing, which are limiting your ability to function
• Are uncertain of how to decide what medical treatments are best for you
• Want to focus your care on quality of life
• Want more information about home-based services, including hospice