Oxygen Therapy for COPD
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum production and wheezing. It’s caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.
Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It is characterized by daily cough and sputum production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure.
COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.
Symptoms of COPD often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and sputum production at least three months a year for two consecutive years.
Other signs and symptoms of COPD include:
- Shortness of breath, especially during physical activities
- Having to clear your throat first thing in the morning, due to excess mucus in your lungs
- A chronic cough that produces sputum that may be clear, white, yellow or greenish
- Blueness of the lips or fingernail beds (cyanosis)
- Frequent respiratory infections
- Unintended weight loss (in later stages)
People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.
Causes of COPD
The main cause of COPD in developed countries is tobacco smoking.
In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.
Only about 25 percent of chronic smokers develop clinically apparent COPD, although up to half have subtle evidence of COPD. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.
How your lungs are affected
Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).
The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.
Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and over-expand, which leaves some air trapped in your lungs when you exhale.
Causes of Airway Obstruction
- Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.
- Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.
Cigarette Smoke and Other Irritants
In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 25 percent of smokers develop COPD.
Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes.
In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1 antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the liver can occur in infants and children, not just adults with long smoking histories.
For adults with COPD related to AAt deficiency, treatment options include those used for people with more common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs.
Complications of COPD include:
- Respiratory infections. People with COPD are more susceptible to colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia will help prevent some infections.
- Heart problems. For reasons that aren’t fully understood, COPD increases your risk of heart disease, including heart attack. Quitting smoking markedly reduces this risk.
- Lung cancer. Smokers with chronic bronchitis have a greater risk of developing lung cancer than do smokers who don’t have chronic bronchitis. Quitting smoking also markedly reduces this risk.
- High blood pressure. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).
- Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression. (adapted from the Mayo Clinic Health Info)
Oxygen Therapy is an Important Part of COPD Treatment
While oxygen therapy for chronic obstructive pulmonary disease (COPD) may make some patients feel isolated or embarrassed, it offers a number of benefits and plays a crucial role in treating severe COPD.
“When the patient progresses to the point where the oxygen level in their blood drops, then they need oxygen,” says Norman Edelman, MD, chief medical officer of the American Lung Association and a professor of medicine at Stony Brook University. “Once you need it, if you take it 24/7 then you’ll have the best results. It’s one of the few things that’s actually been shown to prolong life.”
COPD Treatment: Benefits of Oxygen
In addition to helping you live longer, using oxygen for 15 or more hours a day can have the following benefits:
- Improving the health of your blood
- Make physical activity easier
- Improve your mental function.
Who Should Use Oxygen Therapy?
Oxygen therapy is recommended for use in patients whose COPD is considered stage IV or “very severe” based on the amount of oxygen in the blood or the presence of other health concerns such as pulmonary hypertension or congestive heart failure.
A doctor may prescribe supplemental oxygen before you reach this stage, however, and some people can benefit from using oxygen only during exercise, daily activities, or while sleeping. Your doctor will tell you how much oxygen you need (usually more than 89 percent) and when you should use it.
There are some mild side effects to oxygen therapy, including a reduced sense of smell and taste as well as cosmetic concerns related to the cords that attach the mask or nasal prongs to the face.
COPD Treatment: How Oxygen is Delivered
There are several options for oxygen delivery. You will have a source of oxygen (a tank, cylinder or oxygen concentrator) with a flexible cord that delivers oxygen to the nose by way of prongs (called a nasal cannula) or a mask.
“The easiest thing to use is an oxygen concentrator, which is an electrically driven device that concentrates oxygen in the air,” says Dr. Edelman. “But if you live in a place where electricity is not reliable, this is not a good option.” Many oxygen tanks are portable and rechargeable, so they don’t need constant access to electricity.
Perceived Downsides of Oxygen Therapy
Unfortunately, nearly half of patients feel that using an oxygen tank is bulky and embarrassing. They may not comply with their doctor’s recommendations for continuous use despite the known positive benefits of oxygen therapy. Instead, they may use oxygen for relief of COPD symptoms — although data suggest that as COPD gets worse, patients use their oxygen more often.
Many people avoid using their oxygen therapy when they are attending social or group activities outside of the house, although they may keep a backup supply of oxygen in the car in case they need it.
Some people only use oxygen at night, although studies have shown that using oxygen day and night reduces your risk of death by half compared with people who only use oxygen at night.
If you have concerns about when and where you can use oxygen as prescribed, talk to your doctor. Some patients worry that they might become addicted to oxygen (not true) or that they can no longer travel (also not true).
Your physician is the best person to respond to these concerns and help you determine whether and how oxygen can be part of your COPD treatment.
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