COPD is a disease that causes permanent damage to the lungs. Medications typically treat the disease but cannot undo the lung damage. So far, there is no medical treatment that has been proven to increase life expectancy in this disease, except for oxygen, which can help those who are specifically deficient in blood oxygen levels.
Modalities of controlled exercise as done in pulmonary rehabilitation centers are designed to improve the ability of the COPD patient to do activities of daily living, with less shortness of breath. The cornerstone of treating COPD is the goal of reducing exacerbations or hospitalizations and avoiding progression in the deterioration of the lungs.
People who suffer from COPD know what these exacerbations feel like. They often occur at night or at times when there is no one around, and the person is acutely short of breath and scared, so a common request is to have “oxygen around in case of an emergency.” They do not understand that oxygen will not help them to breathe better. It will just provide more oxygen to the blood, but it will not relieve the unpleasant feeling of shortness of breath. These feelings of shortness of breath are the result of the breathing muscles (diaphragm) working hard and getting tired. Normally, we don’t think about breathing, let alone feel that our breathing muscles are getting tired. That is what the COPD patient experiences.
To address these needs, and to avoid having to go to the emergency room when shortness of breath occurs, a new generation of machines, called “non-invasive ventilators,” has been developed. These machines do more than just give oxygen. They assist the breathing muscles to move air in and out of the lungs, a process known as ventilation.
To understand how the machines work, you have to understand the reason behind the unpleasant feeling of shortness of breath in COPD. Normally the diaphragm, the muscle located underneath the lungs, is responsible for most of the process of ventilation. In the resting state of people without COPD, it is shaped like a dome pointed upwards, and when it contracts and becomes flat, it expands the ribcage and opens the lungs, to allow more air to enter. The elasticity of the lungs is responsible for exhalation and it occurs naturally without any effort.
In COPD, the lungs are over-expanded and they lose their elasticity. Because of this over-expansion, the diaphragm is not dome shaped but already flat. For the COPD patient to inhale there is no way for the diaphragm to contract further, so the effort to bring in air (inhale) is done by other muscles including neck muscles and muscles between the ribs. Those muscles are not as efficient as a fully functional diaphragm. The result is that COPD patients use more energy just to breathe.
Non-invasive ventilators are designed to deliver air into the lungs to give relief and allow rest to the muscles involved in breathing. Previously, the only way to provide this relief was by putting a tube into the throat of the patient and connecting it to a ventilator which is called intubating a patient. This more invasive process necessitates admission to the intensive care unit and it essentially controls all your basic functions. Though done for as limited a time as possible, it still exposes the patient to all the dangers inherent in an ICU, including infections.
Now these home machines are strapped to the mouth and through a process called positive pressure move air in and out of the lungs without the need to put a tube into the patient’s throat. Non-invasive ventilation has literally taken struggling COPD patients out of their prison (repeated ICU visits), allowing them relief in the home setting.
One of the non-invasive prototypes is called the Trilogy, and it’s made by Phillips-Respironics. It is surprisingly small and portable considering the complexity of what it does. Hospitals frequently arrange for these machines to be delivered to the patient’s home in order to expedite the discharge of COPD patients who were admitted for respiratory failure. It is now one of the keys to preventing the need for re-admission later on. The Trilogy also has a feature that allows the patient to avoid strapping on the mask and to just use a mouthpiece while the machine delivers air. This feature is called “sip and puff.” The purpose is to provide some rest and relieve shortness of breath while allowing the patient an additional comfort level.
These new machines are complicated and the settings have to be adjusted by a trained and knowledgeable health professional. COPD is a very complicated chronic condition and so it it warrants the latest technology to improve quality of life. You are now armed with the latest therapeutic information to ensure that you live comfortably with your COPD.
Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.