Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a permanent lung condition caused, most often, by cigarette smoking. It starts with a wheezing cough and gradually progresses to a shortness of breath that accompanies even the slightest exertion, such as dressing or eating. COPD encompasses both emphysema and chronic bronchitis.
Emphysema consists of the destruction of the tiny air sacs (alveoli) in the lungs and the weakening of the support structure around them. This leads to a collapse of the small airways in the lungs, especially on inhalation, and reduces the body's ability to take in oxygen and expel carbon dioxide.
Chronic bronchitis consists of chronic inflammation of the airways, causing a persistent productive cough. This inflammation also impairs the body's ability to exchange new air for old. COPD also involves spasm of the airways similar to what occurs in asthma. Finally, occasional flare-ups occur when bacteria grow in the lungs, leading to acute exacerbation of symptoms.
Because cigarette smoking contributes to both emphysema and chronic bronchitis, anyone who has COPD should stop smoking. Quitting smoking won't reverse the condition, but it might stop COPD from getting worse. Airborne irritants such as chemical fumes exacerbate symptoms and should also be avoided. Standard treatment for COPD includes using bronchodilators, such as ipratropium and albuterol, to reduce muscle spasms, and corticosteroids to control inflammation in the airways. Acute flare-ups are treated with antibiotics. Severe COPD may require continuous oxygen therapy.
Malnutrition is common among people with COPD and seems to correspond to the severity of the condition.1,2 It's been suggested that the caloric needs of people with COPD increase as the disease progresses.3 Because malnutrition in turn can worsen lung function and make people more prone to infection, many researchers now recommend that individuals with COPD receive supplemental nutrition as part of their treatment.4,5
Principal Proposed Natural Treatments
N-acetyl cysteine (NAC) may improve breathing in people with COPD.
NAC is a specially modified form of the dietary amino acid cysteine. Regular use of NAC may diminish the number of severe bronchitis attacks. A review and meta-analysis of available research focused on 8 reasonably well-designed double-blind, placebo-controlled trials of NAC in COPD.7-15 The results of these studies, involving a total of about 1,400 individuals, suggest that NAC taken daily at a dose of 400 to 1,200 mg can reduce the number of acute attacks of severe bronchitis. However, a subsequent 3-year, double-blind, placebo-controlled study of 523 people with COPD failed to find benefit with 600 mg of NAC daily.35
NAC was once thought to aid lung conditions by helping to break up mucus. However, continuing research has tended to cast doubt on this explanation of its action.
For more information, including dosage and safety issues, see the full NAC article.
Other Proposed Natural Treatments
Evidence from three double-blind placebo-controlled studies enrolling a total of 49 individuals suggests that the supplement L-carnitine can improve exercise tolerance in COPD, presumably by improving muscular efficiency in the lungs and other muscles.19-21
Eucalyptus is a standard ingredient in cough drops and in oils sometimes added to humidifiers. A combination essential oil therapy containing cineole from eucalyptus, d-limonene from citrus fruit, and alpha-pinene from pine has been studied for a variety of respiratory conditions. Because these oils are all in a chemical family called monoterpenes, the treatment is called essential oil monoterpenes. A 3-month, double-blind trial of 246 individuals with chronic bronchitis found that oral treatment with essential oil monoterpenes helped prevent acute flare-ups of chronic bronchitis.27 A previous double-blind study, too small to provide reliable results, hints that oral use of essential oil monoterpenes can enhance the effects of antibiotics for acute flare-ups once they do occur.26 It is thought that essential oil monoterpenes work by improving the lungs’ ability to clear secretions.28
A mixture of extracts from echinacea, wild indigo, and white cedar has shown promise for treating a variety of respiratory infections. A well-designed double-blind, placebo-controlled trial of 53 people tested its benefits in acute exacerbations of chronic bronchitis.6 All participants in this trial received standard antibiotic therapy. The results showed that people receiving the herbal medication experienced more rapid improvements in lung function than those given placebo.
Observational studies suggest a correlation between respiratory problems and diets low in antioxidants from food, such as vitamin A, vitamin E, vitamin C, and beta-carotene.29-33 However, such studies don't prove that taking supplements of such nutrients will help—only double-blind, placebo-controlled studies can do that. (For information on the reasons why, see Why Does This Database Rely on Double-blind Studies?) Indeed, a double-blind study of vitamin E and beta-carotene supplementation found no effect on COPD symptoms.34
The effects of other antioxidant supplements on COPD haven't yet been studied.
Evidence from several studies suggests that the standard approved diet, low in fat and high in carbohydrates, worsens exercise performance and lung function in people with COPD, whereas a low-carbohydrate diet may improve COPD symptoms.23-25 Carbohydrates cause the body to produce increased amounts of carbon dioxide, and people with COPD have trouble getting rid of carbon dioxide.
Qigong is an ancient form of Traditional Chinese Medicine consisting of deep breathing accompanied by slow, rhythmic movements. It is intended to promote the healthy flow of "qi" (or vital "energy") within the body. In a randomized trial involving 206 patients with COPD, Qigong appeared to improve respiratory function and activity tolerance.42 In another trial, 80 people with COPD were randomized to receive Qigong or conventional rehabilitation for 6 months. At the end of the trial, there were no significant differences between the two groups.43 In a review of 5 randomized trials with 349 patients with COPD, qigong was associated with improved 6-minute walking distance when compared to no exercise. However, when compared to regular walking exercise, qigong was no more effective for physical performance, lung function, shortness of breath, or quality of life.46
Tai Chi is a traditional form of martial art used more for promoting health than for fighting. Its gentle movements are said to strengthen and balance the body’s “energy", which may improve physical fitness and overall health. In a review of 12 randomized trials with 984 COPD patients, Tai Chi was compared to usual care or other treatments. Tai Chi was done for 15-60 minutes a day, 5-7 days a week, for 6 weeks to 1 year. Overall, Tai Chi was associated with improvements in 6-minute walking test distance, lung function, and lung capacity. However, the trials were of low to moderate quality and were very different from one another. Although results were promising, the authors concluded that more studies are needed.47
Tai Chi was as effective as pulmonary rehabilitation in a randomized trial of 120 adults with COPD. Tai Chi was done 5 days a week for 12 weeks. Pulmonary rehabilitation was done 3 days a week for 12 weeks. None of the participants had used inhaler treatment before. Both interventions were associated improvements in symptoms and quality of life based on a specific questionnaire. At a 24 week follow up, symptom improvement remained. In addition, there were improvements in distances walked in a 6-minute test.48.
Researchers have also studied the potential benefits of acupuncture in people with COPD. Sixty-eight adults were randomized to receive acupuncture or sham (fake) acupuncture once a week for 12 weeks.44 Those who received the real treatment experienced less shortness of breath after an exercise test compared to the control group.
Osteopathic physicians study and practice the same types of medical and surgical techniques as their conventional MD colleagues with the addition of osteopathic manipulative treatment (OMT) as an adjunct procedure. Osteopathic practitioners generally devote their efforts throughout the musculoskeletal system, including soft tissues and joints outside the spine. In one small randomized trial involving 20 patients with stable COPD, OMT showed improvement in 6-minute walk test distance. Distance in patients in the OMT group improved on average by 72.5 meters compared to 23.7 meters for patients in the sham OMT group.45
Herbs and Supplements to Use Only With Caution
Various herbs and supplements may interact adversely with drugs used to treat chronic obstructive pulmonary disease. For more information on these potential risks, see the individual drug article in the Drug Interactions section of this database.
References[ + ]
1. Fiaccadori E, Del Canale S, Coffrini E, et al. Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional status. Am J Clin Nutr. 1988;48:680-685.
2. Openbrier DR, Irwin MM, Rogers RM, et al. Nutritional status and lung function in patients with emphysema and chronic bronchitis. Chest. 1983;83:17-22.
3. Keim NL, Luby MH, Braun SR, et al. Dietary evaluation of outpatients with chronic obstructive pulmonary disease. J Am Diet Assoc. 1986;86:902-906.
4. Keim NL, Luby MH, Braun SR, et al. Dietary evaluation of outpatients with chronic obstructive pulmonary disease. J Am Diet Assoc. 1986;86:902-906.
5. Pingleton SK, Harmon GS. Nutritional management in acute respiratory failure. JAMA. 1987;257:3094-3099.
6. Hauke W, Kohler G, Henneicke-Von Zepelin HH, et al. Esberitox® N as supportive therapy when providing standard antibiotic treatment in subjects with a severe bacterial infection (acute exacerbation of chronic bronchitis). a multicentric, prospective, double-blind, placebo-controlled study. Chemotherapy. 2002;48:259-266.
7. Grandjean EM, Berthet P, Ruffmann R, et al. Efficacy of oral long-term N-acetylcysteine in chronic bronchopulmonary disease: a meta-analysis of published double-blind, placebo-controlled clinical trials. Clin Ther. 2000;22:209-221.
8. Hansen NCG, Skriver A, Brorsen-Riis L, et al. Orally administered N-acetylcysteine may improve general well-being in patients with mild chronic bronchitis. Respir Med. 1994;88:531-535.
9. Grassi C, Casali L, Rossi A, et al. A comparison between different methods for detecting bronchial hyperreactivity. Bronchial hyperreactivity: methods of study. Eur J Respir Dis Suppl. 1980;106:19-27.
10. Grassi C, Morandini GC. A controlled trial of intermittent oral acetylcysteine in the long-term treatment of chronic bronchitis. Eur J Clin Pharmacol. 1976;9:393-396.
11. Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy? Eur Respir J. 1994;7:94-101.
12. Rasmussen JB, Glennow C. Reduction in days of illness after long-term treatment with N-acetylcysteine controlled-release tablets in patients with chronic bronchitis. Eur Respir J. 1988;1:351-355.
13. Parr GD, Huitson A. Oral fabrol (oral N-acetylcysteine) in chronic bronchitis. Br J Dis Chest. 1987;81:341-348.
14. Boman G, Bcker U, Larsson S, et al. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis. 1983;64:405-415.
15. Verstraeten JM. Mucolytic treatment in chronic obstructive pulmonary disease. Double-blind comparaive clinical trial with N-acetylcysteine, bromhexine and placebo. Acta Tuberc Pneumol Belg. 1979;70:71-80.
19. Dal Negro R, Pomari G, Zoccatelli O, et al. L-carnitine and rehabilitative respiratory physiokinesitherapy: metabolic and ventilatory response in chronic respiratory insufficiency. Int J Clin Pharmacol. 1986;24:453-456.
20. Dal Negro R, Turco P, Pomari C, et al. Effects of L-carnitine on physical performance in chronic respiratory insufficiency. Int J Clin Pharmacol. 1988;26:269-272.
21. Dal Negro R, Zoccatelli D, Pomari C, et al. L-carnitine and physiokinesiotherapy in chronic respiratory insufficiency. Preliminary results. Clin Trials J. 1985;22:353-360.
22. Fujimoto S, Kurihara N, Hirata K, et al. Effects of coenzymeQ10 administration on pulmonary function and exercise performance in patiens with chronic lung diseases. Clin Investig. 1993;71:S162-S166.
23. Efthimiou J, Mounsey PJ, Benson DN, et al. Effect of carbohydrate rich versus fat rich loads of gas exchange and walking performance in patients with chronic obstructive lung disease. Thorax. 1992;47:451-456.
24. Angelillo VA, Bedi S, Durfee D, et al. Effects of low and high carbohydrate feedings in ambulatory patients with chronic obstructive pulmonary disease and chronic hypercapnia. Ann Intern Med. 1985;103:883-885.
25. Frankfort JD, Fischer CE, Stansbury DW, et al. Effects of high- and low-carbohydrate meals on maximum exercise performance in chronic airflow obstruction. Chest. 1991;100:792-795.
26. Ulmer WT, Schott D. Chronic obstructive bronchitis. Effect of Gelomyrtol forte in a placebo-controlled double-blind study [in German; English abstract]. Fortschr Med. 1991;109:547-550.
27. Meister R, Wittig T, Beuscher N, et al. Efficacy and tolerability of Myrtol standardized in long-term treatment of chronic bronchitis. A double-blind, placebo-controlled study. Study Group Investigators. Arzneimittelforschung. 1999;49:351-358.
28. Dorow P, Weiss T, Felix R, et al. Effect of a secretolytic and a combination of pinene, limonene and cineole on mucociliary clearance in patients with chronic obstructive pulmonary disease [in German; English abstract]. Arzneimittelforschung. 1987;37:1378-1381.
29. Singh RB, Niaz MA, Ghosh S, et al. Dietary intake and plasma levels of antioxidant vitamins in health and disease: a hospital-based case-control study. J Nutr Environ Med. 1995;5:235-242.
30. Schwartz J, Weiss ST. Dietary factors and their relation of respiratory symptoms. The Second National Health and Nutrition Examination Survey. Am J Epidemiol. 1990;132:67-76.
31. Miedema I, Feskens EJM, Heederik D, et al. Dietary determinants of long-term incidence of chronic nonspecific lung diseases. The Zutphen Study. Am J Epidemiol. 1993;138:37-45.
32. Sridhar MK. Nutrition and lung health: should people at risk chronic obstructive lung disease eat more fruit and vegetables? BMJ. 1995;310:75-76.
33. Schwartz J, Weiss ST. Relationship between dietary vitamin C intake and pulmonary function in the First National Health and Nutrition Examination Survey (NHANES I). Am J Clin Nutr. 1994;59:110-114.
34. Rautalahti M, Virtamo J, Haukka J, et al. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med. 1997;156:1447-1452.
35. Decramer M, Rutten-van Molken M, Dekhuijzen PN, et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet. 2005;365:1552-1560.
36. Murali PM, Rajasekaran S, Paramesh P, et al. Plant-based formulation in the management of chronic obstructive pulmonary disease: A randomized double-blind study. Respir Med. 2005 May 16. [Epub ahead of print]
37. Kuethe F, Krack A, Richartz BM, et al. Creatine supplementation improves muscle strength in patients with congestive heart failure. Pharmazie. 2006;61:218-222.
38. Fuld JP, Kilduff LP, Neder JA, et al. Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2005;60:531-537.
39. Cerda B, Soto C, Albaladejo MD, et al. Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr. 2005 Nov 9. [Epub ahead of print]
40. Faager G, Soderlund K, Skold CM, et al. Creatine supplementation and physical training in patients with COPD: a double blind, placebo-controlled study. Int J Chron Obstruct Pulmon Dis. 2006;1:445-453.
41. Deacon SJ, Vincent EE, Greenhaff PL, et al. Randomised controlled trial of dietary creatine as an adjunct therapy to physical training in COPD. Am J Respir Crit Care Med. 2008 Apr 17.
42. Chan AW, Lee A, Suen LK, Tam WW. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial. Complement Ther Med. 2011;19(1):3-11.
43. Ng BH, Tsang HW, Jones AY, So CT, Mok TY. Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial. J Altern Complement Med. 2011;17(3):243-251.
44. Suzuki M, Muro S, Ando Y, et al. A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD). Arch Intern Med . 2012;172(11):878.
45. Zanotti E, Berardinelli P, Bizzarri C. Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study. Complement Ther Med. 2012;20(1-2):16-22.
46. Ding M, Zhang W, et al. Effectiveness of t'ai chi and qigong on chronic obstructive pulmonary disease: A systematic review and meta-analysis. J Altern Complement Med. 2014;20(2):79-86.
47. Ngai SP, jones AY, Tam WW. Tai Chi for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2016;(6):CD009953.
48. Polkey MI, Qiu ZH, Zhou L, et al. Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial. Chest. 2018;153(5):1116-1124.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 7/6/2018
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