Chronic obstructive pulmonary disease is a condition which results from a combination of bronchitis and emphysema, usually caused by smoking. People with COPD may experience shortness of breath and sputum production.

Tailoring of inhaled therapy

The mainstay of therapy for those with COPD is inhaled treatment, with a combination of bronchodilators ± inhaled steroids.

Bronchodilators are medicines which relax the muscles within the walls of the airways, aiding airflow and easing the sensation of breathlessness. Tailoring of inhaled steroids help to treat inflammation and the underlying disease process of COPD.

However, more recent evidence suggests that the use of inhaled steroids should be targeted to a selected minority of patients whose airways are actually responsive to this treatment.  Whereas inhaled steroids may be of great benefit to a few patients, they carry the potential for unnecessary side-effects in others.  Careful assessment is required to target this treatment to those most likely to benefit.

The assessments which we perform include measurement of exhaled nitric oxide (FENO), bronchodilator responsiveness and blood tests, as well as a full clinical assessment including your previous respiratory history, examination and review of existing and further xrays and scans.

Lung volume reduction procedures

Some patients with more advanced COPD may benefit from more radical treatments, such as lung volume reduction.  Because COPD causes the lungs to lose their natural springiness, they tend to become over-inflated.  Breathing with over-inflated lungs requires more work and is less efficient, which increases the sensation of breathlessness.

Some patients may benefit from a procedure to remove a portion of lung, either surgically or endoscopically by causing certain segments of the lung to collapse or fold up into less space.  Two different endoscopic treatments are possible.

A one-way valve is deployed within an airway, which allows air out but not back into the upstream segment. This helps to reduce the volume of the lung.

Several valves are deployed within one lobe of the lung.

The second method is to introduce a number of coils which restore some of the natural springiness to the lung, helping to prevent over-expansion.  In this subject coils have been inserted into the upper lobes of both lungs, which have the effect of reducing their volume)­­­

By whichever method, removal of this excessive lung volume improves thoracic mechanics and relieves the sensation of breathlessness.  Although these procedures carry a small risk, lung volume reduction is one of the few treatments which has the potential to extend life expectancy in those with severe COPD.

Selection of patients for lung volume reduction depends upon the findings from various investigations including a CT scan and full lung function testing in our lab.  After careful discussion of the pros and cons we can then refer those people who may benefit to a surgical centre for consideration and further tests.

If you have COPD and would like to discuss any of the above possible treatments or anything else, please contact us for an appointment at which we can discuss all aspects of your respiratory health and the details of the programme.  You can email or call on 01483 555800 ext 5297 or 07495 261 587.