May 22, 2020 by John Fernandez
Personalized Treatments Can Help COPD Patients Breathe Easier
Innovative treatments are available to help the estimated 12 million Americans with chronic obstructive pulmonary disease (COPD) breathe a bit easier A personalized treatment plan that combines devices that clean and open the airways to and from the lungs, with long-acting inhalers and medications can improve quality of life, slow down loss of lung function and prevent complications, according to Michael Hernandez, M.D., a pulmonologist and member of Baptist Health’s Quality Network (BHQN).
COPD can cause mucus to build up in the airways, triggering coughing, wheezing and difficulty breathing. This chronic congestion can lead to dangerous infections like pneumonia. Lung clearing devices like a “lung flute” help bring up phlegm from the bottom of the lungs to make breathing easier, says Dr. Hernandez. When a patient blows into the flute-shaped hand-held device, low-frequency sound waves travel to the lungs and vibrate and thin the secretions so they can be expelled.
Other lung-clearing devices use a different method to thin mucus. By creating and combining positive expiratory pressure and high-frequency oscillations, these devices help loosen mucus in the large and small airways during exhalation. High-frequency chest wall oscillation devices use an inflatable vest that inflates and deflates rapidly, applying gentle pressure to the chest wall. This works to loosen and thin mucus and move it toward the larger airways, where it can be cleared by coughing or suctioning.
“The vest is often used in our hospitals to treat patients who have severely obstructed airways and reduced lung function, which makes it difficult for them to use other lung-clearing devices,” said Dr. Hernandez. “Some patients also may benefit from having this system at home.”
“Airway clearance devices are not replacements for COPD medications, but rather should be used to complement a comprehensive COPD treatment plan,” Dr. Hernandez advised.
In July, the FDA approved a new soft-mist inhaler for long-term, once-daily maintenance treatment of airflow obstruction in patients with chronic bronchitis and emphysema – two progressive lung conditions associated with COPD. The inhaled spray relaxes and widens the muscles of the airways.
“This medication has a fairly novel delivery system that makes it effective for people who cannot properly time the inhalation of other long-acting beta agonists (medications that affect the muscles around the airways),” Dr. Hernandez said.
Dr. Hernandez and other experts find that many COPD patients do best on “triple therapy” – taking three different medications that treat different aspects of the disease. The medications include a long-acting beta-agonist, an inhaled corticosteroid and the anticholinergic, tiotropium bromide. A study published by the American Thoracic Society found that when patients took all three medications, their severe episodes of breathing difficulty, known as exacerbations, dropped by 62 percent.
“Corticosteroids are not recommended for some elderly patients because they can contribute to bone loss and eye problems. However, when this medication is withdrawn from the treatment plan, the two medications are still very effective at reducing exacerbations,” Dr. Hernandez noted.
A medication option for people with severe COPD is roflumilast tablets can help. This oral pill has an anti-inflammatory effect and also decreases exacerbation incidences. Dr. Hernandez warns that one common side effect of this medication is weight loss, and it is not recommended for people with liver problems.
Rehabilitation, Education and Support
A comprehensive COPD treatment plan also should include pulmonary rehabilitation, Dr. Hernandez advises. A program at South Miami Hospital includes medical management, emotional support, exercise, breathing retraining and nutritional counseling.
Many people with COPD also benefit from staying socially active and participating in support groups. Also offered at South Miami Hospital are Better Breathers Club, a free educational workshop, and a bi-monthly Pulmonary Hypertension Support Group.
Although there is no cure for COPD, a personalized treatment plan and lifestyle changes can help patients feel better and improve their quality of life. Cigarette smoking is the major risk factor for developing the disease. Quitting smoking, says Dr. Hernandez, is the most important lifestyle change people can make.
“When people quit smoking, their lung function immediately starts to improve and COPD treatments are more effective,” Dr. Hernandez said.