Chronic lower respiratory disease, or CLRD, is the fourth leading cause of death in the United States. Chronic obstructive pulmonary disorder, or COPD, is a form of CLRD. And while no cure exists for COPD, there are a number of effective treatments to help patients manage their symptoms, from inhalers and conditioning exercises to prescribed steroids and surgery.
Early Stages of COPD
COPD is a progressive disease, meaning that its symptoms get worse over time. “In the beginning, patients are able to manage the disease with exercise and a strict inhaler regimen to increase their breathing capacity,” said Dr. Gabriel Loor, surgical director of the lung transplant program at Baylor St. Luke’s Medical Center, “but over time and as the disease progresses, it becomes harder to manage.”
Some inhalers, for example, open up the airways to help patients breathe, but that is only temporarily effective up until the medication wears off and patients begin to experience inflammation in the lungs once again. “The tissue that supports your breathing unit, called alveolus, is the connected tissue of the lung that gives it flexibility and elasticity to expand and deflate. When that starts to break down, it stays stiff and it just can’t deflate,” said Loor. Over time, those cells start forming scars, and a lot of inflammation occurs in the lungs.
To counteract that cycle and stop the inflammation, patients may be prescribed steroids, which come in oral and inhaled forms, but when steroids are no longer controlling symptoms, patients may consider a permanent solution.
Patients with severe cases of COPD who have exhausted most medical management options will experience an irreversible decline in their health and quality of life. “The body devotes every resource in your body to breathing. You spend every living hour trying to breathe,” said Loor. “You become very thin and your muscle starts to break down, and if left untreated a person cannot survive.”
A select group of patients may be candidates for lung volume reduction surgery (LVRS). This is a surgical procedure to remove diseased, emphysematous lung tissue that is responsible for ”dead space,” which is the volume of inhaled air that does not participate in the gas exchange (the taking in of oxygen and removal of carbon dioxide). Bronchoscopic lung volume reduction (BLVR), a non-surgical treatment to decrease dead space, is also available for certain patients. BLVR, which consists of deploying bronchial valves or coils that slightly block the areas of the diseased lung, is emerging as a potential alternative to LVRS and a less invasive method to achieve lung volume reduction in patients with emphysema and hyperinflation.
In the 1990s, it was very rare for people living with COPD to consider lung transplantation as a long-term solution, but fast forward 20 years, and “transplants for people with COPD is not only a good option, but in many times, it’s the ideal option for patients with severe emphysema and who are still good candidates,” said Loor.
That’s in part because new technologies are making the donor procurement process less laborious and organs more viable. Loor is the principal investigator for a “breathing lung” device, a new donor lung preservation method that doubles the usual time donor lungs can remain outside the body prior to transplantation. “It gives us more options, more donors to look at, because the machine keeps the lungs viable for longer periods of time,” said Loor.
That means patients with COPD can get an organ faster than before because the donor lungs can now be retrieved from greater geographical areas. “I don’t have to worry so much about limiting the number of donors that my recipients have access to. We go outside of our border in Texas a lot more,” said Loor.
The quality of the organ seems to be better when transported via this device. “Randomized trials comparing this device to our usual way of doing it with ice have shown that the quality is better within the first 3 critical days of the transplant, so now I can offer patients with COPD a better lung.”
“Lung transplantation still has challenges that require further innovation such as long term rejection and other risks associated with the operation itself. So it’s important to not consider lung transplant too soon. But once indicated, lung transplant is an excellent option for good candidates.”
For information on the latest innovations in pulmonary care, schedule an appointment with your St. Luke’s Health pulmonologist or primary care physician.
NIH NHLBI | COPD
CDC | Basics About COPD