Chronic Obstructive Pulmonary Disease

Also indexed as: Chronic Obstructive Lung Disease (COLD), COPD, Emphysema, Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) refers to the combination of chronic bronchitis and emphysema, resulting in obstruction of airways. 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.

Checklist for Chronic Obstructive Pulmonary Disease

Rating Nutritional Supplements Herbs
3Stars N-acetyl cysteine (for bronchitis)  
2Stars L-carnitine Ivy leaf
1Star Coenzyme Q10
Fish oil (EPA/DHA)
Magnesium
Vitamin C		 Anise
Elecampane
Eucalyptus
Gumweed
Lobelia
Mullein
Wild cherry
Yerba santa
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of COPD? 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.

How is it treated? Doctors recommend that people with COPD stop smoking and avoid secondhand smoke. Medications, such as bronchodilators, expectorants, and corticosteroids, are commonly prescribed in oral or inhaled (using a nebulizer or inhaler) forms. Additional therapies may include pneumococcal (pneumonia) and flu vaccinations, supplemental oxygen therapy, and breathing rehabilitation programs. In cases of severe COPD, lung volume reduction surgery or a lung transplant may be recommended.

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.

Nutritional supplements 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.

L-carnitine has been given to people with chronic lung disease in trials investigating how the body responds to exercise.12 13 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.

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.14 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,15 though research has yet to investigate whether fish oil supplements would help people with COPD.

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.16 One group of researchers reported that 47% of people with COPD had a magnesium deficiency.17 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.18 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.19 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.20 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.21

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.22

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.23 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.24 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.

Other integrative 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.25 26

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. 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.

13. 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.

14. Sridhar MK. Nutrition and lung health. BMJ 1995;310:75–6.

15. 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.

16. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnesium Trace Elem 1990;9:132–6.

17. 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.

18. Skorodin MS, Tenholder MF, Yetter B, et al. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 1995;155:496–500.

19. Okayama H, Aikawa T, Okayama M, et al. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076–8.

20. 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.

21. 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.

22. Meyer-Wegner J. Ivy versus ambroxol in chronic bronchitis. Zeits Allegemeinmed 1993;69:61–6 [in German].

23. Hoffman D. The Herbal Handbook: A User’s Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 67.

24. Boyd EM. Expectorants and respiratory tract fluid. Pharmacol Rev 1954;6:521–42 [review].

25. Gualtierotti R, Solimene U, Tonoli D. Ionized air respiratory rehabilitation technics. Minerva Med 1977;68:3383–9.

26. 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.