Chronic Obstructive Pulmonary Disease
Also indexed as: Chronic Obstructive Lung Disease, COPD,
Emphysema, Pulmonary Disease
Breathe easier if you have COPD, a disease that leaves you winded
and worn out. According to research or other evidence, the following self-care steps may help
keep oxygen flowing freely through your airways:
- Steer clear of smoke
- Kick the smoking habit, and avoid secondhand smoke and other
respiratory irritants
- Get to know NAC
- Take 200 mg of the supplement N-acetyl cysteine three times a day
to help break down mucus and supply antioxidant protection to lung tissue
- Add L-carnitine to your fitness routine
- Improve breathing during exercise by taking 2 grams of this
nutritional supplement twice a day
- Find relief with ivy leaf
- Ease symptoms naturally by taking 50 drops of a concentrated
alcohol extract twice a day
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full chronic obstructive
pulmonary disease article for more in-depth, fully-referenced information on medicines,
vitamins, herbs, and dietary and lifestyle changes that may be helpful.
About chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) refers to the combination of chronic bronchitis and emphysema, resulting in obstruction of
airways and poor oxygen transport in the lungs, respectively.
Although chronic bronchitis and emphysema are distinct conditions, smokers and former
smokers often have aspects of both. In chronic bronchitis, the linings of the bronchial tubes
are inflamed and thickened, leading to a chronic, mucus-producing cough and shortness of breath. In emphysema, the
alveoli (tiny air sacs in the lungs) are damaged, also leading to shortness of breath. COPD is
generally irreversible and may even be fatal.
Product ratings for chronic
obstructive pulmonary disease
What are the symptoms?
Symptoms of COPD develop gradually and may initially include shortness of breath during
exertion, wheezing especially when exhaling, and frequent coughing that produces variable
amounts of mucus. In more advanced stages, people may experience rapid changes in the ability
to breathe, shortness of breath at rest, fatigue,
depression, memory problems, confusion, and
frequent waking during sleep.
Medical options
Over-the-counter guaifenesin
(Robitussin®, Mucinex®) may help to thin mucous.
Bronchodilators, such as albuterol
(Proventil®, Ventolin®), salmeterol
(Serevent®), ipratropium
(Atrovent®), tiotropium (Spiriva®), and metaproterenol (Alupent®); oral corticosteroids, including prednisone
(Deltasone®); and inhaled
corticosteroids, such as fluticasone (Flovent®), triamcinolone (Azmacort®),
flunisolide (AeroBid®), and budesonide (Pulmicort®), as well as the combination fluticasone/salmeterol (Advair®), are commonly used
prescription drugs. Mucolytics such as Acetylcysteine (Mucomyst®) are prescribed to help
thin mucus secretions.
People with COPD should stop smoking and avoid secondhand smoke in order to slow the rate
of lung function decline. Individuals with COPD should receive yearly pneumococcal (pneumonia)
and flu vaccinations. Supplemental oxygen
therapy and breathing rehabilitation programs are recommended in some situations. Severe cases
might require lung volume reduction surgery or a lung transplant.
Dietary changes that may be helpful
Malnutrition is common in people with COPD and may further compromise lung function and the
overall health of those with this disease.1 However, evidence of malnutrition may
occur despite adequate dietary intake of nutrients.2 Researchers have found that
increasing dietary carbohydrates increases carbon dioxide production, which leads to reduced
exercise tolerance and increased breathlessness in people with COPD.3 On the other
hand, men with a higher intake of fruit (which
is high in carbohydrates) over a 25-year period were at lower risk of developing lung
diseases.4 People with COPD should, therefore, consider eliminating most sources of
refined sugars, but not fruits, from their
diet.
Chronic bronchitis has been linked to allergies in many reports.5
6 7 In a preliminary trial, long-term reduction of some COPD symptoms
occurred when people with COPD avoided allergenic foods and, in some cases, were also
desensitized to pollen.8 People with COPD interested in testing the effects of a
food allergy elimination program should talk with a doctor.
Lifestyle changes that may be helpful
Smoking is the underlying cause of the majority of cases of emphysema and chronic
bronchitis. Anyone who smokes should stop, and, although quitting smoking will not reverse the
symptoms of COPD, it may help preserve the remaining lung function. Exposure to other
respiratory irritants, such as air pollution, dust, toxic gases, and fumes, may aggravate COPD
and should be avoided when possible.
The common cold and other respiratory
infections may aggravate COPD. Avoiding exposure to infections or bolstering resistance with immune-enhancing nutrients and herbs may be
valuable.
Vitamins that may be helpful
N-acetyl cysteine (NAC) helps break down
mucus. For that reason, inhaled NAC is used in hospitals to treat bronchitis. NAC may also
protect lung tissue through its antioxidant
activity.9 Oral NAC, 200 mg taken three times per day, is also effective and
improved symptoms in people with bronchitis in double-blind research.10
11 Results may take six months. NAC does not appear to be effective for people with COPD
who are taking inhaled steroid medications.12
L-carnitine has been given to people with
chronic lung disease in trials investigating how the body responds to exercise.13
14 In these double-blind trials, 2 grams of L-carnitine, taken twice daily for two
to four weeks, led to positive changes in breathing response to exercise.
In a double-blind study, people with COPD received creatine or a placebo for 12 weeks. After the first 2
weeks of supplementation, all participants underwent an outpatient pulmonary rehabilitation
program. Compared with the placebo, creatine significantly increased muscle strength, muscle
endurance, and overall health status, but not exercise capacity.15 The amount of
creatine used in this study was 5 grams three times a day for 2 weeks, and then 5 grams once a
day for 10 weeks.
A review of nutrition and lung health reported that people with a higher dietary intake of
vitamin C were less likely to be diagnosed
with bronchitis.16 As yet, the
effects of supplementing with vitamin C in people with COPD have not been studied.
A greater intake of the omega-3 fatty acids found in fish oils has been linked to reduced risk of
COPD,17 though research has yet to investigate whether fish oil supplements would
help people with COPD. In a double-blind trial, people with COPD received a fatty acid
supplement (providing daily 760 mg of gamma-linolenic acid, 1,200 mg of alpha-linolenic acid,
700 mg of eicosapentaenoic acid, and 340 mg of docosahexaenoic acid) or a placebo (80% palm
oil and 20% sunflower oil) during an eight-week rehabilitation program. Compared with the
placebo, the fatty acid supplement significantly improved exercise capacity.18
While two of the fatty acids supplied in this supplement (eicosapentaenoic acid [EPA] and
docosahexaenoic [DHA] acid) are found in fish oil, is not known which components of the
supplement were most responsible for the improvement. Gamma-linolenic acid is found in evening primrose oil, black currant seed oil, and
borage oil; alpha-linolenic acid is found in
flaxseed oil and other oils.
Many prescription drugs commonly taken by people with COPD have been linked to magnesium deficiency, a potential problem because
magnesium is needed for normal lung function.19 One group of researchers reported
that 47% of people with COPD had a magnesium deficiency.20 In this study, magnesium
deficiency was also linked to increased hospital stays. Thus, it appears that many people with
COPD may be magnesium deficient, a problem that might worsen their condition; moreover, the
deficiency is not easily diagnosed.
Intravenous magnesium has improved breathing capacity in people experiencing an acute
exacerbation of COPD.21 In this double-blind study, the need for hospitalization
also was reduced in the magnesium group (28% versus 42% with placebo), but this difference was
not statistically significant. Intravenous magnesium is known to be a powerful
bronchodilator.22 The effect of oral magnesium supplementation in people with COPD
has yet to be investigated.
Researchers have also given coenzyme Q10
(CoQ10) to people with COPD after discovering their blood levels of CoQ10 were lower than
those found in healthy people.23 In that trial, 90 mg of CoQ10 per day, given for
eight weeks, led to no change in lung function, though oxygenation of blood improved, as did
exercise performance and heart rate. Until more research is done, the importance of
supplementing with CoQ10 for people with COPD remains unclear.
Antioxidants in general are hypothesized to be important for neutralizing the large amounts
of free radicals associated with COPD. However, use of two antioxidant supplements (synthetic
beta-carotene, 20 mg per day, and vitamin E, 50 IU per day) did not help smokers with
COPD in a double-blind trial, despite the fact that people who ate higher amounts of these
nutrients in their diets appeared to have lower risk.24
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
One double-blind trial found an ivy leaf
extract to be as effective as the mucus-dissolving drug ambroxol for treating chronic bronchitis.25
Mullein is classified in the herbal
literature as both an expectorant, to promote the discharge of mucus, and a demulcent, to
soothe and protect mucous membranes. Historically, mullein has been used as a remedy for the
respiratory tract, particularly in cases of irritating coughs with bronchial congestion.26 Other
herbs commonly used as expectorants in traditional medicine include elecampane, lobelia, yerba santa (Eriodictyon
californicum),wild cherry bark, gumweed
(Grindelia robusta),anise(Pimpinella anisum), and eucalyptus. Animal studies have suggested that some of
these herbs increase discharge of mucus.27 However, none have been studied for
efficacy in humans.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
Negative ions may counteract the allergenic effects of positively charged ions on
respiratory tissues and potentially ease symptoms of allergic bronchitis, according to preliminary
research.28 29
References:1. Pingleton SK, Harmon GS. Nutritional management in acute respiratory
failure. JAMA 1987;257:3094–9.
2. Fiaccadori E, Del Canale S, Coffrini E, et al. Hypercapnic-hypoxemic
chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional
status. Am J Clin Nutr 1988;48:680–5.
3. Efthimiou J, Mounsey PJ, Bensen DN, et al. Effect of carbohydrate rich
versus fat rich loads on gas exchange and walking performance in patients with chronic
obstructive lung disease. Thorax 1992;47:451–6.
4. Miedema I, Feskens EJM, Heederik D, et al. Dietary determinants of
long-term incidence of chronic nonspecific lung diseases. Am J
Epidemiol 1993;138:37–45.
5. Businco L, Businco E. Allergic pathogenesis in chronic bronchitis.
Allergol Immunopathol (Madr) 1975;3:1–8.
6. Krawczyk Z. Role of allergy of the immediate type in the pathogenesis
of chronic bronchitis in adults. Pneumonol Pol 1976;44:829–36 [in Polish].
7. No author listed. Preliminary study on the relation between allergy
and chronic bronchitis. Chin Med J 1976;2:63–8.
8. Rowe AH, Rowe A Jr, Sinclair C. Food allergy: its role in the symptoms
of obstructive emphysema and chronic bronchitis. J Asthma Res 1967;5:11–20.
9. Van Schayck CP, Dekhuijzen PN, Gorgels WJ, et al. Are anti-oxidant and
anti-inflammatory treatments effective in different subgroups of COPD? A hypothesis.
Respir Med 1998;92:1259–64.
10. Boman G, Bäcker U, Larsson S, et al. Oral acetylcysteine reduces
exacerbation rate in chronic bronchitis: a report of a trial organized by the Swedish Society
for Pulmonary Diseases. Eur J Respir Dis 1983;64:405–15.
11. Multicenter Study Group. Long-term oral acetylcysteine in chronic
bronchitis. A double-blind controlled study. Eur J Respir Dis
1980;61:111:93–108.
12. Decramer M, Rutten-van Molken M, Dekhuijzen PN, et al. Effects of
N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized
on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet
2005;365:1552–60.
13. Dal Negro R, Pomari G, Zoccatelli O, Turco P. L-carnitine and
rehabilitative respiratory physiokinesitherapy: metabolic and ventilatory response in chronic
respiratory insufficiency. Int J Clin Pharmacol Ther Toxicol 1986;24:453–6.
14. Dal Negro R, Turco P, Pomari C, De Conti F. Effects of L-carnitine on
physical performance in chronic respiratory insufficiency. Int J Clin Pharmacol Ther
Toxicol 1988;26:269–72.
15. Fuld JP, Kilduff LP, Neder JA, et al. Creatine supplementation during
pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax
2005;60:531–7.
16. Sridhar MK. Nutrition and lung health. BMJ
1995;310:75–6.
17. Shahar E, Folsom AR, Melnick SL, et al. Dietary n-3 polyunsaturated
fatty acids and smoking-related chronic obstructive pulmonary disease. Atherosclerosis Risk in
Communities Study Investigators. N Engl J Med 1994;331:228–33.
18. Broekhuizen R, Wouters EFM, Creutzberg EC, et al. Polyunsaturated
fatty acids improve exercise capacity in chronic obstructive pulmonary disease.
Thorax 2005;60:376–82.
19. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic
obstructive lung disease: effect of therapy. Magnesium Trace Elem
1990;9:132–6.
20. Fiaccadori E, Del Canale S, Coffrini E, et al. Muscle and serum
magnesium in pulmonary intensive care unit patients. Crit Care Med
1988;16:751–60.
21. Skorodin MS, Tenholder MF, Yetter B, et al. Magnesium sulfate in
exacerbations of chronic obstructive pulmonary disease. Arch Intern Med
1995;155:496–500.
22. Okayama H, Aikawa T, Okayama M, et al. Bronchodilating effect of
intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076–8.
23. Fujimoto S, Kurihara N, Hirata K, Takeda T. Effects of coenzyme Q10
administration on pulmonary function and exercise performance in patients with chronic lung
diseases. Clin Investig 1993;71(8 Suppl):S162–6.
24. Rautalahti M, Virtamo J, Haukka J, et al. The effect of
alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care
Med 1997;156:1447–52.
25. Meyer-Wegner J. Ivy versus ambroxol in chronic bronchitis. Zeits
Allegemeinmed 1993;69:61–6 [in German].
26. Hoffman D. The Herbal Handbook: A User’s Guide to Medical
Herbalism. Rochester, VT: Healing Arts Press, 1988, 67.
27. Boyd EM. Expectorants and respiratory tract fluid. Pharmacol
Rev 1954;6:521–42 [review].
28. Gualtierotti R, Solimene U, Tonoli D. Ionized air respiratory
rehabilitation technics. Minerva Med 1977;68:3383–9.
29. Jones DP, O’Connor SA, Collins JV, et al. Effect of long-term
ionized air treatment on patients with bronchial asthma. Thorax
1976;31:428–32.