COPD Questions

[jackdup]

Three questions if I might
First, do the medications prescribed for COPD (Spiriva, Symbicort, Advair) slow the progression of COPD or only provide symptomatic relief? If they do not slow the progression, then given some of the side effects I may not use any of them.

The second question relates to quitting. Is it likely that if a person quits smoking their FEV1 (currently 67%) would improve and if so what would the likely amount of improvement be, and what timeframe would one expect to see an improvement in the FEV1 and breathing after smoking for 42 Years?

The third question is, is there anything you can recommend to aid the lungs in clearing out all of the tar and other “muck” deposited from 42 years of smoking?

Thank you

[David Tinkelman, M.D.]

The first question – in persons with COPD prone to frequent exacerbations there is evidence to suggest that the frequency of exacerbations may be reduced with the use of the three medications you list.  As there is often a permanent loss of pulmonary function with an exacerbation, reducing exacerbations may slow the progressive loss of pulmonary function.  Whether or not this increases longevity is still being debated.

Second – the answer depends on the manner of obstruction.  Were the cause excessive secretions and were the secretions to diminish with smoking cessation, one might see a discernible improvement in FEV1, >15%.  If the obstruction is mostly on the basis of airway collapse, minimal if any improvement would be the norm.  Improvement, if it is to occur may not take place for 4-6 months.  In most instances the improvement post smoking cessation would best be described as slight or very little.

Further, in regard to this question, the greatest benefits from smoking cessation are:  1) less frequent exacerbations including fewer episodes of recurrent acute bronchitis and 2) a significant reduction in the rate of lung function loss.  That is, lung function continues to go down but much slower than it would were you to continue smoking and, in some instances the rate of loss may eventually (several years later) approximate that of non smokers.

Third – no, to my knowledge no techniques, including washing-out the lungs with normal saline solution, have been efficacious in cleaning-out the tar and other stuff

[26245]

Please read this before you decide to take the medications that are commonly prescribed for copd. I have stage III copd. My lung doctor is not as open-minded as dr Tinkelman and got terribly upset when I confessed that I was not taking my steroids and bronchodilator and that from extensive readings in the Internet I had figured out steroids were dangerous and did not help keep the disease in check. He made me understand that if I did not take the medicines I could not expect them to administer the tests and whatever else I might need in future, and of course he also denied vehemently there were any risks entailed. So I have this big question, why do doctors all over the world (I live in Spain) "push" these noxious drugs so much ? As for what these drugs can do to you, just read this http://inhealth.cnn.com/living-life-to-the-fullest-with-copd/8-common-complications-of-copd, it's a list of possible complications of copd drawn up by a mainstream organization, CNN Health, seemingly without any intention to go against the pharmaceutical-medical establishment, but points 2-3-5-6-7-8 (about Osteoporosis - Pneumonia - Shingles - Trouble Sleeping - Unhealthy Weight - Urinary Symptoms) are very revealing. Is there a miracle cure? or just any cure? I doubt it very much, maybe in future they'll come up with something. I administered to myself acetylcysteine for a month or so a while ago and have not had an exacerbation since, but it could be a coincidence.

[jackdup]

Your reponse

"Third – no, to my knowledge no techniques, including washing-out the lungs with normal saline solution, have been efficacious in cleaning-out the tar and other stuff"

Followup question

Well the lungs eventually clean out all of this residue on their own or does it just stay there, for the most part, for life?

Thank you for your help