Managing COPD

NHA Letter • October 2104Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by persistent airflow limitation and long-term decline in lung function associated with increased inflammation in the airways.1

COPD results from genes interacting with environmental exposures. Cigarette smoking is the most common cause of COPD, but pipes, cigars, water pipes, and marijuana smoking are also risk factors.1 Exposure to other toxic particles in the air (through dust, chemicals, and fumes) increases risk, as does a history of lower respiratory tract infections during childhood, chronic asthma, and poor nutrition.1

Symptoms

Most people with COPD experience a combination of signs and symptoms of chronic bronchitis, emphysema, and asthma. These include:

  • cough
  • worsening breathlessness and exercise intolerance
  • wheezing
  • sputum (phlegm) production

The first symptom is often chronic cough, which may or may not produce sputum. Difficulty breathing may not be noticeable until the disease is more advanced.1 With time, people with COPD may also experience fatigue, loss of muscle mass and weakness, osteoporosis, anemia, depression, mild cognitive impairment, high blood pressure, and heart failure.

Diagnosis

The following questionnaire has been scientifically evaluated and shown to identify people who are more likely to have COPD.3

  • Do you cough several times most days?
  • Do you bring up phlegm or mucus most days?
  • Do you get out of breath more easily than others your age?
  • Are you older than 40?
  • Are you a current or ex-smoker?

If you answered yes to three or more of these questions, you may have COPD, but you will need further testing to know for sure.

The most important test for diagnosing COPD and monitoring its severity and progression is spirometry. This common office test, in which you breath into a tube attached to the spirometer machine, measures how much air you inhale, how much you exhale, and how quickly you exhale.

Conventional Treatments Used

Since there is no cure, the goal of treating COPD is to maintain or improve quality of life. In addition to smoking cessation, the primary conventional treatment for COPD is drug therapy. Surgery and lung transplant are last-resort conventional treatments.

Drug treatment tends to begin with an inhaled short-acting bronchodilator, such as albuterol. As the disease progresses, additional drugs, such as long-acting bronchodilators (either beta-2 agonists or anticholinergics) are commonly prescribed, often in conjunction with inhaled steroids.

The use of these inhaled medications is associated with improved lung function and quality of life and reduced exacerbations. (The more exacerbations a patient with COPD has, the more damaged the lungs become and the faster the disease progresses.)

Despite their definite benefits, long-acting bronchodilators are associated with side effects such as:

  • increased heart rate or palpitations
  • nervous or shaky feeling
  • tremor
  • upset stomach
  • trouble sleeping
  • muscle aches or cramps

Meanwhile, the downsides to inhaled steroids include:4

  • increased risk for pneumonia
  • adrenal suppression
  • significant increase in risk for cataracts and glaucoma
  • possible decreases in bone mineral density and increased risk for fractures
  • candida (yeast) infections
  • hoarse voice
  • skin bruising.

Top-Researched Integrative Medicine Treatments for COPD

Vitamin D. About 33% to 77% of people with COPD have a vitamin D deficiency. The prevalence is higher in advanced stages of the disease.5 Some, but not all, studies have found a direct relationship between vitamin D levels and lung function in COPD patients.5

The most important question is whether higher levels of vitamin D can help treat COPD. Results have been mixed, but promising. In one study, patients with severe vitamin D deficiency experienced a 43% reduction in the annual rate of COPD exacerbations with vitamin D treatment. The study also showed that vitamin D supplementation improved immune function, strengthened the muscles involved in inspiration, and improved oxygen consumption in these patients.5

More clarity about vitamin D’s benefits should come soon. Two larger vitamin D studies are currently underway.6,7 There’s no need to await the results of these trials, however, before starting on vitamin D. Integrative and naturopathic physicians have been recommending high-dose vitamin D to most patients with COPD for years. Take 2,000 IUs per day or work with an integrative physician who can prescribe the ideal dose for you based on your current levels as measured by a blood lab test.

NAC (n-acetyl-cysteine). NAC is a unique form of the amino acid l-cysteine. Researchers believe NAC may work in a number of ways to treat COPD.8

  • It can thin and break up mucus, making it easier for the body to clear it from the lungs.
  • It can rapidly enter cells and release cysteine for production of the body’s most important and powerful antioxidant, glutathione.8,9
  • It has anti-inflammatory properties.
  • It has been shown to improve the body’s innate immune response.

Through all of these mechanisms, NAC could improve functioning in the small airways and reduce air trapping.

High-dose NAC (typically 600 mg twice a day) can reduce the total number of COPD exacerbations by an average of 41% and can prevent exacerbations in 25% of patients.10 The more severe the COPD, or the more frequently exacerbations are experienced, the better NAC may work.11

Antioxidants and fish oil. Researchers have found that daily supplementation with vitamins A, C, and E (antioxidants), and daily supplementation with omega-3 fatty acids (anti-inflammatories) or eating fish at least three times per week directly, significantly improves spirometry measures of lung function.12,13

The same associations are found with vitamin D and carotenes, such as beta-carotene.13

All COPD patients should consider taking a good multivitamin/mineral and fish oil supplement that provides a daily dose of at least 1,000 mg EPA and DHA combined.

In addition, the more fruit, vegetables, fish, vitamin E, and whole grains people consume, the less likely they are to develop COPD, the better their lung function (measured as forced expiratory volume in one second [FEV1]), and the less likely they are to die of COPD in the long term.13 On the opposite side of the spectrum, diets high in processed, refined foods have been associated with accelerated decline in FEV1.13

Precautions and drug interactions

Both NAC and vitamin D are generally regarded as safe and well tolerated.14 The most common complaints are gastrointestinal upset, but these are rare in the dosages recommended here. NAC should not be used by women who are breastfeeding. Use NAC with caution if taking anticoagulants or nitroglycerin. Do not use high doses of vitamin D if you have high calcium in your blood or urine and use with caution if you have a history of kidney stones.


1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2014 PDF.
2. Am Health Drug Benefits. Apr 2014; 7(2): 98–106.
3. Global Initiative for COPD website.
4. EBSCO Information Services. DynaMed [database online]. COPD.
5. Arch Bronconeumol. 2014;50(5):179–184.
6. ClinicalTrials.gov Identifier: NCT00977873.
7. ClinicalTrials.gov Identifier:NCT 01728571 .
8. Chest. 2014 Jan;145(1):194-5.
9. Brain Behav. Mar 2014; 4(2): 108–122.
10. COPD. 2014 Jun;11(3):351-8.
11. Chest. 2014 May 15. doi: 10.1378/chest.13-2784.
12. Public Health Nutr. 2013 Sep 27:1-6.
13. Transl Res. 2013 Oct;162(4):219-36.
14. Natural Standard. Professional Monograph. N-acetyl-cysteine.

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UHN Staff

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