Chronic Obstructive Pulmonary Disease (COPD)

COPD Overview:

COPD is an umbrella term for disorders characterised by a limitation in airflow into the lungs due to an inflammatory response. This includes emphysema, chronic bronchitis, and chronic asthma.

Although some cases are reversible, many cases are the result of long term inflammation and damage to the epithelial tissue in the lungs, resulting in fibrosis, and irreversible damage to the respiratory lining.

 

Aetiology:

Generally caused by chronic exposure to an airborn irritant such as smoke or air pollution. This leads to inflammation in the airway and alveoli of the lungs. This is thought to be mediated by an increase in protease activity and a decrease in antiprotease activity (esp α1 -antitrypsin) from the neutrophils in the lungs. Neuropeptides and reduced levels of vascular endothelial growth factor may also contribute to apoptotic destruction of lung parenchyma. Over many years, this can lead to damage and breakdown of the lung tissue.

In chronic bronchitis, this damage involves a hypersecretion of mucus into the bronchial passage, which comes with an increased risk and frequency of infection.

In emphysema, elastin breaks down, resulting in damage to the alveolar septa and a loss of elastic recoil of the bronchial walls.

In both conditions, the end result is a reduction in epithelial tissue, reduced gas exchange, and trapped air in the lungs.

In about 30% of COPD patients, colonisation of Haemophilus influenzae is also found.

+ Emphysema

  • Enlargement of the airspaces distal to the terminal bronchioles.
  • Caused by a destruction of the alveolar walls without fibrosis.
  • Eventually there is a loss of elastic recoil and lung hyperinflation
  • Airway resistance increases, as does the work of breathing, resulting in hypoxia and hypercapnoea.

+ Chronic Bronchitis

  • Productive cough most days, for 3 consecutive months, for at least 2 years.
  • Mucus gland hypertrophy in the bronchial tree
  • Increased goblet cells in the small airways (metaplasia)
  • Decreased number of ciliated cells
  • Hypersecretion of mucosa & lumen occlusion by mucus plugging
  • Mononuclear inflammatory processes
  • Focal squamous metaplasia
  • Smooth muscle hyperplasia
  • Fibrosis in the brochioles and resulting distortion
  • Alveolar hypoxia can lead to pulmonary vasoconstriction and pulmonary hypertension, resulting in less blood going to the left side of the heart, lowered vascular output, lowered circulatory volume, activation of RAAS, and fluid retention.

Learn more about bronchitis.

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Symptoms:

Shortness of breath

Wheezing

Tightness in the chest

Excessive mucus in the lungs

Chronic cough

Cyanosis of the lips or fingernail beds

Frequent respiratory infection

Fatigue

Swelling of the ankles and feet

 

Diagnostic Considerations

  • Pink puffer and blue bloater
  • Increased respiratory rate
  • Pitting edema in lower limbs
  • Loss of cardiac dullness on percussion
  • Genetic markers:
    • α1 -antitrypsin
    • 30 other genetic variants identified

Emphysema vs Chronic Bronchitis

Diagnostic Test Emphysema Chronic Bronchitis
Overall Appearance "Pink Puffer" "Blue Bloater"
Characteristic Findings Barrel Chest Jugular Venous Distention (JVD)
Respiratory Rate Increased Increased
Palpation Pitting Edema Pitting Edema
Auscultation Wheezing? Wheezing?
FVC INSERT INSERT
FVC1 <80% predicted value <80% predicted value
Chest X-Ray Hyperexpansion, pulmonary hypertension, Bullae Hyperexpansion, pulmonary hypertension
alpha-1-antitrypsin INSERT INSERT
Arterial Blood Gases INSERT INSERT
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Therapeutic Aims:

1. Improve Gas Exchange

...

  • Bronchodilators(Grindelia camporum, Adhatoda vasica, Drosera rotundifolia, Euphorbia spp, Coleus forskohlii, Glycyrrhiza glabra Magnesium)
  • Anticatarrhal(Solidago vigaurea, Hydrastis canadensis, Euphorbia hirta, Euphrasia officinalis, Plantago lanceolata, Sambucus nigra, Verbascum thaspus)
  • Mucus Membrane Trophorestoratives(Hydrastis candensis, Centella asiatica)
  • Circulatory Stimulants(Armoracia rusticana, Myrica cerifera, Sambucus nigra)

2. Eliminate Infection

(If necessary)

  • Antimicrobials(Thymus vulgaris, Allium sativum, Echinacea spp.)
  • Immunomodulators(Ganoderma lucidum, Astragalus membranaceus, Eleutherococcus senticosus)
  • action(herbs)

3. Reduce Inflammation & Allergic Response

...

  • Antinflammatories(Glycyrrhiza glabra, Verbascum thapsus, Allium cepa, Plantago spp, Boswellia serrata, Curcuma longa, Zingiber off, Camellia sinensis, Rehmannia glutinosa)
  • Antioxidants(herbs)
  • Respiratory Demulcents(Chrondus crispus, Plantago lanceolata, Verbascum thaspus, Glycyrrhiza glabra)
  • Anti-Asthmatics(Drosera rotundiflora, Euphorbia hirta, Justicia adhatoda)
  • Anti-Allergy(Albizia lebbeck, Scutellaria baicalensis )

4. Address Symptoms

(Such as cough, catarrh, fever)

  • Antitussives(Prunus seritona, Passiflora incarnata)
  • Respiratory Antispasmodics(Asclepias tuberosa, Drosera rotundifolia, Marrubium vulgare, Inula helenium, Euphorbia hirta, Prunus seritona, Thymus vulgaris, Justicia adhatoda, Hyssopus officinalis, Coleus forshkolii)
  • Diaphoretics(Archillea millefolium, Eupatorium perfoliatum, Allium sativum, Armoracia rusticana, Sambucus nigra, Tilia cordata)
  • Mucolytics(Allium Sativum, Amoracia rusticana, Pimpinella anisum, Cinnamomum cassia, Zingiber officinalis, Angelica archangelica)
  • Relaxing Expectorants(Asclepias tuberosa, Marrubium vulgare, Viola odorata, Althaea off, Tussilago farfara, Drosera rotundifolia, Foeniculum vulgare, Plantago spp, Hyssopus officinalis, Thymus vulgaris, Verbascum thapsus)
  • Stimulating Expectorants(Inula helenium, Polygala senega, P. tenuifolia, Lobelia inflata (Sched), Cephaelis ipecacuanha, Glycyrhizza glabra, Euphorbia hirta, Marrubium vulgare, Justicia adhatoda)

5. Address Complicating Factors

(Hayfever, leaky gut, autoimmunity)

  • Anti-Allergy(Albizia lebbeck, Scutellaria baicalensis )
  • action(herbs)
  • action(herbs)
 

Diagnostic Considerations:

  • Chest Xray
  • Vital signs
  • Chest auscultation
  • Blood testing:
    • Arterial blood glad (glad?... wtf?)
    • Full blood count
 

Differential Diagnosis:

  • Bronchiectasis
  • Untreated chronic asthma
  • Heart failure
  • Tuberculosis
  • alpha-1-antitrypsin deficiency
  • Acute bronchitis
  • Pulmonary embolism
  • Lung cancer 
 

Herbs For COPD:


Author:

Justin Cooke

The Sunlight Experiment

Updated: April 2018


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