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(HealthDay News) — Millions of Americans take angiotensin-converting enzyme (ACE) inhibitors to lower their blood pressure, but a new study suggests they might also increase their odds of developing lung cancer.
Among people taking these drugs for more than five years, the increased risk may be as high as 14 percent. Although that seems a small number, it could represent a large number of patients, the study authors noted.
“The silver lining of our findings is that while we found an association, the risk at the individual patient level is likely low, even after 10 years of use,” said lead researcher Laurent Azoulay, an associate professor of epidemiology and oncology at McGill University in Montreal.
“For this reason, this should not deter patients from taking these drugs, should their physician deem the treatment appropriate,” he said.
Azoulay also cautioned that this is an observational study, and it can’t prove these drugs actually cause lung cancer.
Deirdre Cronin Fenton, from the department of clinical epidemiology at Aarhus University in Denmark, said patients should weigh the benefits of these drugs against a small possible risk.
“In an individual patient, any concerns about the risk of lung cancer should be balanced by the survival benefit associated with the use of ACE inhibitors,” said Cronin Fenton, who wrote an editorial that accompanied the study.
Both were published Oct. 24 in the medical journal BMJ.
For the study, Azoulay and his colleagues collected data on nearly 1 million patients whose medical records were in a British database. These patients began taking drugs to control blood pressure between 1995 and 2015.
The participants were at least 18, with no history of cancer, and they were followed up for an average of six years. During that time, nearly 8,000 developed lung cancer.
After accounting for factors that might influence the findings, such as age, gender, weight, smoking, drinking and history of lung disease, Azoulay’s team found that ACE inhibitors were tied to a 14 percent increased risk for lung cancer.
The risk for lung cancer was seen after five years of taking these drugs. For those who took them for more than 10 years, the risk increased to 31 percent, the researchers found.
A specialist not involved with the new study said patients taking ACE inhibitors should not worry because the benefits of these drugs far outweigh any risk for lung cancer.
“ACE inhibitors have been extensively studied in a multitude of large-scale, randomized clinical trials in very diverse patient populations,” said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.
In these trials, the benefits of ACE inhibitors have outweighed any potential risks, and many of these studies showed reductions in deaths without any evidence of an increased risk of cancer in general or lung cancer in particular, he said.
“These findings should not raise concerns about the safety of ACE inhibitors,” Fonarow said.
SOURCES: Laurent Azoulay, Ph.D., associate professor, epidemiology and oncology, McGill University, Montreal; Deirdre Cronin Fenton, Ph.D., department of clinical epidemiology, Aarhus University, Denmark; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Oct. 24, 2018, BMJ
Lung Cancer Symptoms, Stages, Treatment
Lung Cancer: The Leading Cause of Cancer Death
Lung cancer has emerged as the leading killer of men and women stricken with invasive cancer, affecting husbands and wives, friends and neighbors, and causing suffering for many families. In the United States, lung cancer overtook breast cancer as the leading cause of cancer deaths in women in 1987. Lung cancer deaths account for a quarter of all American cancer deaths, killing more people every year than prostate, breast, and colon cancer combined. Over 157,000 Americans are estimated to have died from lung cancer in 2015.
This disease is difficult to detect in its early stages, and treatments for lung cancer in its later stages provide a poor prognosis: Those with stage IV non-small cell lung cancer—the most common type—have an estimated 1 percent survival rate five years after diagnosis. The other type of lung cancer—small cell lung cancer—is even more aggressive. According to the American Cancer Society, the overall survival rate for lung cancer as of Jan. 1, 2014 stands at just 3%.
What Causes Lung Cancer?
The exact cause of lung cancer is still being investigated. Certain risk factors have been shown to play a part in causing cells to become cancerous. Risk factors for lung cancer include smoking, exposure to air pollution, and genetics.
Does Smoking Cause Lung Cancer?
The major cause of lung cancer in men and women is mainly due to cigarette smoking. In 1876, a machine was invented to make rolled-up cigarettes and thus provided cheap tobacco products to almost everyone. At that time, lung cancer was relatively rare. Smoking dramatically increased and so did lung cancers following this innovation. Currently about 90% of all lung cancers are related to smoking. Radon gas, pollution, toxins, and other factors contribute to the remaining 10%.
Cigarettes and cigarette smoke contains over 70 cancer-causing chemicals (carcinogens). Some of the carcinogens found in cigarette smoke include:
- Lead (a highly poisonous metal)
- Arsenic (an insecticide)
- Cadmium (a battery component)
- Isoprene (used to make synthetic rubber)
- Benzene (a gasoline additive)
Cigar smoke is particularly heavy on tobacco-specific nitrosamines (TSNAs), which are considered particularly cancerous.
Lung Cancer and Cilia
Cigarette smoke damages and can kill hair-like projections on airway cells termed cilia. The cilia normally sweep out toxins, carcinogens, viruses, and bacteria. When the cilia are damaged or destroyed by smoke, all of these items may accumulate in the lungs and may cause problems such as infections or lung cancer.
Lung Cancer Symptoms
Unfortunately, lung cancers often have either no early symptoms or nonspecific early symptoms that people often dismiss. About 25% of people with lung cancer and no symptoms are diagnosed after having a chest X-ray or CT during a routine test or as a procedure for other problems. Lung cancer symptoms that may be detected are included below.
List of Lung Cancer Symptoms
- Cough (chronic, recurrent)
- Weight loss
- Shortness of breath or wheezing
- Coughing up phlegm that contains blood
- Chest pain
Three Common Lung Cancer Screening Methods
Screening for lung cancer is usually accomplished using three methods.
A physical exam will look for signs of wheezing, shortness of breath, cough, pain and other possible signs of lung cancer. Depending on the advancement of the cancer, other early signs of lung cancer symptoms may include a lack of sweating, dilated neck veins, face swelling, excessively constricted pupils, and other signs. The physical exam will also include the patient’s history of smoking and a chest X-ray.
Sputum Cytology Exam
A sputum cytology exam involves a microscopic examination of a patient’s mucus (sputum).
Spiral CT Exam
This method of CT scanning builds a detailed image of the body’s internal workings. Inside a spiral CT machine, detailed images are taken of the relevant parts of the patient’s body. Those images are then linked to an X-ray machine to create 3D images of the patient’s internal organs. These images may reveal potentially cancerous tumors.
A study by researchers suggested that people aged 55 to 74 years old who had smoked at least one pack of cigarettes a day for 30 or more years may benefit from a spiral CT study of the lungs. At best, the screening methods find about 30% of lung cancers leaving the bulk (about 70%) cancers of lung undetected. In addition, some test results are not clearly diagnostic which can lead to patient concerns and possibly unnecessary biopsies or surgeries.
Lung Cancer Diagnosis
If the screening tests suggest a person has lung cancer, definitive diagnostic tests may be done by a pathologist. The pathologist will examine the patient’s lung cells in sputum, phlegm, or from a biopsy sample to type and stage the lung cancer.
Lung Cancer: Biopsy
As stated previously, a tissue sample taken from the patient’s suspected cancer is usually the best method to establish a definitive lung cancer diagnosis. In general, lung biopsies are obtained by either needle biopsy, a lung bronchoscopy technique, or by surgical removal of tissue. Many other tests may be done to get more information about the cancer’s spread.
See the following slides for types of lung cancer and lung cancer stages, including stage IV lung cancer.
Types of Lung Cancer
There are only two major types of lung cancers: small cell lung cancer and non-small cell lung cancers. Less than 5% of lung cancer tumors will take the form of a carcinoid tumor, while other cancerous tumors are even more rare, including adenoid cystic carcinomas, lymphomas, and sarcomas. Although cancer from another part of the body may spread to the lungs, these are not categorized as lung cancer.
Non-Small Cell Lung Cancer
Non-small cell lung cancers are the most common type of lung cancer. These cancers account for about 90% of all lung cancers and are less aggressive than small cell lung cancers, meaning they spread to other tissues and organs more slowly.
Small Cell Lung Cancer
Small cell lung cancer, also called oat cell lung cancer, accounts for about 10% of all lung cancers. This form of cancer tends to spread quickly.
Lung Cancer Stages: Stage 0 Through Stage 4
After the type of lung cancer is determined, the type is then assigned a lung cancer stage. The stage indicates how much the cancer has spread in the body (for example, to the lymph nodes or to distant organs like the brain). Stages for non-small cell lung cancers are different from small cell lung cancers. The stages listed below are taken from the National Cancer Institute’s lung cancer staging information:
Small Cell Lung Cancer Stages
Limited stage: In this form, small cell lung cancer is limited to one side of the chest, typically in the lungs and lymph nodes. About one in three people with small cell lung cancer have limited stage cancer upon the first diagnosis.
Extensive stage: This refers to small cell lung cancer that has spread throughout one lung, spread into both lungs, to lymph nodes on the other side of the chest or to other body parts. About two in three people with small cell lung cancer have extensive stage cancer upon first diagnosis.
Non-Small Cell Lung Cancer Stages
Occult (hidden) stage: In this stage, cancer cells appear in a sputum cytology exam or other test, though no tumor location can be found.
Stage 0 (carcinoma in situ): In this lung cancer stage, cancer cells are only found in the top layer of cells lining air passages and has not crept deeper into the lungs or spread beyond the air passages.
Stage I: A small lung cancer tumor (less than 3 centimeters across) is discovered, but has not spread to surrounding lung membranes, lymph nodes, or the main bronchial branches of the lungs.
Stage II: There are several ways that stage II lung cancer may be diagnosed. One is that the lung cancer has spread to lymph nodes near the lungs.
- Stage IIA: If the tumor is between 3 centimeters and 5 centimeters, the lung cancer is defined as stage IIA. Other factors can lead to this classification as well.
- Stage IIB: If the lung cancer tumor is between 5 centimeters and 7 centimeters, it is categorized as Stage IIB. Other factors can lead to this classification as well.
Stage III: As in stage II lung cancer, stage III has several definitions. One is that the lung cancer is found in both the lung and lymph nodes in the middle of the chest. Stage III lung cancer is divided into two subsets.
- Stage IIIA: This defines a lung cancer that has spread on the same side of the chest from where it started.
- Stage IIIB: This defines a lung cancer in which the cancer has spread to either the opposite side of the chest or above the collar bone.
Stage IV: This is the most advanced stage of lung cancer. The cancer can be any size, but two of these three things have happened:
- The cancer has spread to the opposite lung from where it began.
- Cancer cells have been discovered in the fluid surrounding the lung.
- Cancer cells have been discovered in the fluid surrounding the heart.
Lung Cancer Survival Rates
The American Cancer Society statistics are currently based on people diagnosed between 1998 and 2000 so the data may not reflect the effects of newer treatments. The data indicates that survival rates of patients living 5 years after being diagnosed with non-small cell lung cancers was dependent on the stage of the disease.
Stage I was about 49% (with surgical removal, about 75%) while stage IV survival was about 1%. Small cell lung cancers are more aggressive and the data, like that for non-small cell lung cancers, is not reflective of current survival rates.
However, even some data collected as late as 2008 indicates slow progress in increasing 5-year survival rates. The overall rate of both limited-stage and extensive-stage small cell lung cancer is about 6%. The overall rate of all stages (I to IV combined) non-small cell lung cancer is about 15%.
Early-Stage Lung Cancer Treatment: Surgery
Early stage (stage 0 or even some stage I) cancer treatment of non-small cell lung cancer may benefit from surgery. Part or all of a lung segment that contains the cancer may be removed; in some individuals, this may result in a cure. However, many patients still undergo chemotherapy, radiation therapy or both to kill any cancer cells not removed by surgery. Because small cell lung cancers are almost never diagnosed early, surgery (and other treatments) may prolong life but rarely, if ever, result in a cure.
Advanced Lung Cancer Treatment
Most small cell and non-small-cell lung cancers are treated with chemotherapy; they may also be treated with radiation therapy and surgery. In many patients with advanced disease, these methods may be used together, depending on the patient’s condition and recommendations by their cancer doctors.
Targeted Lung Cancer Therapies
New therapeutic treatments are being tried; for example, some therapies termed targeted therapies are designed to prevent or stop lung cancer cells from growing by targeting the new blood vessels that are needed to allow the cancer cells to survive and grow; other treatments target growth and multiplication of lung cancer cells by interfering with chemical signals required by growing or multiplying cancer cells (illustrated in this slide).
Clinical Trials for Lung Cancer
In addition to targeted therapies, there are a number of clinical trials that a person may qualify for. Some may be available in your hometown. These clinical trials have patients try the newest potentially helpful therapeutic methods and drugs to combat lung cancers. The National Cancer Institute’s web site listed below offers a list of current clinical trials; you and your doctor may find a clinical trial that may help you with this disease.
Life After Lung Cancer Diagnosis
After a diagnosis of lung cancer, it is not unusual to feel depressed and upset. However, research is ongoing and it is possible to survive and extend your life with treatment. Even with the diagnosis, there is evidence that people who develop a healthy lifestyle and stop smoking do better than those who do not change.
Lung Cancer and Secondhand Smoke
Tobacco smokers put others at risk of developing lung cancer. A nonsmoker (wife, child, significant other) who lives with a smoker has a 20% to 30% increase in risk of developing lung cancer due to exposure to smoke concentrations in their local environment.
Lung Cancer and Work Exposures
Although smoking results in the highest risk of causing lung cancers, other environmental exposures to certain compounds and chemicals increase the risk of lung cancer. Such agents as asbestos, uranium, arsenic, benzene, and many others increase the risk for developing lung cancers. Exposure to asbestos may cause lung cancer (mesothelioma) many years after the initial exposure so people may be at risk for lung disease for decades (10 to 40 years).
Lung Cancer and Radon Gas
Another chemical, radon gas, is considered to be the second leading cause of lung cancer. It occurs naturally but can seep into homes and collect in basements and crawl spaces. It is colorless and odorless but can be detected with relatively simple and inexpensive test kits. Smokers exposed to this gas have a higher risk of developing lung cancer than nonsmokers.
Lung Cancer and Air Pollution
There are a number of investigators that suggest air pollution contributes to the development of lung cancers. Several studies present data that airborne pollutants like diesel exhaust may cause some people to develop lung cancers. Researchers estimate that about 5% of lung cancers are due to air pollutants.
Increased Risk Factors for Lung Cancer
Although much is understood about lung cancers, there are still many things and situations that are unclear. For example, it is unclear why some families have a history of individuals with lung cancer and no clear risk factors. The same is true for some patients who develop lung cancers with no clear risk factors. Another occurrence such as drinking water that has high arsenic concentrations may increase lung cancer risk but how the process happens is not clear. In addition, the reason why adenocarcinoma in the lungs is more common in nonsmokers than smokers is also not known.
Lung Cancer Prevention
For the majority of lung cancers, prevention is possible if a person never smokes and avoids second-hand smoke. For smokers who quit — within 10 years — the risk of getting lung cancer drops to about the same risk as if they had never smoked. Avoiding other risk factors (for example, certain chemicals or compounds like benzene or asbestos or air pollution) may also prevent some people from developing lung cancers.
Additional Information on Lung Cancer
For more information about Lung Cancer, please consider the following:
- American Cancer Society
- National Cancer Institute
- American Lung Association
- Centers for Disease Control and Prevention
Reviewed by Charles Patrick Davis, MD, PhD
Lung Cancer Risks: Myths and Facts
Myth: It’s Too Late if You’ve Smoked for Years
Fact: Quitting has almost-immediate benefits. Your circulation will improve and your lungs will work better. Your lung cancer risk will start to drop over time. Ten years after you kick the habit, your odds of getting the disease will be half of what they are now.
Myth: Low-Tar or ‘Light’ Cigarettes Are Safer Than Regular
Fact: They’re just as risky. And beware of menthol: Some research suggests that menthol cigarettes may be more dangerous and harder to quit. Their cooling sensation prompts some people to inhale more deeply.
Myth: It’s OK to Smoke Pot
Fact: Marijuana smoking may raise your lung cancer risk. Many people who use pot also smoke cigarettes. Some research shows that people who do both could be even more likely to get lung cancer.
Myth: Antioxidant Supplements Protect You
Fact: When researchers tested these products, they unexpectedly found a higher risk of lung cancer among smokers who took beta-carotene. Talk to your doctor first. It’s OK to get antioxidants from fruits and vegetables.
Myth: Pipes and Cigars Aren’t a Problem
Fact: Just like cigarettes, they’ll put you at risk for cancers of the mouth, throat, esophagus, and lungs. Cigar smoking, in particular, makes you much more likely to get heart disease and lung disease.
Myth: Smoking Is the Only Risk
Fact: It’s the biggest one, but there are others. The No. 2 cause of lung cancer is an odorless radioactive gas called radon. Given off by rock and soil, it can seep up into homes and other buildings. You can test your house or office for it. Call your state or county health department for information.
Myth: Talcum Powder Is a Cause
Fact: Research shows no clear link between lung cancer and accidentally breathing in talcum powder. People who work with other chemicals, including asbestos and vinyl chloride, are more likely to get the disease.
Myth: If You Have Lung Cancer, Quitting Is Pointless
Fact: If you stop, your treatment may work better and your side effects could be milder. And if you need surgery, ex-smokers tend to heal better than smokers. If you need radiation for cancer of the larynx, you’re less likely to become hoarse if you don’t light up. And in some cases, quitting makes a second cancer less likely to start.
Myth: Exercise Doesn’t Affect Your Risk
Fact: People who get regular physical activity may be less likely to get lung cancer, studies show. Working out also helps your lungs work better and helps prevent heart disease, strokes, and many other serious conditions.
Myth: Air Pollution Isn’t a Cause
Fact: Tobacco is by far the biggest threat, but air pollution is a risk factor, too. People who live in areas with a lot of it are more likely to get lung cancer than those who live where the air is cleaner. Many U.S. cities have cut down on air pollution in recent years, but there are still dangerous levels in other parts of the world.
Additional Information on Lung Cancer
For more information about Lung Cancer, please consider the following:
- American Cancer Society
- National Cancer Institute
- American Lung Association
- Centers for Disease Control and Prevention
Reviewed by Suchita Pakkala, MD
COPD Lung Symptoms, Diagnosis, Treatment
What is COPD?
COPD is the abbreviation for chronic obstructive pulmonary disease. COPD is a lung disease that results from obstructions in the airways of the lungs that lead to breathing problems. Although COPD is a progressive disease, early diagnosis and treatment may slow its progression. COPD may be complicated by chronic bronchitis or emphysema; some patients develop both problems that lead to additional breathing problems. Some clinicians consider chronic bronchitis and emphysema as simply further manifestations of COPD.
How Does COPD Affect the Lungs?
Damage to the lung tissue over time causes physical changes in the lungs and the airways become clogged with thick mucus. Compliance (the ability of the lung tissue to expand) becomes weakened because of this lung tissue damage. This weakened compliance or elasticity of the lungs means that oxygen cannot get to the air spaces where oxygen and carbon dioxide exchange occurs in the lung. This all leads to coughing to remove the thick mucus and eventually, difficulty in breathing.
Shortness of breath is the primary symptom of COPD. It occurs with daily activities and is caused by blocked or clogged airways and damaged or destroyed alveoli where oxygen is absorbed and carbon dioxide is released. Other COPD symptoms may include wheezing, chest tightness, and a chronic cough. The affected individual may tire easily, have frequent colds and flu infections, and produce excessive mucus or sputum. Symptoms of COPD slowly worsen and people with advanced symptoms of COPD may:
- Be obese from lack of exercise
- Have muscle loss and declining endurance
- Have morning headaches
- Have a bluish or greyish color underneath the fingernails due to decreased oxygen levels in the blood
- Conversely, some patients with COPD and emphysema may lose weight
Smoking and secondhand smoke plays a significant role in causing COPD. About 85% to 90% of all COPD deaths are related to smoking. The other causes are related to environmental irritants (pollution), and a rare few are genetically passed through family members (for example, people with Alpha-1 antitrypsin deficiency [AAT] are likely to develop COPD symptoms).
COPD Triggers: What Makes COPD Worse?
Half of all COPD exacerbations are triggered by bacterial or viral infections, whereas the rest of the triggers are caused by environmental factors. Minimizing exacerbations and avoiding COPD triggers can slow the progression of COPD. The following are common indoor and outdoor COPD triggers:
- Tobacco smoke
- Pet dander
- Stronger odors- perfumes, scented candles, and air fresheners
- Chemical fumes- cleaning products, paints, and solvents
- Pollution-outdoor pollution (vehicle exhaust, gas station fumes) indoor pollutants (fumes and odors from cooking, fireplace, dirty air filters
- Extremes in temperatures- extreme heat or cold
COPD: Chronic Bronchitis
Many patients with COPD also develop chronic bronchitis. Chronic bronchitis is a cough that occurs every day and causes inflammation of the airways, mucus overproduction, and frequent viral or bacterial infections. Since smoking is often the cause of chronic bronchitis, the “smoker’s cough” is a likely sign of COPD and chronic bronchitis. Treatment for chronic bronchitis can include bronchodilators, steroids, and oxygen therapy. Quitting smoking and avoiding air-borne bronchial irritants is also suggested.
Emphysema is a disease of the lung. In emphysema, the alveoli (small air sacs in the lungs that facilitate the exchange of carbon dioxide and oxygen) are damaged and die. Carbon dioxide and oxygen is not exchanged, and eventually the alveoli die leaving holes in the lungs that result in lost lung tissue and increased symptoms of COPD. Symptoms of emphysema usually include shortness of breath and sometimes cough and wheezing. Treatment for emphysema may include bronchodilating medications, steroids, antibiotics, and oxygen. Quitting smoking is also strongly suggested.
COPD Diagnosis: Physical Exam
An important part of the diagnosis of COPD is the physical exam, the patient’s breathing history, smoking history, and family history of COPD. The first simple, non-invasive test performed is usually with a pulse oximeter (shown in the picture on this slide). Oximetry measures the amount (% saturation) of oxygen in your blood. It is a way to test how much oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs. The pulse oximeter is placed on a body part (finger, ear lobe) and uses light to measure the oxygen levels.
COPD Diagnosis: Spirometry Breath Test
Spirometry is a test that measures how much air you can move in and out of your lungs over a short period of time, and is used to test for COPD. Spirometry involves breathing into a large hose connected to a machine, called a spirometer. The test can identify early COPD, and even help determine the stage of COPD in the patient. The test also shows how well certain medicines affect a person’s COPD symptoms.
COPD Diagnosis: Chest X-Ray
A chest X-ray may be able to show enlarged lungs that can occur in some patients with COPD (due to hyperinflation). However, X-ray is more useful to help rule out or rule in other problems that may cause symptoms similar to COPD, such as pneumonia.
COPD Treatment: Bronchodilators
Bronchodilators are medications that are commonly used to treat COPD by relaxing bronchial muscles. By relaxing these muscles, the airway becomes larger and allows air to pass through the lungs easier. Some are short-acting (4 to 6 hours) and are used when symptoms increase sharply, while longer-acting bronchodilators are used on a daily basis to treat more chronic COPD symptoms. People with COPD may use both types, depending on their symptoms.
COPD Treatment: Once-Daily Inhaler
There are at least 10 different inhalers available; they may contain one or more medications that may reduce COPD symptoms (bronchodilators, corticosteroids or combinations of both medications). For example, Spiriva contains tiotropium while Stiolto Respimat contains tiotropium bromide and olodaterol and is a once-daily inhaler available to COPD patients. This treatment relaxes muscles in the airways to improve breathing, but it should not be used to treat asthma. Stiolto Respimat is proven to be more effective that Spiriva or olodateral alone.
Before utilizing a once-daily inhaler, check with your doctor to help you choose the inhaler that is the best choice for your condition.
COPD Treatment: Corticosteroids
Corticosteroids reduce the inflammation in airway tissues and thus allow the airway to open. This medicine is often taken by inhaler, but also may be administered by pills and/or injection. Oral corticosteroids are used to treat COPD when symptoms get rapidly worse. Inhaled corticosteroids are used to treat stable symptoms of COPD or COPD symptoms that are slowly getting worse. Both corticosteroids and bronchodilators are often prescribed to patients with COPD.
COPD Treatment: Lung Training
It is possible to significantly slow COPD progression and to improve breathing with pulmonary rehabilitation classes. Part of this rehabilitation includes stress management and breathing control techniques. Pulmonary rehabilitation classes are taught by specialists who help improve one’s physical condition as well as how to manage COPD after completing the course. Pulmonary rehabilitation will educate clients on breathing techniques, medications, nutrition, relaxation, oxygen, travel, and how to stay healthy and avoid COPD exacerbations.
Breathing Exercises for COPD
Having COPD makes it harder to breath, which can lead to avoiding activities that leave you breathless. Here are some breathing exercises for people living with COPD:
- Pursed-Lips Breathing
This exercise involves breathing in through the nose (as if smelling something) for about two seconds. Then, purse the lips (like you are whistling or kissing) for two to three times longer than when you inhaled. Repeat as needed. This exercise makes exhaling easier for the person, and they also are able to extend exhalation, which provides improved oxygen and carbon dioxide gas exchange.
Pursed-lips breathing offers the following benefits:
- Slows down breathing
- Keeps airways open longer so your lungs can get rid of more stale, trapped air
- Reduces the work of breathing
- Increases the amount of time you can exercise of perform an activity
- Improves the exchange of oxygen and carbon dioxide
- Diaphragmatic (Abdominal/Belly) Breathing
The diaphragm is supposed to do most of the work when breathing, but COPD prevents the diaphragm from working properly. Instead the neck, shoulders, and back are used while breathing. Diaphragmatic breathing may seem more difficult than pursed-lip breathing and seeking help from a health care professional is recommended.
Begin by sitting back or lying down. Relax your shoulders and place one hand on your chest and the other on your belly. Inhale through the nose for two seconds. During inhalation, your belly should move outward and more than your chest. Exhale slowly through pursed-lips and gently press on your belly. This helps get the air out by pushing on the diaphragm. Repeat as needed.
Diaphragmatic breathing offers the following benefits:
- Increases total air volume exchange
- Trains the diaphragm
- Easier breathing
- Coordinated Breathing
Shortness of breath may cause you anxiety and you might hold your breath. Coordinated breathing helps to prevent this from happening. Before you are able to begin an exercise, inhale through the nose. Exhale, through pursed-lips, during the most strenuous part of the exercise. Coordinated breathing can be practiced during exercise or when feeling anxious.
- Deep Breathing
Shortness of breath can be caused by air getting trapped in your lungs and deep breathing can prevent this from happening. This exercise will also allow you to breathe in more fresh air. Begin by sitting or standing with your elbows slightly back, allowing your chest to expand more. Inhale deeply and hold your breath for a count of five. Exhale slowly and deeply until all the air has been released. Repeat as needed.
- Huff Cough
The huff cough helps you cough up mucus that had built up in your lungs. COPD can make it difficult to cough without getting tired, but the huff cough makes it easier to cough up mucus. Begin by sitting in a comfortable position and inhale slightly deeper than normal. Exhale while making a “ha, ha, ha” sound, as if you are trying to steam up a mirror. This allows you to become less tired when coughing up mucus. Repeat as needed.
COPD Treatment: Oxygen Therapy
COPD lowers oxygen in the blood. As COPD progresses, many people have oxygen levels so low that they get very short of breath doing simple everyday tasks like walking a few steps or just standing up for a few minutes. These people with COPD usually get some relief with supplemental oxygen administered through nasal tubing. Using oxygen at home for more than 15 hours a day can increase quality of life and help COPD patients live longer. Care must be taken when near someone using supplemental oxygen because it is flammable. Smoking, lit candles, or other open flames or sparking items (such as sparklers or gas cooking flames) should not be near someone using supplemental oxygen.
COPD Treatment: Antibiotics
Unfortunately, partially or completely blocked airways full of mucus are good places for pathogens (agents that causes disease such as a virus or bacterium) to occupy and multiply. People with COPD are at a higher risk for infections because they have partially or completely blocked airways. If fever accompanies an increase in shortness of breath, people with COPD should see their doctor to avoid serious infections. Antibiotics may be prescribed for bacterial infections.
COPD Treatment: Surgery
Surgery is not often used to treat people with COPD, but some people may benefit from certain procedures.
Surgical Procedures for COPD
Typically, a bullectomy is meant for patients with COPD related to emphysema. When the air sac walls are destroyed, larger air spaces (bullae) will form. A bullectomy will remove the bullae and allow some lung expansion.
Lung Volume Reduction
Lung volume reduction surgery (LVRS) takes place in patients who suffer from COPD related to emphysema. This procedure reduces the lung size by removing damaged tissues. The remaining lung and surrounding muscles are able to work more efficiently and allow functional airways to do better gas exchange.
A lung transplant is typically performed in patients with very severe COPD. During a lung transplant, the damaged lung is removed and replaced with a healthy lung. The procedure improves COPD symptoms and the quality of life for some select patients (average survival is about 5 years after transplant). However, a lung transplant can cause infections and possibly death if the body rejects the new lung.
COPD and Exercise
All people with COPD are usually advised to exercise, even those on supplemental oxygen. Walking is considered by most clinicians as the best form of exercise to begin with and to develop endurance. Patients can start slowly and gradually increase their endurance.
Types of Exercises for COPD Patients
- Stretching- start by stretching the arms and legs before and after exercising in order to prepare the muscles for activity and prevent injury and muscle strain
- Cardiovascular or aerobic- walking, jogging, jumping rope, bicycling, cross-country skiing, skating, rowing, and low-impact aerobics
- Strengthening- repeated muscle contractions until the muscle becomes tired
Benefits of Exercise with COPD
- Improve circulation and help the body better use oxygen
- Improve COPD symptoms
- Build energy levels so you can do more activities without becoming tired or short of breath
- Strengthen heart and cardiovascular system
- Increase endurance
- Lower blood pressure
- Improve muscle tone and strength; improve balance and joint flexibility
- Strengthen bones
- Help reduce body fat
- Help reduce stress, tension, anxiety, and depression
- Boost self-image and self-esteem
- Improve sleep
- Make you feel more relaxed and rested
Check with your doctor about exercising before you begin any exercise program.
The prognosis for people with mild COPD is very good, but the prognosis may worsen as the severity of staging increases. The average life expectancy of a COPD patient who undergoes a lung transplant is about five years. Patients diagnosed with COPD have a much better outlook if they quit smoking. COPD prognosis is dependent on the stage of the illness and the health of the patient.
The BODE Index
The BODE Index is a way to measure a patient’s COPD prognosis. This test takes into account the patient’s body mass index (BMI), airway obstruction (measured by FEV1), dyspnea (measured by the MMRC dyspnea scale), and exercise tolerance (measured by a 6-minute walk). The BODE Index can assess a COPD patient’s life expectancy.
There are four stages of COPD and each stage has different symptoms. Patients will usually participate in a pulmonary function test (PFTS) when being diagnosed with their stage of COPD.
Stage I (Mild COPD) Symptoms
- Shortness of breath when hurrying or walking on a slight incline
- No cough or mucus
- PFT results are usually 80% or more
Stage II (Moderate COPD) Symptoms
- Walking slower
- Become breathless when walking
- Possible cough or mucus
- PFT results are 50%-80%
Stage III (Severe COPD) Symptoms
- Stopping to regain breath after a few minutes of walking
- Possible cough and/or mucus
- Increased fatigue
- PFT results are 30%-50%
Stage IV (Very Severe COPD) Symptoms
- Too breathless to leave the house
- Breathless during everyday tasks
- Reduced quality of life
- PFT results are less than 30%
COPD and Diet
A healthy diet can help lessen symptoms of COPD. Obesity can make breathing and daily chores more difficult, while being too thin may cause weakness. Your doctor or a nutritionist can give you some guidance about a healthy diet for you. The following are some general dietary suggestions:
- Avoid under and over eating
- Monitor calories
- Limit salt intake
- Drink water, not caffeinated or carbonated drinks
- Eat high fiber foods (bran, fresh fruit)
- Avoid gas-producing foods (fried foods, beans)
- Eat small meals (3) with healthy snacks (2-3) every day
COPD: Smoking and Cancer
As mentioned previously, smoking, the leading cause of lung cancer, is also a major cause of COPD. Consequently, it is not surprising that many people with COPD also develop lung cancer. What is the best thing you can do to prevent COPD and lung cancer? Stop smoking, now. People who are diagnosed with COPD and who continue to smoke will have COPD progress faster. Smokers who quit will have COPD progress slower. Smoking cause the airway tissues to become damaged or destroyed. In addition, the many toxins in cigarette smoke can increase blood pressure, heart rate, and increase the risk for lung cancer.
Living With COPD
Living with COPD can be very difficult, but there are ways that can help you diminish symptoms and slow the progression of COPD. Although several have been described in the preceding slides, here is a list of ways to improve your daily life:
- Stop smoking
- Eat a healthy diet
- Stay active (exercise to improve your endurance)
- Use your medications as directed
- Get the flu vaccine every year and get vaccinated against pneumococcal pneumonia
- Use sanitary hand washing techniques and avoid people with respiratory infections or those that have symptoms (cough, sneezing, nasal drip)
Contact your doctor immediately if you develop increasing symptoms of COPD and develop a fever.
Reviewed by Charles Patrick Davis, MD, PhD