COPD Support - FAQ

Questions for Dr. Ramsdell:

What about stem cell research to help those with COPD?

Stem cell research is a very early phase for COPD -- so far it has not been particularly encouraging.

Do homeopathic medicines help?

Most homeopathic medications have not been studied adequately. They probably do no harm but people should be careful to monitor how they are reacting if they try them. The fact that they haven't been studied means that we don't really understand adverse effects.

Can the enzyme Serrapeptase help lung scarring in a patient with COPD?

No real good evidence that this will prevent scarring.

Why are some people able to maintain their lung function (FEV1 %) over long periods of time, say longer than 10 or 20 years?

This probably has to do with their genetic makeup controlling things such as immunity and mechanical characteristics of their lung defense mechanisms. It may also be impacted by continuing environmental exposure (e.g., secondhand smoke, pollution).

How often do you suggest spirometry?

Spirometry is critical to making the initial diagnosis. It is probably useful once a year in the absence of exacerbations. It is very helpful more often (perhaps monthly) following an acute exacerbation to document returned to baseline or stabilization.

You mentioned that there are no disease modifying drugs. What about Spiriva, Tudorza, and other "maintenance" medications?

These drugs help control symptoms and allow people to function better than they would had they not use them. They are not disease modifying in the sense that they have not been shown to prolong life.

Can you explain CO2 retention?

CO2 diffuses very easily through the alveolar wall (more easily than oxygen) as a result CO2 is more easily excreted than oxygen is absorbed. Therefore, most patients will have low blood oxygen levels long before they start to have CO2 retention (i.e., difficulty excreting CO2). When destruction lung tissue and blood vessels as a consequence of emphysema reaches a critical point and CO2 cannot defuse adequately and it builds up in the blood.

Is N-aceylcystein useful for COPD patients?

This is not proven to be useful in COPD.

Questions for the Lung Helpline:

Is it normal for people with COPD and on 02 24/7 at 4lpms to be taken off cold turkey?

If oxygen is used after an "exacerbation" due to some type of infection or other episode, the oxygen may only be needed until a person recovers. It is not uncommon to take a person directly to room air, as long as they are being monitored, and the oxygen saturation is being measured for a period of time. In most cases, there is no need to "wean" off the oxygen. The lungs do not work differently or become dependent on the oxygen.

What over-the-counter meds do people use to stop mucus?

Water is the best option, drinking several glasses a day to stay well hydrated (as long as you are not on some type of fluid restrictions). Mucinex is another product that we often recommend to help with retained secretions. Many people with chronic lung disease have a daily production of mucus, so if the mucus cannot be stopped, the goal is to get it out as easy as possible to help prevent infection.

When should pulmonary rehab be instituted and what is the criteria?

Pulmonary rehab is recommended for patients with chronic respiratory impairment who still have shortness of breath and reduced exercise tolerance despite optimal medical management. If you remember from the webinar, rehab is usually added as the disease becomes more severe. While a majority of patients in rehab programs have some form of COPD, this is also for people with many other chronic lung diseases that meet the same criteria.

What type of surgical interventions are available and for which patients?

Lung Volume Reduction Surgery (LVRS) is beneficial for a subset of patients with COPD. There are very tight guidelines on exactly who will benefit from this surgery. Other investigational procedures involve the use of a bronchoscope to either place stents to keep the airway open, or create channels to help reduce the air trapping in the most diseased parts of the lungs. Bullectomy may also be an option for those patients that have a large bulli. Lung transplantation is also an option for some people with COPD.

What is the chance that nonsmokers who were exposed to parental smoking for 20 years will develop COPD?

There is some evidence that second hand tobacco smoke can reduce lung volumes, and may contribute to COPD. Risk factors besides smoking include exposure to heavy second hand smoke, pollution, workplace exposures, and indoor cooking fire without proper ventilation. The exact risk may not be known. I would advise asking your doctor about a spirometry test, as this is the best way to find out if you are at risk.

I am on Symbicort and Spireva with Albuteroal when needed. I wake at night with extremely dry mouth. Is this a side effect of the medicines?

Yes, this can be related to most of the inhaled medications. Make sure you use a spacer when applicable, and that you rinse your mouth out very well after use. Many people keep a bottle of water near their bed to help with this. This is more of an issue in the winter months, when the air is already very dry.

What can I do to keep from getting a "sore throat virus" that makes me ill (sob, cough, mucus, tired) for a month or more? What specialist could i consult besides Pulmonologist & PCP to help stay healthy against virus?

Despite the best efforts, some people are unable to completely avoid this type of infection, especially this time of year. Of course, frequent hand washing by everyone in the home, avoiding touching your mouth or nose after touching things in public, avoiding anyone who might be sick, and avoiding crowds this time of year can all help. We also recommend the annual flu vaccine, the pneumonia vaccine, getting plenty of rest and exercise, and a healthy diet. If you use any inhalers like Symbicort or Advair, it becomes even more important to rinse your mouth out very well with every use, as this could also contribute to a sore throat.