Dear Dr. Roach: Would you tell me about the causes and treatment of COPD? I would like to know if medication is available, and whether the progression of the disease can be slowed or stopped. Is exercise appropriate? Also, I have seen ads for stem-cell therapy; does this hold any promise?
S.F.
COPD, which stands for “chronic obstructive pulmonary disease,” is a lung disease that limits the ability to move air into and out of the lungs. It is the third leading cause of death in the U.S., and the fourth in Canada. The two most-common forms of COPD are emphysema and chronic bronchitis. Some people have symptoms of both asthma and COPD. COPD is occasionally misdiagnosed as asthma. The earliest symptom of COPD is shortness of breath on exertion, and the other important symptoms are cough and sputum production.
In the U.S. and Canada, about 80 per cent of people with COPD have a history of smoking, the rest having exposure to dust and fumes in the environment.
Alpha-1 antitrypsin is an enzyme that some people are missing: These people are prone to develop COPD and liver disease. This happens in people who have never smoked, but smoking dramatically worsens the condition. People with COPD should be evaluated for this enzyme deficiency as early as possible.
Treatment for COPD is designed to improve symptoms and slow progression of the disease. Inhaled medicines to reduce obstruction, such as albuterol and ipratropium, are effective for short-term improvement in symptoms. Inhaled steroids reduce exacerbations and modestly slow progression of the disease.
For the majority of people with COPD due to smoking, the most important therapy is quitting smoking as soon as possible. Pulmonary rehabilitation, physical therapy and supplemental oxygen improve certain subgroups of people with COPD. Surgery, including lung-reduction surgery and lung transplant, rarely are used, but they may be appropriate for some individuals.
I do not recommend stem-cell therapy at this time, unless it is part of a clinical trial. You can find out about trials at clinicaltrials.gov.
Dear Dr. Roach: I am almost 78 years old and have acid reflux. It is pretty well under control. I have been on Prilosec or omeprazole (once a day, before breakfast) since 2009. I am careful about what I eat and when, particularly in the evening. We have raised the head of our bed about four inches. I have had one endoscopy to stretch a stricture, and the report is that everything looked OK.
In my desire to get off PPIs, my gastroenterologist has me taking a reflux suppressant, Gaviscon Advance, two teaspoons daily at bedtime. This nonprescription medication is ordered from England via Amazon. He says the product available in the U.S. does not have the ingredient that the Advance from England has.
The idea is that I begin tapering off the omeprazole and substituting the Gaviscon Advance. It also comes in chewable tablets. According to the bottle label, it forms a protective layer that floats on the stomach’s contents, preventing reflux. I would like to have your opinion of this medication.
C.P.
The U.K. version of Gaviscon Advance contains potassium bicarbonate, an antacid, and sodium alginate, which is intended to form a physical barrier to reflux. I reviewed several scientific studies confirming its effectiveness, both in relieving symptoms and in protecting the stomach from excess acid. It’s a novel approach to the problem, and it might be appropriate for someone who can’t take other treatments or in whom other treatments do not work.
I had trouble getting it from the U.K. site, but none at all from the Canada Amazon site.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
