Chronic Obstructive Pulmonary Disease (COPD) (cont.)

The goals of COPD treatment are:

1. to prevent further deterioration in lung function;
2. to alleviate symptoms;
3. to improve performance of daily activities and quality of life.

The treatment strategies include:

1. quitting cigarette smoking;
2. taking medications to dilate airways (bronchodilators) and decrease airway inflammation;
3. vaccination against flu influenza and pneumonia;
4. regular oxygen supplementation; and
5. pulmonary rehabilitation.

The most important treatment for COPD is quitting cigarette smoking. Patients who continue to smoke have a more rapid deterioration in lung function when compared to others who quit. Aging itself can cause a very slow decline in lung function. In susceptible individuals, cigarette smoking can result in a much more dramatic loss of lung function. It is important to note that when one stops smoking the decline in lung function eventually reverts to that of a non-smoker.

Unfortunately, only about one third of the patients can abstain from smoking long-term. Reasons for difficulty in quitting include nicotine addiction, stress in the workplace and at home, depression, peer pressure, and advertising from cigarette companies.

Nicotine in cigarettes is addictive and therefore cessation of smoking can cause symptoms of nicotine withdrawal including anxiety, irritability, anger, depression, fatigue, difficulty concentrating or sleeping, and intense craving for cigarettes. Patients likely to develop withdrawal symptoms typically smoke more than 20 cigarettes a day, need to smoke shortly after waking up in the morning, and have difficulty refraining from smoking in non-smoking areas. However, some 25% of smokers can stop smoking without developing these symptoms. Even in those smokers who develop symptoms of withdrawal, the symptoms will decrease after several weeks of abstinence.

To help those patients with symptoms of withdrawal during the early weeks of smoking cessation, nicotine chewing gum (Nicorette Gum), nicotine inhalers, and nicotine skin patches (Habitrol, Nicoderm CQ, Nicotrol) are available in the United States. Nicotine replacement therapy can deliver enough nicotine into the blood to reduce but not totally eliminate withdrawal symptoms. Nicotine replacement methods in conjunction with intense patient education and behavioral modification programs have improved the rates at which individuals quit smoking. Nicotine skin patches are easy to use. They generally are used for four to six weeks, sometimes with a tapering period of several additional weeks. The addiction potential of nicotine skin patches is low. Sometimes a combination of several nicotine replacement therapies are utilized. It is important to note, that patients that continue to smoke while on replacement therapy are at increased risk for heart complications.

Bupropion (Zyban, Wellbutrin) is an antidepressant that has been found to decrease cravings for cigarettes. It has been shown to be of benefit to patients who want to quit smoking.

Varenicline (Chantix) is a medication is to aid in smoking cessation and has been approved for use in the US. Varenicline works in two ways; by cutting the pleasure of smoking and reducing the withdrawal symptoms that lead smokers to light up again and again. This medicine is taken over a 12 week course and can work in ways that bupropion does not.

In addition to nicotine withdrawal symptoms, quitting cigarette smoking also may lead to weight gain of about 8-10 pounds on average though more in some patients. Quitting smoking also can lead to depression and worsening of symptoms of chronic ulcerative colitis. Therefore quitting smoking should be undertaken with a doctor's supervision. Nevertheless, the benefits of quitting smoking (decreasing the rate of lung deterioration, decreasing risks of heart attack, lung cancer and other cancers, decreasing the chance of developing stomach ulcers, etc.) far outweigh these potential negative effects.

Source: MedicineNet.com
http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm