The Encyclopedia of Natural Medicine, 3rd Ed.

Chronic Obstructive Pulmonary Disease

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• Cough, with or without mucus

• Fatigue

• History of repeated respiratory infections

• Shortness of breath (dyspnea) that gets worse with mild activity

• Trouble catching one’s breath

• Wheezing

Chronic obstructive pulmonary disease (COPD) has two main forms: chronic bronchitis, which involves a long-term cough with mucus; and emphysema, which involves destruction of the lungs over time.

Although chronic bronchitis and emphysema are distinct conditions, people with COPD often have aspects of both. In chronic bronchitis, the linings of the bronchial tubes are inflamed and thickened, leading to a chronic, mucus-producing cough and shortness of breath. In emphysema, the alveoli (tiny air sacs in the lungs) are damaged, also leading to shortness of breath. COPD is generally irreversible and may even be fatal.

Symptoms of COPD usually develop gradually and may initially include shortness of breath during exertion, wheezing (especially during exhaling), and frequent coughing that produces variable amounts of mucus. In more advanced stages, people may experience rapid changes in the ability to breathe, shortness of breath at rest, fatigue, depression, memory problems, confusion, and frequent waking during sleep.

Causes

Smoking is the leading cause of COPD. The more a person smokes, the more likely it is that he or she will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are:

• Exposure to certain gases or fumes in the workplace

• Exposure to heavy amounts of secondhand smoke and pollution

• Frequent use of cooking fire without proper ventilation

Therapeutic Considerations

Obviously, people with COPD must stop smoking and/or exposure to lung irritants, as this is the best way to slow down the lung damage.1

The natural approach to COPD involves three primary goals: (1) stimulation of normal processes that promote the expectoration (removal) of mucus, (2) thinning the mucus to aid expectoration, (3) enhancement of immune function, and (4) decreasing the chronic inflammation in the lungs. The approaches described in the chapter “Bronchitis and Pneumonia” are appropriate here as well, because from a naturopathic perspective the aims are very similar. The major difference is that in COPD the focus is definitely more on the use of expectorants and mucolytics, especially if the problem is emphysema.

In addition, as COPD progresses it generally requires complementary conventional medical care. Therefore, the goal should also be to try to address any nutrient depletions caused by drug therapy. Medications used to treat COPD include:

• Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol

• Inhaled steroids to reduce lung inflammation

• Anti-inflammatory medications such as montelukast (Singulair) and roflumilast (Daliresp) are sometimes used

An especially useful therapy for COPD is the use of oral NAC (N-acetylcysteine); in more serious cases it can be inhaled with the addition of glutathione. The NAC acts as a mucolytic, helping clear mucus from the bronchioles, and the glutathione substantially decreases inflammation in the lungs.2

In severe cases or during flare-ups, even more aggressive therapy may be necessary, including oral steroids, oxygen therapy, and antibiotics.

An often unrecognized consequence of many prescription drugs commonly taken by people with COPD is a magnesium deficiency produced by the drugs.3 That is potentially very serious, as magnesium is needed for normal lung function. One group of researchers reported that 47% of people with COPD had a magnesium deficiency.4 In this study, magnesium deficiency was also linked to increased hospital stays.

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QUICK REVIEW

• Chronic obstructive pulmonary disease (COPD) has two main forms: chronic bronchitis and emphysema.

• Smoking is the leading cause of COPD.

• The natural approach to COPD involves four primary goals: (1) stimulation of normal processes that promote the expectoration of mucus, (2) thinning the mucus to aid expectoration, (3) enhancement of immune function, and (4) reduction of lung inflammation.

• As COPD progresses it generally requires complementary conventional medical care.

• Oral magnesium supplementation is strongly indicated.

Just as in the treatment of an acute asthma attack, intravenous magnesium has improved breathing capacity in people experiencing an acute worsening of COPD.5 In one double-blind study, the need for hospitalization was also reduced in the magnesium group (28% vs. 42% with a placebo), but this difference was not statistically significant. Intravenous magnesium is known to be a powerful bronchodilator.

Given that many people with COPD may be magnesium deficient and that magnesium may also improve lung and airway function, oral magnesium supplementation in people with COPD is very much indicated.

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TREATMENT SUMMARY

As described above, the basic approach is to use an expectorant, a mucolytic, and immune-supportive nutrients. We also recommend the use of a salt pipe or bottle blowing (see the chapter “Bronchitis and Pneumonia”).

Diet

Follow the general guidelines in the chapter “A Health-Promoting Diet.” Especially important are foods with high antioxidant content, such as dark leafy vegetables, berries, and legumes.

Nutritional Supplements

• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”

• Key individual nutrients:

  images Vitamin C: 500 to 1,000 mg per day

  images Vitamin E (mixed tocopherols): 100 to 200 IU per day

  images Magnesium (bound to aspartate, citrate, fumarate, malate, or succinate): 200 to 300 mg three times per day

  images Selenium: 100 to 200 mcg per day

  images Vitamin D3: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)

• Fish oils: 1,000 mg EPA + DHA per day

• One of the following:

  images Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day

  images Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day

  images Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or higher per day

Expectorants

• Take one or both:

  images Lobelia inflata:

Dried herb: 0.2 to 0.6 g three times per day

Tincture: 15 to 30 drops three times per day

Fluid extract: 8 to 10 drops three times per day

  images Hedera helix (ivy leaf), available as tincture, fluid extract, and dry powdered extract in capsules and tablets; typical dosage for adults and children over 12 years of age for a 4:1 dry powdered extract is 100 mg per day (the equivalent of 420 mg dried herbal substance); for children 1–5 years old, dosage is the equivalent of 150 mg dried herbal substance; for children 6–12 years old, the equivalent of 210 mg dried herbal substance

Mucolytics

• Take one or more of the following:

  images Guaifenesin:

  – Adults and children 12 years of age and older: 200 to 400 mg every four hours. Do not take more than 2,400 mg in a two-hour period.

  – Children age 6 to 11: 100 to 200 mg every four hours, with no more than 1,200 mg in a 24-hour period. For children age 2 to 5, the dosage is 50 to 100 mg every four hours, with no more than 600 mg in 24 hours.

  – Guaifenesin is not recommended for children under 2 years of age.

  images N-acetylcysteine: 200 mg three times per day

  images Bromelain (1,200 to 1,800 MCU or GDU): 500 to 750 mg three times per day between meals