Treatments We Offer for COPD

The single most important step people with COPD can take to improve their health is to quit smoking. It is one of the only ways to prolong life for those with chronic lung disease.

We offer patients individual sessions with pulmonary physicians to:

• Discuss smoking cessation strategies
• Initiate medication therapies to aid in smoking cessation
• Enroll in smoking cessation programs

To make an appointment to discuss smoking cessation, call the Division of Pulmonary, Critical Care and Sleep Medicine at 617-667-LUNG (5864) and ask to schedule a visit with a lung specialist.

Patients and doctors can also obtain free nicotine patches and counseling from a Massachusetts program called Quitworks.

Additional Resources
Quit Smoking from the AHA
CDC: Quit Smoking

We offer a comprehensive physical therapy program for people with COPD and other lung diseases whose daily activities are limited because of shortness of breath. Walking and climbing stairs, for example, can be very difficult if you cannot catch your breath. The benefits of pulmonary rehabilitation in combination with appropriate medical therapy have repeatedly shown in studies to improve breathing.

Our pulmonary rehabilitation program will help you:

• Learn more efficient breathing strategies during activities such as stair climbing
• Manage chronic sputum production
• Begin a supervised exercise program that includes aerobic training such as walking or cycling, along with strength and flexibility exercises
• Increase endurance to perform daily activities at home and in the community

Covered by most insurance plans, the program is typically six to eight weeks long with small classes and individualized attention. You will need a physician referral. For more information, please call 617-754-9100.

Please note that if distance prevents you from attending pulmonary rehabilitation at BIDMC, we can make arrangements to provide rehabilitation in a local institution, with oversight from our BIDMC team.

Affiliated Programs
Beth Israel Deaconess Hospital-Plymouth
Outpatient Pulmonary Rehab Programs

A number of different medications, in different forms, are available to treat COPD: pills, liquids, or inhaled medicine delivered directly to the lungs. We follow recommendations and consensus statements from the American Thoracic Society (ATS) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD). You may need medication on a regular basis or only when you have a flare-up of symptoms (known medically as an exacerbation). Drug therapies can be as simple as one drug (monotherapy) or triple therapy, which include:

• Bronchodilators, the backbone of any COPD treatment regimen to open the airways
• Anti-inflammatory medicines, such as steroids, reduce inflammation (swelling) in the lung airways
• Antibiotics to treat lung infections
• Phosphodiesterase-4 (PDE-4) inhibitors to reduce inflammation (swelling) and promote smooth muscle bronchodilation (relaxing the smooth muscle surrounding the lungs helps widen the airways)

Our COPD Clinic can review your medicines to be sure you are taking the right type and dose, and advise about any new medications that may be available.

Our clinic will also provide instruction on correct use of inhalers and an “Action Plan” for what steps to take when an exacerbation of chronic bronchitis occurs, including whether antibiotics or anti-inflammatory medications are appropriate.

Additional resources from the American Thoracic Society:
COPD Patient Education

It is important to get yearly vaccination as prescribed by your physician. (Check with your doctor, because some patients have other conditions that make a vaccination inadvisable.) Immunization can protect against flu and pneumonia, and lessen the risk of a respiratory infection. Respiratory infections can be especially serious for those with COPD. You may also need a booster vaccine for pertussis (whooping cough).

Medical treatments are also available if you have alpha-1 antitrypsin (AAT) deficiency. This inherited disorder can lead to lung diseases such as emphysema. AAT is a protein made in the liver that helps protect the lungs and other body organs.

People who have emphysema because of low AAT levels may benefit from infusions (medications delivered intravenously) of the AAT protein derived from human plasma. Over time, these infusions may slow progression of emphysema and hopefully reduce symptoms associated with emphysema.

When your lungs become severely damaged in the setting of COPD, they cannot deliver enough oxygen into your blood. In this situation oxygen therapy may be helpful. It may improve breathing, energy and can help people with COPD live longer. You may need oxygen only while sleeping, doing specific activities, or you may need it throughout the day. Portable systems can deliver oxygen with the use a facemask or nose prongs (nasal cannula). Some patients may benefit from a transtracheal oxygen catheter. In this situation, a surgeon can place a small flexible tube (catheter) into the windpipe on the lower part of your neck to deliver oxygen directly into the lungs.

Endobronchial valves are a minimally invasive treatment for people with severe COPD/emphysema. The valves are an implant designed to fit in the airways of the lungs. The valves are placed in selected airways during a bronchoscopy procedure (no incisions or cutting required) and are an alternative to the more invasive traditional lung volume reduction surgery.

If you have severe COPD/emphysema you may struggle to catch your breath while doing everyday tasks. This is because the damaged parts of your lungs have lost their ability to release trapped air and have become overinflated. Endobronchial Valves are tiny, one-way valves that allow the trapped air to be exhaled from the lungs and prevent more air from becoming trapped there.

Generally, candidates who should be evaluated for Valve Treatment are patients who:

• Have a confirmed diagnosis of COPD or emphysema
• Have to stop to catch their breath often, even with taking their medication as directed
• Have reduced lung function

These are general criteria but the trained physicians at BIDMC can help determine if you are a candidate.

Under anesthesia, the doctor will use a small tube with a camera called a bronchoscope inserted through the mouth to place small, umbrella-shaped, one-way valves inside the airways that lead to the most diseased part of the lung.

During the procedure your doctor will place on average of four valves in the airways. The number of valves placed will depend on the individual anatomy of the patient’s airways and physician discretion.

The valve stops inflow and allows escape of the trapped air in the diseased tissue so the healthier areas of the lung can breathe easier.

By deflating the overblown portion of the lung, the valve helps reduce the volume (size) of the diseased and over-inflated lung. Healthier lung tissue can expand and function more normally.

Patients may stay in the hospital for a minimum of 3 nights. Some patients who experience a complication may be required to stay longer.

After the procedure, you will continue to use the medicines that your doctor has prescribed for your condition.

Please email us if you are interested in more information about this newly FDA approved therapy and whether or not you are a candidate.

Emphysema damages the air sacs of the lung, causing them to over-inflate and enlarge. Very large air sacs are called bullae. If these large sacs are concentrated together, and not spread throughout the lung, then surgeons can perform a bullectomy to remove them. Once removed, the large sacs are no longer pressing on the healthy lung, so the remaining healthy tissue functions better for easier breathing.

Emphysema destroys lung tissue. The hyperinflated (enlarged) portion of the lung compresses the relatively normal parts of the organ and limits its function. Lung volume reduction surgery (LVRS) removes the hyperinflated portion of one or both lungs, most of which is non-working tissue.

This gives the remaining healthier lung(s) and breathing muscles (the diaphragm and muscles in between the ribs) more room to expand in the chest cavity for easier breathing.

A small percentage of patients with COPD may be candidates for organ transplantation to replace one or both lungs. Although COPD affects approximately 30 million Americans, only a few hundred will undergo lung transplantation in the U.S.

Our multidisciplinary team can determine whether patients might be eligible to undergo lung transplantation and assist in referring patients to our partner lung transplantation centers in Boston.

We can also provide follow-up care once you have had a lung transplant. Patients who are likely to benefit most from a lung transplant include those with:

• Severe COPD
• Idiopathic* pulmonary fibrosis (IPF), when tissue deep in the lungs becomes scarred over time (fibrosis) and cannot exchange oxygen
• Cystic fibrosis (CF), an inherited disease that causes a build-up of mucus (and bacteria) in the lungs and other organs
• Emphysema caused by alpha-1 antitrypsin deficiency
• Idiopathic* pulmonary arterial hypertension (IPAH), increased pressure in the pulmonary arteries that causes shortness of breath, chest pain and other symptoms that may eventually limit all physical activity

* When a cause for a particular disease cannot be determined, the term “idiopathic" is used.