1. How are inflammation and COPD related?

The higher the number of inflammatory cells within the airways (as body’s own protective mechanism), the higher is the airflow obstruction, and the COPD is worse.

2. Why does COPD cause cachexia and wasting?

COPD involves inflammation. Inflammation causes the body to secrete a number of chemically active substances. These substances alter a particular protein (viz leptin), which is responsible for the body’s energy balance by different mechanisms. The alteration in the leptin levels may in turn affect the body’s response to nutritional intake, causing a net negative balance.

3. Does influenza vaccine really help?

People with COPD who are vaccinated prior to flu season, during the season that year, are admitted fewer times to the hospital for pneumonia, die less frequently, and visit their doctors less frequently for respiratory problems.

4. Is there an “ideal” treatment for COPD exacerbations?

Treating a patient with COPD exacerbation with IV (intravenous) steroids (different from the muscle-building kind) for 72 hours and then switching to oral dose of steroids tapered over two weeks causes fewer deaths or need for mechanical ventilation and less problems with blood sugar control than compared to treating patients without steroids or treating with steroids for eight weeks.

5. Like asthmatics, are COPDers benefited from inhaled steroids?

Though the rate of decline of the airway obstruction appears to remain the same, the health status and measurable indices for the airway obstruction (viz FEV1- the amount of air that can be exhaled in one second) are minimally better in people treated with inhaled steroids as compared to those who are not. There is evidence that inhaled steroids do reduce the frequency of acute exacerbations and the need for hospitalization. There are ongoing long-term studies in progress which should give us a more definitive answer.

6. Can NIV (non-invasive ventilation) save you from mechanical ventilation?

Early (when the chemical balance of the blood is only mildly deranged) use of NIV in COPD patients admitted to the hospital causes fewer deaths and less frequent use of mechanical ventilation in them. This method of artificial ventilation does not require the placement of a tube through the mouth or nose to support the patient’s breathing.

7. How would I benefit from a lung transplant?

Though lung transplant may not improve your survival for two years, you may benefit from symptom relief if you have end stage lung disease from COPD.

8. What exactly do I gain from LVRS (lung volume reduction surgery)?

If as an end stage COPDer you have undergone LVRS you may have the benefit of improved QOL (quality of life) and improved walking distance without getting breathless, as compared to your counterparts who did not have surgery. Currently, ongoing studies including less invasive techniques are defining those who will benefit most from this form of treatment.

9. Does intensive multidisciplinary rehabilitation program have a role in the

treatment of COPD?

COPDers undergoing intensive rehabilitation will report better quality of life than COPDers who don’t, although there is no survival advantage at the end of one year. This form of treatment is definitely a must by today’s standards.

10. Should all COPD exacerbations be treated with antibiotics?

Most physicians now use antibiotics for treatment of acute exacerbations. Their choice of antibiotics may depend on the local bacterial populations and their sensitivities to specific antibiotics. Ongoing studies in this aspect of treatment may show additional benefits beyond the elimination of a certain bacteria.

Early Detection of Lung Cancer

Sputum cytology is an important method for the detection of lung cancer in the early stages. Unfortunately, not all medical centers have highly trained cyto-pathologists and technicians. All patients who smoke should be given pulmonary function tests. Results may indicate COPD and could help identify patients at highest risk for lung cancer. If the subsequent sputum cytology is not an option, at least a PA and lateral chest x-ray should be done. Not everyone is ready to accept these new concepts that fly in the face of conventional dogma. It is time, however, that the old lung cancer studies of the 1970’s gave way to new findings made possible in this high-tech era. These new procedures will produce exciting new opportunities for respiratory therapists, nurses, and physicians.