Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases, including emphysema and chronic bronchitis. These diseases make breathing difficult. COPD can make it hard to catch your breath. Because breathing takes such hard work when you have COPD, you can become exhausted.

Overview and Symptoms

Emphysema harms the air sacs and makes the lungs over-inflated. Chronic bronchitis causes the airways to narrow.

You might not notice COPD in its early stages. The disease can develop over a long period of time without causing shortness of breath. If you experience any of these symptoms, smoke, or have a family history of COPD, it is important to talk with your doctor right away:

  • A cough with mucus that does not go away
  • Shortness of breath
  • Chest tightness and wheezing
COPD can be diagnosed in many ways.

  • Spirometry, a painless procedure during which you blow into a tube to measure how much air your lungs can hold, and how long it takes to breathe out.
  • Blood tests can help determine if the lungs are working properly.
  • Chest X-rays or CT scans allow doctors to examine detailed images of your lungs.
  • Additional tests may include an echocardiogram (which is an ultrasound test to check heart structure and function); cardiopulmonary exercise testing (a test on a bike or treadmill which can check how well the heart and lungs work together); or a sleep study (to check for COPD-related sleep disturbances).

Specialists in our COPD Clinic review test results in a team case conference, and then together create an individualized treatment plan. The conference includes physicians and specialists from general pulmonology, interventional pulmonology, thoracic (chest) surgery, thoracic radiology, palliative (comfort) care, and pulmonary rehabilitation. Our team approach among different specialists helps ensure precise diagnosis and treatment, and well-coordinated care for you.

Treatment

Our COPD and Emphysema Clinic provides the latest treatment options for patients with advanced chronic obstructive pulmonary disease (COPD). BIDMC is the first hospital in Boston to offer two new minimally invasive procedures — endoscopic lung volume reduction coils and endobronchial valves — that do not require a major operation and hold great promise for patients with COPD/emphysema.

The COPD and Emphysema Clinic’s full array of treatment options.

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

We offer individual sessions with pulmonary physicians to:

  • Discuss smoking cessation strategies
  • Initiate medication therapies to aid in smoking cessation
  • Help patients enroll in smoking cessation programs

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

Pulmonary Rehabilitation
- 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.

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 insurances, the program is typically six to eight weeks long with small classes and individualized attention.

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

Medications

- There are a number of different medications, in different forms, to treat COPD: pills, liquids or inhaled medicine delivered directly to the lungs.

You may need medication on a regular basis or only when you have a flare-up of symptoms.

  • Bronchodilators, the backbone of any COPD treatment regimen, open the airways
  • Anti-inflammatory medicines reduce inflammation (swelling) in the lung airways
  • Antibiotics treat lung infections
  • Phosphodiesterase-4 (PDE-4) inhibitors reduce inflammation (swelling) and promote smooth muscle bronchodilatation (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.

Vaccines

- Vaccines to guard against flu and pneumonia are also an important treatment step. Immunization can lower 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).

Alpha-1 Antitrypsin Deficiency

- There are also medical treatments 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 of the AAT protein. Over time, these infusions may slow the progression of emphysema and hopefully reduce symptoms associated with emphysema.

Oxygen Therapy

- When your lungs cannot deliver enough oxygen into your blood, oxygen therapy may be helpful. It may improve breathing and energy, and help people with COPD live longer.

You may need oxygen only for specific activities, or throughout the day. Portable oxygen systems use a facemask or nose prongs (a nasal cannula). Some patients may benefit from a transtracheal oxygen catheter. Doctors insert a small, flexible tube (catheter) into the windpipe to deliver oxygen directly into the lungs.

Minimally Invasive Procedures

BIDMC is the first hospital in Boston to offer two new minimally invasive procedures — endoscopic lung volume reduction coils and endobronchial valves — that do not require a major operation and hold great promise for patients with severe emphysema.

Both the coils and valves are each offered as part of a clinical study to evaluate their effectiveness. These devices may make it easier to breathe, exercise and enjoy everyday life for patients who are not responding to medicine, or who are too sick or prefer not to undergo surgery. Doctors in the COPD Clinic can determine if you may be a candidate for one of these endoscopic procedures.

Lung Volume Reduction Coils: Using a bronchoscope (a thin, flexible tube inserted through the mouth or nose under light anesthesia), doctors place coils (tiny, flexible spirals) in the airways of the lung.

The coils catch, gather, compress and reduce the size of the diseased and over-inflated lung tissue.

As the overblown lung shrinks, there is more room for the healthier lung areas and the diaphragm (breathing muscle) to expand. Patients can breathe easier.

Endobronchial Valves: Using a bronchoscope inserted through the mouth under anesthesia, doctors place small, umbrella-shaped, one-way valves inside the airways that lead to the most diseased part of the lung.

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.

Surgical Options

Some patients with advanced COPD/emphysema may benefit from lung surgery: bullectomy, lung volume reduction surgery (LVRS), or lung transplantation.

Bullectomy: 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.

Lung Volume Reduction Surgery: 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.

Lung Transplanation: A small percentage of patients with COPD may be candidates to replace one or both lungs from an organ donor. 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 one of two experienced local 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 chronic obstructive pulmonary disease (COPD)

  • 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

  • Certain kinds of emphysema

  • 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 

Palliative Care

Palliative care is specialized medical care for people with serious illness, focusing on providing patients with relief from the symptoms, pain and stress of a serious illness — whatever the diagnosis. The goal is to improve quality of life for both you and your family.

Palliative care offers expertise in:

  • Pain and symptom management

  • Assistance in complex medical decision-making

  • Psychosocial and spiritual support

You and your family may benefit from seeing the palliative care team if you:

  • Are struggling to cope with a new serious diagnosis or with the changes of advancing illness

  • Have symptoms, such as pain or difficulty breathing, which are limiting your ability to function

  • Are uncertain of how to decide what medical treatments are best for you

  • Want to focus your care on quality of life

  • Want more information about home-based services, including hospice

Learn More

The Chest Disease Center combines a team of highly skilled specialists with state-of-the-art facilities to provide multidisciplinary evaluation, treatment and care to patients who have benign (non-cancerous) and malignant (cancerous) lung diseases.

Chest Disease Center