Most COPD conversations start with the basics. When someone is first diagnosed, things like medications, exercise, and developing action plans take center stage as you start learning how this condition works. To me, this is like the starting level of a video game. You learn what the controls do and how to move around the game world. That learning eventually takes you to the end of the level, where there is usually a puzzle to solve or a boss to fight. You put everything you have learned to that point to use, beat the challenge, and move on to the next level. As you progress, you start getting new tools or abilities to help you keep up with the challenges that become more and more difficult.
Working to overcome your COPD symptoms can be very similar. In the beginning, a medication or two may be enough to keep you active and your symptoms relatively low. However, as time goes by and your health changes, you may need to bring in some extra help to help you continue to meet your goals. Fortunately, there are a few things out there already that can “power up” your COPD care!
Beyond Bronchodilators
Depending on your symptoms, there are some medications outside of the usual inhalers and nebulizers that may help. Some people, especially those with a lot of phlegm or who find their symptoms flaring a lot, may see relief from certain antibiotics. Macrolides, the most common of which is azithromycin, have some anti-inflammatory properties along with their ability to fight infections. When taken by mouth a few times each week, macrolides may help you better manage your cough and keep you out of the hospital. However, they do have some potential side effects, so you will want to weigh the pros and cons carefully with your prescriber. Similarly, a newer class of medications called phosphodiesterase-4 (PDE-4) inhibitors can also act as anti-inflammatories. Like macrolides, they are taken as pills which means they can have effects outside the lungs. A new inhaled medication that also has PDE-4 effects, called ensifentrine, is likely to be approved sometime in 2024.
Relief Valves
If you ever feel like you cannot get enough air out before your next breath starts, you know what it is like to have air trapping in your lungs. In COPD, your lungs can lose some of their stretch, which means they do not deflate fast enough. Parts of your lungs can then over-inflate, adding pressure so that even healthier parts of your lungs do not work as well. Scientists have created tiny one-way valves that can be placed in the damaged parts of your lungs to allow them to deflate completely and stay deflated. That way, those healthier lung units can work more effectively. In addition, this technique (bronchoscopic lung volume reduction, or BLVR) can be done without a surgical incision. A pulmonologist uses a flexible tube called a bronchoscope to navigate your airways and place the valves where they belong. Not everyone’s anatomy works well with these valves, so again it is important to discuss the idea with your health care team. We have put together a BLVR 101 deck that covers the essentials to help you with that conversation, including a patient-focused section at the end.
Taking a Load Off
Finally, many people with COPD just get tired from all the extra work it takes to breathe. That can lead to poor sleep, low energy levels, and not being able to recover when you HAVE to exert yourself. Fortunately, there are some machines available to help you there, too. Respiratory assist devices (RADs) use extra pressure to make it easier to take a deep breath. Deeper breaths usually mean more oxygen in and more carbon dioxide out, which means a healthier breathing cycle. These machines are most commonly used at night; you may know them as noninvasive ventilators (NIVs). They help you have a better, more restful sleep period and can even be programmed to help treat sleep apnea, giving you even more benefit. Some machines can be used during the day with a portable oxygen source, helping improve activity tolerance and exercise capacity, too.
Scientists and health care professionals are constantly looking for new ways to improve the quality of life for people living with COPD. With new procedures and medications constantly under development, there are always new options to help you reach your goals and live your best life! Have you used any of the tools discussed here? Have questions about other things you may have seen or heard about? Let’s chat about it!