10 Questions to Ask Your Doctor About COPD Treatment
Wondering where to begin with a COPD diagnosis? We've got the answers to some of your most pressing concerns about the disease.by Alison Gwinn Health Writer
If you watch broadcast TV, you've no doubt seen a lot of commercials for COPD medication. But what exactly is COPD, and what are the treatments for it? Who gets it, and why? Can you cure it? We took 10 of the most frequently asked questions about the disease to the experts, so they could give it to us straight. Here’s what we learned.
1. How does my doctor test for COPD?
People who have COPD, or chronic obstructive pulmonary disease, typically show up at the doctor’s office complaining of shortness of breath or coughing, says Nikita Desai, M.D., a pulmonologist at the Cleveland Clinic. To figure out what’s going on, your doctor will ask about your symptoms, as well as anything you might have been exposed to (like cigarette smoke, air pollutants or chemicals). You’ll likely be asked to take a pulmonary function test. This involves three things: spirometry (blowing into a tube to measure how quickly your air comes out); a lung volume test (measuring the relative size of your lungs, given your age, ethnicity, height, and gender); and a diffusion compacity test (seeing how well your body can take in air and swap oxygen for CO2 in your bloodstream).
2. Is COPD curable?
No. Unfortunately, COPD is a chronic medical condition (hence the name). It’s not curable and in some cases is progressive, says Dr. Desai. Its severity can depend on your race, gender, environment, and even genetics. The good news: The right treatment can help you reduce symptoms and slow the rate of progression. “Treatment is guided by different principles,” says Greg Diette, M.D., a professor of medicine at Johns Hopkins University who specializes in asthma and obstructive lung disease. “One is whether you are having symptoms regularly. The other is whether you are having flares of the disease. With that information, we can organize a patient’s care.”
3. Could other things be causing my shortness of breath, besides COPD?
It’s possible. “If you’re having trouble going up a flight of stairs, you could have COPD, but it could be caused by other things, too,” says Dr. Diette. “The body is a complex system—if your heart, lungs, liver, kidneys, or any other part of your body is not functioning normally, it can contribute to shortness of breath.” For instance, asthma, certain heart conditions, and anemia can all mess with your oxygen-carrying capacity. Your doc will likely rule out these possibilities first, before arriving at a COPD diagnosis.
4. What can I do to help my condition?
“You can’t reverse lung disease, but you can make certain lifestyle changes so you have the best quality of life possible,” says Dr. Desai. It goes without saying (but we’ll say it anyway) that if you smoke, you’ve got to quit asap. “That will have the biggest impact in reducing the progression of the disease and improving symptoms,” she says. Your doctor can share with you tools to help you quit, from counseling to medical aids. “These can include nicotine replacement in the form of patches, gum, lozenges and sprays, as well as varenicline and bupropion,” says Dr. Diette. Other ways to make it easier to live with the disease: Get your annual flu shot and a pneumococcal (or pneumonia) vaccine to avoid upper respiratory infections that can exacerbate symptoms, and make exercise a staple of your daily routine (more on that, below).
5. What is pulmonary rehabilitation and should I get it?
Pulmonary rehab refers a supervised program of physical exercise and breathing techniques, along with counseling about your condition—and yes, you should get it. If your doctor doesn’t mention it, you should bring it up. “A rehabilitation program helps patients breathe better and move around more easily, and it improves their quality of life by helping them manage mental health issues, like depression and anxiety,” says Dr. Desai. “Some studies show that patients are less likely to return to the hospital after an acute flare if they start rehab as they recover.”
6. How do bronchodilators work?
Most patients who have regular COPD symptoms will be prescribed either a short-acting or long-acting bronchodilator. This type of medication works by relaxing your airway so you can breathe more easily. It’s frequently administered through an inhaler (make sure to ask your physician or a respiratory therapist how to use one properly). Classes of bronchodilators include beta-agonists, anticholinergics, and methylxanthines (which are taken in pill, liquid, injection, or suppository form). Some COPD meds, like Trelegy, include a combination of meds.
7. Should I exercise if I am short of breath?
Absolutely. “No matter what stage of COPD you have, we recommend exercise,” says Dr. Diette. “With advanced COPD, there is a vicious cycle where you feel short of breath, so you exercise less, and then your muscles get deconditioned, so you do even less. Regular activity can help prevent that downward spiral.” On the flip side, maintaining physical fitness also cuts your lungs some slack. “An Olympic athlete can run up a flight of steps with no problem because his muscles are more efficient,” says Dr. Diette. “If someone is not fit, they have to hyperventilate to exercise hard. So if you have COPD, you want your muscles to be in as good a shape as possible to help out your lungs.” Always talk with your doc before starting a workout routine, to figure out the best program for your situation.
8. Are there other common medications for COPD?
Yes. Your doc might prescribe a corticosteroid, which acts as an anti-inflammatory and can be used to calm flares. Another common med is called Daliresp (roflumilast). “It helps a very specific subgroup of patients who have frequent flares and chronic bronchitis so they bring up a lot of phlegm every day,” says MeiLan Han, M.D., a professor of medicine in the division of pulmonary and critical care at the University of Michigan. Another, Elixophyllin (theophylline), is like a bronchodilator in pill form, says Dr. Han. It has been around for decades but has side effects like heart rate elevations, so is not as commonly used today as it once was.
9. Do I need oxygen therapy?
“As COPD progresses, shortness of breath may worsen and cause blood oxygen levels to drop,” says Dr. Desai. “At that point, we may recommend that a patient wear an oxygen device. It provides non-invasive, positive-pressure ventilation similar to a CPAP machine, which some people use to treat sleep apnea.” To receive oxygen therapy, you are usually first diagnosed with a significant degree of hypoxemia, meaning your blood is not getting enough oxygen.
10. Will I need surgery?
Though COPD treatment typically focuses on lifestyle changes and medication, surgery is a possibility as last resort. In lung volume reduction surgery, your doctor will remove damaged tissue from an over-inflated lung in order to reduce its size and allow the remaining healthy lung tissue to grow. Studies show it can improve shortness of breath, quality of life, and survival rates. Lung transplants are another option, “but they are reserved for people who are very far along,” says Dr. Diette, “and they need to be timed to extend a person’s life.” All surgeries come with risks, so you’ll want to talk with your doc about the pros and cons of each procedure.