Complementary and Integrative Treatments For Chronic Obstructive Pulmonary Disease (COPD)

Although we fortunately do not have to think of breathing to remember to do it, when we do consider it, it very neatly breaks down into two movements. The in-breath and the out-breath. During an in-breath, air enters the lungs through the bronchi and fills the tiny air sacs (alveoli), where gas exchange occurs with the blood. Then, in an out-breath, the natural elasticity of the alveoli and the relaxation of the diaphragm and other muscles push the air out of the lungs.

Chronic Obstructive Pulmonary Disorder (COPD) is when the lungs are damaged in such a way that both the in-breath and the out-breath can become difficult or limited. An estimated 27 million Americans suffer from COPD, 12 million of whom are not yet diagnosed. Up to 90% of these cases are caused by smoking tobacco. This results in COPD being the third most common cause of death worldwide.

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What is Chronic Obstructive Pulmonary Disease (COPD)?

COPD is a group of progressive lung disorders. The main ones are chronic bronchitis and pulmonary emphysema. Together they affect both the ability to inhale and exhale properly.  

The inhibition of the in-breath occurs mostly through chronic bronchitis, which causes narrowing of the airways and buildup of mucus, physically obstructing the space through which the air flows. Just like when pinching a hose that is carrying water, this makes it more challenging to get fresh air into the lungs.

On the other hand, pulmonary emphysema (PE) affects exhalation The natural elasticity of the lungs and relaxation of the diaphragm is what pushes air out of the lungs, so when the elasticity is damaged, sometimes not as much of the air leaves the lungs, so there is less space for fresh air to enter. This makes for lower oxygen concentrations of the air in the lungs, even right after an in-breath.

COPD Symptoms

While there are numerous subtypes of COPD with some overlap in symptoms, the two main types are chronic bronchitis and emphysema.

Common symptoms of chronic bronchitis:

• Frequent coughing
• Excess mucus production
• Shortness of breath
• Wheezing
• Tightness in the chest

This diagnosis requires that there has been a chronic cough with mucus for at least 3 months of each of the past 2 years.

Common symptoms of emphysema:

• Cough
• Rapid breathing
• Excess sputum production
• Wheezing
• Shortness of breath, worse with activity
• Fatigue
• Heart problems
• Sleep problems
• Depression or Anxiety
• Weight loss

What Causes COPD?

COPD is caused by irreversible damage to the lungs. This damage is most often propagated by tobacco smoking. Other noxious exposures, like fine dust or toxic fumes at work or in the environment (i.e., air pollution), also play a role.

Gastroesophageal reflux (GERD) is also a well-known risk factor. The genetic variant causing a deficiency in alpha-1-antitrypsin is associated with the emphysema end of the COPD spectrum.

In the case of chronic bronchitis, the irritation leads to chronic inflammation and thickening of the walls of the bronchi and increased production and secretion of mucus by the goblet cells. This leads to a poorer ability of the little hairs in the lung lining to move contaminants up and out, as well as to a cycle of inflammation and congestion which impairs the ability to move air in and out.

In the case of emphysema, the damage occurs to the small sacs where air exchange occurs (alveoli). This starts with exposure to an irritant (i.e., cigarette smoke), which leads to an inflammatory response. In the course of the inflammatory response, the alveoli become irreversibly damaged. This is where gas exchange occurs, so that can be impaired. Airflow is also impaired, specifically the ability to exhale a lot of volume quickly (FEV1).

Impaired antioxidant defense, while not itself a cause, may increase vulnerability to damage as a result of exposure to cigarette smoke or other lung-damaging toxins.

Functional Medicine Labs to Test for Root Cause of COPD

The conventional diagnosis of COPD relies most heavily on lung function testing and other physical tests, rather than primarily on blood tests. In this case, functional medicine testing is in addition to testing performed to diagnose and monitor COPD patients and tailor treatment plans to improve outcomes.

Functional medicine practitioners loot at least one layer deeper into the root cause of an illness such as COPD. Some of the tests that may be used by functional medicine providers to provide additional direction for COPD patients include:

Advanced Oxidative Stress Profile

Given the significant increase in oxidative stress seen in those suffering from COPD and the role of oxidative stress in the progression of COPD, it may be useful to test antioxidant status both at baseline and during the course of treatment to monitor the effectiveness of interventions. The Advanced Oxidative Stress Profile test panel assesses oxidative/reductive balance. It includes the following biomarkers: % Reduced Glutathione, 8-OHdG, Creatinine, F2, Isoprostane, and Glutathione.

Redox/Antioxidant Protection Assay

This test dovetails nicely with the Advanced Oxidative Stress Profile, providing personalized recommendations for which specific antioxidants may be most beneficial for the individual at this point in time. The antioxidants are individually tested against the patient’s immune cells and rated according to the degree of improvement in immune cell function with the addition of the specific antioxidant or antioxidant-rich food. It can also be ordered bundled with the Cellular Micronutrient Assay (CMA) as the Cellular Nutrition Assay (CNA). This may make sense if there are reasons to be concerned about micronutrient nutrition status.

Metals Combo Test

Exposure to cadmium dust is linked to the development of COPD. As toxic metals can be stored in the body in tissues for years, if heavy metal exposure may have been a contributing factor, testing for heavy metals can be useful as a baseline and monitoring during specific interventions intended to mobilize and eliminate heavy metals. The Metals Combo Test includes Cadmium as well as a handful of the most common heavy metals to provide a comprehensive analysis of heavy metal exposure both in the past and present.

Alpha 1 Antitrypsin, Quantitative

A genetic deficiency in alpha 1 antitrypsin generally leads to the development of COPD at an earlier age. Knowing one’s levels would be useful to make more informed decisions about smoking, occupational and environmental exposures one is willing to accept, and potentially the intensity of nutritional interventions chosen. This blood test reports alpha 1 antitrypsin levels.

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Complementary and Integrative Treatments For Chronic Obstructive Pulmonary Disease (COPD)

Given the major contribution of oxidative stress and inflammation to the onset and progression of COPD, dietary and complementary interventions are often focused on antioxidant and anti-inflammatory effects.

COPD Diet

There is evidence that shows that a Mediterranean Diet is protective in individuals with COPD. Carotenoids and Vitamin E may protect against the damage caused by pollution that initiates the process of COPD. These can be found in vegetables (carrots, tomatoes, kale) (carotenoids) and in many nuts (Vitamin E). Another study in this review article showed a 10% improvement in lung function in ex-smokers in the group eating curcumin through regular curry consumption.

Supplements for COPD

There are many supplements that integrative practitioners use to help with COPD. Here are three of the most common:  

N-Acetyl Cysteine

N Acetyl Cysteine (NAC) acts as an antioxidant by increasing cellular glutathione levels and also has the ability to thin mucus. These are both potentially beneficial effects in COPD, which is worsened by oxidative stress and excess mucus.

There is evidence that high-dose oral NAC may decrease the rate of exacerbations in COPD. NAC is typically taken orally in capsules. Doses are commonly in the 600 mg once to three times a day range.

Vitamin D

COPD patients, due to difficulty exercising outdoors, often tend to spend more time indoors. This limits skin exposure to the sun and frequently results in Vitamin D deficiency.

A 2022 systematic review showed that Vitamin D could benefit those with COPD in a handful of ways, including by improving lung function (FEV1 and FEV1/FVC), reducing acute exacerbations, and reducing CAT scores. Vitamin D, as a fat-soluble vitamin, can build up to toxic levels in the body, so higher doses over a prolonged period of time should only be taken while monitoring vitamin D levels. Generally, supplementing with 2000 to 4000 IU of the D3 form daily is safe and effective in gradually improving Vitamin D status where it has been deficient. Vitamin D is most often taken orally and is well absorbed from oil-based forms, such as drops, which can also be easy to take and not have a limitation based on the digestion of a capsule.

Vitamin C

Vitamin C is widely used as a nutrient that typically acts as an antioxidant. In addition to acting as an antioxidant on its own, it also can significantly increase levels of glutathione, a very potent antioxidant in red blood cells. In the case of COPD, oxidative stress worsens the disease and progression, and several antioxidants are among the potential treatments.

A 2022 systematic review showed that Vitamin C could improve lung function (FEV1% and FEV1/FVC) and serum antioxidant status in those with COPD. Doses showing the most effect were over 400 mg daily. It is common practice and generally safe to supplement in the range of 200 to 2000 mg daily through oral routes, which may include dissolvable powders or capsules.

Improving Forced Expiratory Volume in COPD Patients

Many of us enjoy the mental relaxation resulting from practicing yoga or tai chi. These forms of exercise are also especially accessible to those who may have somewhat limited exercise capacity. Even so, a 2022 systematic review showed that yoga and tai chi significantly improved forced expiratory volume in 1 second (FEV1%), a test of lung function, in COPD patients.

Singing is something many of us enjoy doing and may intuitively feel makes us feel better. Even though it may not seem like exercise for the body or lungs, a 2009 study showed that weekly singing classes improve quality of life and lung function as related to expiration in people with COPD.  

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Summary

COPD is a common lung disorder that causes a major decline in quality of life as it progresses. Fortunately, some of the risk factors are changeable, such as smoking, and there are functional medicine tools to help slow the progression and improve the quality of life when it has been diagnosed. Starting early and committing fully to lifestyle interventions provides the most opportunity for delay of progression and improvement/maintenance of quality of life.