What Other Treatments Are Available?
Many treatments are available, including educational programs, such as pulmonary rehabilitation, and different surgical procedures. All treatments should be reviewed with your healthcare provider and options should be discussed. The information in this treatment section is meant to give you basic information that will prepare you for that discussion.
Is surgery useful in COPD?
Surgery for people with COPD may be useful for those with large, isolated areas of emphysema in their lungs. Emphysema, however, comes in many types. One type of emphysema, seen in some patients with COPD, is emphysema affecting mostly the top portion of the lungs. If the enlarged air sacs caused from emphysema get outsized, the sacs are called bullae. Bullae may press down on the healthy parts of the lung that are near the bullae and a bullectomy may be needed. In some cases when damage to the lung has occurred mainly in the upper parts of the lung, lung volume reduction surgery (LVRS) may be needed. Only a small number of people with COPD actually have the kind of emphysema that requires and benefits from surgery.
What is a bullectomy?
A bullectomy is the removal of overinflated air sacs called bullae. These sacs are made up of what remains of hundreds of destroyed alveoli. These alveoli become destroyed from emphysema. In the patient with COPD, a bullectomy helps restore the work of the good parts of the lungs and removes the large, useless airsacs caused by emphysema. Most people with COPD have many good sacs available throughout the lungs and therefore would not benefit from surgery, or they may have many bullae in the lung that are small in size and cannot be surgically removed.
What is lung volume reduction surgery (LVRS)?
Lung volume reduction surgery (LVRS) was first performed in the 1930s and was considered "experimental" surgery. It was not until the 1990s that surgeons improved the surgical technique to make it available for some patients. Like the surgery for a bullectomy, LVRS involves removing useless air sacs. However, unlike the bullectomy, LVRS removes about one third of the upper portion of each lung (the upper lobes). This third of the lung may include some good tissue, but mostly useless tissue. As it is a major procedure, the circumstances must be just right for it to be done. Only people with a lot of emphysema in the upper lungs (seen on a CT scan) will benefit. The individual must have a strong heart and a healthy remaining lung after the procedure to justify the risk of the surgery. They must also show that they are willing to keep physically fit. For this reason, many surgeons require a person to stop smoking and complete a program of pulmonary rehabilitation before having the surgery. The success of this surgery depends on the type of surgery, severity of the patient’s lung and heart disease, and the person’s motivation to work to get well after the surgery.
What about lung transplantation?
Lung transplantation is the removal of one or both lungs. The lung, or both lungs, are replaced with someone else’s lung (lungs). Most patients with COPD will do better without a lung transplant. Common reasons for unsuitability for a lung transplantation include lung disease that is not severe enough to justify the risk of a transplant, health that is not strong enough to undergo the procedure or other organs in their body (e.g. heart, liver) that are not functioning properly.
What if I need general surgery for some other condition?
The older we get, the more likely it is that we will need to have surgery for one reason or another. People with COPD may therefore need surgery at some time in their life. Like anyone else, the more health problems you have, the greater the risk of complications during or after surgery. The lungs are affected by any surgery near the lungs and the anesthesia. Therefore, there are greater risks with surgery if you have COPD. Some people with COPD do very well during and after surgery, others do not. Your healthcare provider will evaluate you, the type of surgery you will have and will determine the need to do tests to find out if the surgery is a reasonable risk for you.
Are there tests or treatments I should have before any general surgery?
Before surgery, it is important to know the current state of your lungs. One or more breathing tests may be ordered for this evaluation. Before the surgery, you may need to be placed on additional medications such as steroids or antibiotics, as a precaution. Your healthcare provider may also be in contact with your surgeon to discuss your situation if they believe they need more information about the surgery. Besides the strength of your lungs, the healthcare team will want to be reasonably certain that you are in good overall physical health to undergo surgery. Some will recommend you undergo pulmonary rehabilitation in order to get you as physically fit as possible. If you can, you should begin an exercise program of your own, to build up your strength. Walking is a good form of exercise. If you smoke, you must stop at least 2 weeks before surgery, and then, hopefully, for good.
What is pulmonary rehabilitation?
Pulmonary rehabilitation is a program of education and exercise classes that teaches you about your lungs, how to exercise and how to do activities with less shortness of breath, and how to "live" better with your lung condition.
How will pulmonary rehabilitation help me?
By attending education classes, you will learn many things about your lungs. For example, the following topics will be discussed: what is wrong with your lungs, what your medicines do, when to call your healthcare provider and how to keep from being hospitalized. During group meetings, you will meet others with breathing problems. This gives you time to share concerns and approaches to living with breathing problems.
The exercise classes will help you to be more active with less shortness of breath. Usually, you will be exercising both your arms and legs. The exercise classes will help you feel better and become stronger by helping you get into better shape.
What should I look for in a pulmonary rehabilitation program?
You should look for a program that is designed for people with lung problems. The program should be run by healthcare providers who have experience in caring for people with chronic lung conditions. The classes may be in a group setting or customized for the needs of one person. In either case, the classes should be tailored to your needs.
What is the cost of a pulmonary rehabilitation program?
The cost of a pulmonary rehabilitation program can vary greatly depending on where you live. If more than one program is available in your area, compare the costs and the services offered.
Is pulmonary rehabilitation covered by insurance?
Insurance coverage is different between rehabilitation programs and insurance policies. Contact your insurance company or speak to the staff about program coverage.
Can I enter pulmonary rehabilitation if I smoke?
Some programs offer help with quitting smoking as part of the pulmonary rehabilitation program. Others require that you stop smoking before beginning the program. Rehabilitation and medications cannot reverse the damage caused by smoking. If you smoke, make a serious effort to quit. Get help if needed. Stopping smoking is an important part of getting stronger and healthier (see Management of stable COPD: smoking cessation).
How do I enroll in a pulmonary rehabilitation program?
Begin by talking to your healthcare provider about your interest in pulmonary rehabilitation. He or she can give you a referral to a program.
What happens after I finish the program?
What you learn and practice during the program should carry over into your daily life after the program ends. If you stop exercising after the program, the improvements you have made will soon be lost. The staff will work with you to design a long-term plan of exercise. The staff will guide you how and when to exercise at home. Many programs offer a "maintenance" plan so that you can continue to exercise with others with breathing problems.
What if I cannot afford pulmonary rehabilitation or a program is not available in my community?
If you do not have a program in your area, there are many things you can do on your own. Your quality of life can be improved by stopping smoking, learning how to correctly use inhaled medicines and by exercising regularly. Below is a simple exercise plan for a person with a lung condition. Talk with your healthcare provider, however, before starting an exercise plan.
One of the most important exercises for someone with lung problems is walking regularly. Begin walking slowly at a very comfortable pace for a period of time (say 5-10 minutes daily) 3-5 days a week. Do not increase the time you are walking until you can walk the entire time without stopping. When you can walk without stopping to rest, increase the time you are walking by 1-2 minutes each week. For example, if you can walk nonstop for 5 minutes a day for 5 days in one week, increase your walking to 7 minutes each day. Many people with severe lung disease can reach the goal of walking 30 minutes without stopping. Some people with lung problems require oxygen during exercise. If you have been prescribed oxygen for regular use, be sure to use it with exercise. If you are not sure about using oxygen, talk with your healthcare provider. Some of the resources listed below may help you either find a program or provide you with more information about lung conditions.
Resources for finding the right pulmonary rehabilitation program
Pulmonary rehabilitation programs are found in many parts of the world. There are both national and state organizations and societies that can help you find a program and information about your breathing problem.
Groups to contact for finding a program in the USA are:
- American Lung Association, telephone 1-800-LUNGUSA or www.lungusa.org, or contact your State or local chapter of the Lung Association.
- American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), telephone 312-644-6610 or www.aacvpr.org.
Other places to find contact information about lung disease are as follows:
- American College of Chest Physicians
- Canadian Lung Association
- The Pulmonary Education and Research Foundation (PERF)
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