COPD is a group of serious lung diseases that includes emphysema and chronic bronchitis. It is a leading cause of morbidity and mortality worldwide and the fourth leading cause of death in the United States. Its epidemiology has changed over the years and the key changes are a rising mortality rate and a greater incidence among women. COPD is typically considered a disease due to cigarette smoking, however it can also occur in non smokers. Worldwide, up to 10 percent of adults aged 40 and older have lung impairment consistent with chronic obstructive pulmonary disease. As expected, this lung condition is more common in smokers, males, older adults, and persons living in urban areas.

Lower respiratory illness in childhood is associated with later development of asthma and wheezing that can persist into adulthood, and may be a risk factor for adult chronic obstructive pulmonary disease.

COPD natural treatment, alternatives to medication
Research regarding the use of natural supplements to treat COPD is quite early, so no confident statements can be made at this time, but antioxidants and the following nutrients and herbs could be considered: I think there may be a benefit to regularly drinking fresh vegetable juices that include carrot, celery, beet, parsley, cucumber, and others.

Vitamins C, D, and natural E complex could be of benefit.

Omega- 3 fatty acids can be anti-inflammatory agents. Japanese researchers at Kagoshima University Hospital found that supplements of omega-3 fatty acids appeared to improve patients' breathing difficulties -- possibly by countering the airway inflammation seen in those with COPD. Omega-3 polyunsaturated fatty acids are found largely in oily fish, and to a lesser extent in flaxseed, walnuts, soybeans and canola oil. Half of the 64 patients drank a liquid supplement rich in omega-3 fats each day; the other half drank a supplement containing omega-6 fats, another type of polyunsaturated fat found in many foods, including vegetable oils and meat. After two years, patients in the omega-3 supplement group showed an overall improvement on tests that measured their breathing during a short bout of exercise.
     Am J Clin Nutr. 2015. Fish intake and risk of chronic obstructive pulmonary disease in 2 large US cohorts. Higher fish intake is associated with a lower risk for COPD.

Acetylcysteine, the potent antioxidant, may be helpful for lung tissue. The dosage could be 100 to 300 mg most days of the week.
CoQ10, normally used for heart failure, could be of benefit in 30 to 50 mg doses.
Glutamine is an amino acid that may help some individuals.
BCAA supplements could be helpful for protein synthesis. You can purchase BCAA supplements over the counter.
Creatine may help with muscle strength and endurance and exercise. One or two grams a day could be of benefit.

Combination of several nutrients
Multidiscip Respiratory Medicine. 2013. Effects of nutraceutical diet integration, with coenzyme Q10 (Q-Termulticompound) and creatine, on dyspnea, exercise tolerance, and quality of life in COPD patients with chronic respiratory failure. The protein-calorie malnutrition, resulting in muscle mass loss, frequently occurs in severe COPD patients with chronic respiratory failure (CRF), causing dyspnea, reduced exercise tolerance and impaired quality of life. The cause of this occurrence is an intake-output energy imbalance. A documented deficit of phosphocreatine and reduced mithocondrial energy production can contribute to this imbalance. Aim of this study is to verify whether a dietary supplementation with creatine and coenzyme Q10, important mitochondrial function factors, is able to influence this mechanism leading to dyspnea (shortness of breath) reduction and improving exercise tolerance and quality of life. 5 COPD patients with chronic respiratory failure (in long term O2 therapy), in stable phase of the disease and without severe comorbidities were assigned to: group A (30 patients) with daily dietary supplementation with Creatine 340 mg + 320 mg Coenzyme Q-Ter (Eufortyn),  The nutraceutical diet integration with Q-Ter and creatine, induced an increasing lean body mass and exercise tolerance, reducing dyspnea, quality of life and exacerbations. These results provide a first demonstration that acting on protein synthesis and muscular efficiency can significantly modify the systemic consequences of the disease.

Antioxidants and COPD reduction and improvement
Oxidative stress and chronic inflammation are important features in the pathogenesis of chronic obstructive pulmonary disease ( COPD ). Oxidative stress has important consequences for several elements of lung physiology and for the pathogenesis of COPD, including oxidative inactivation of antiproteases and surfactants, mucus hypersecretion, membrane lipid peroxidation, alveolar epithelial injury, remodeling of extracellular matrix, and apoptosis. Therefore, targeting oxidative stress with antioxidants or boosting the endogenous levels of antioxidants is likely to be beneficial in the treatment of COPD. Antioxidant and/or anti-inflammatory agents such as thiol molecules (glutathione and mucolytic drugs, such as N-acetyl-L-cysteine and N-acystelyn), dietary polyphenol (curcumin -diferuloylmethane, a principal component of turmeric), resveratrol (a flavanoid found in red wine), green tea (theophylline and epigallocatechin-3- gallate), ergothioneine (xanthine and peroxynitrite inhibitor), quercetin, erdosteine and carbocysteine lysine salt, have been reported to control NF-kappaB activation, regulation of glutathione biosynthesis genes, chromatin remodeling and hence inflammatory gene expression. Since a variety of oxidants, free radicals and aldehydes are implicated in the pathogenesis of COPD it is possible that therapeutic administration of multiple antioxidants will be effective in the treatment of COPD. Antioxidant therapeutic targets in COPD. Curr Drug Targets. 2006.

Soy foods
Dr. Andy H. Lee of the Curtin University of Technology, Perth, Australia, studied 278 COPD patients (244 men and 34 women) between the ages of 50 and 75 years who were diagnosed within the past 4 years. They also recruited 340 people (272 men and 68 women) without the disease. Control subjects consumed more soy per day (about 60 grams) than patients with COPD (about 45 grams). Dr. Andy H. Lee says the risk was significantly reduced among those who ate more soy. Similar decreases in the risk were observed with higher intakes of tofu and bean sprouts. The more soy people consumed, the fewer breathing problems they had, particularly breathlessness. Respiratory Research, 2009.

Nitrates makes COPD worse
Those who smoke increase their risk of developing COPD, emphysema and chronic bronchitis if they eat lots of cured meat. Cured meats such as sausage, ham, bologna, bacon and hot dogs contain high levels of nitrites, which are added to prevent rancidity and bacterial growth and enhance a meat's pink color. And just like cigarette smoking and air pollution, nitrites generate molecules known as reactive oxygen and nitrogen species that have been linked to COPD. American Journal of Epidemiology, December 15, 2007.

Creatine
Skeletal muscle wasting and dysfunction are strong independent predictors of mortality in patients with chronic obstructive pulmonary disease. Creatine nutritional supplementation produces increased muscle mass and exercise performance in health. A controlled study was performed to look for similar effects in 38 patients with COPD.  Creatine supplementation led to increases in fat-free mass, peripheral muscle strength and endurance, health status, but not exercise capacity. Creatine may constitute a new ergogenic treatment in COPD. Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2005.

Multidiscip Respir Med. 2013. Effects of nutraceutical diet integration, with coenzyme Q10 (Q-Termulticompound) and creatine, on dyspnea, exercise tolerance, and quality of life in COPD patients with chronic respiratory failure. Aim of this study is to verify whether a dietary supplementation with creatine and coenzyme Q10, important mitochondrial function factors, is able to influence this mechanism leading to a dyspnea reduction and improving exercise tolerance and quality of life. 55 COPD patients with chronic respiratory failure (in long term O2 therapy), in stable phase of the disease and without severe comorbidities were assigned (double-blind, randomized) to: group A (30 patients) with daily dietary supplementation with Creatine 340 mg + 320 mg Coenzyme Q-Ter (Eufortyn(R), Scharper Therapeutics Srl) for 2 months whereas Group B (25 patients) received placebo. All patients continued the same diet, rehabilitation and therapy during the study. The nutraceutical diet integration with Q-Ter and creatine, in COPD patients with CRF in O2TLT induced an increasing lean body mass and exercise tolerance, reducing dyspnea, quality of life and exacerbations. These results provide a first demonstration that acting on protein synthesis and muscular efficiency can significantly modify the systemic consequences of the disease.

Ginseng improves pulmonary functions and exercise capacity in patients with COPD.
Ginseng is a root that has been used to treat patients with various illnesses for the last 2000 years. The purpose of this study was to evaluate the effects of Ginseng extract (G115) on Pulmonary Function Tests (PFTs), Maximum Voluntary Ventilation (MVV), Maximum Inspiratory Pressure (MIP) and Maximal Oxygen Consumption (VO2max) in patients with moderately-severe Chronic Obstructive Pulmonary Disease. Results: Ginseng 100 mg bid for three months, but not placebo, improved PFTs, MVV, MIP and VO2 max in patients with moderately-severe COPD with no side effects. Arch Chest Dis. 2002.

COPD and Glutamine, Glutamate
Low plasma glutamate and glutamine concentrations are often seen in COPD. Glutamine or glutamate supplementation may be a good option for preventing further metabolic disturbances in such patients. However, the metabolic effects of glutamate supplementation have never been compared with those of glutamine supplementation. In a new study, repeated ingestion of glutamine and glutamate resulted in different effects on the plasma amino acid concentration. In both groups, ingestion of glutamine but not of glutamate increased the plasma concentrations of citrulline and arginine, substrates produced in the intestine and the liver.

Omega-3 helpful in COPD
Japanese researchers at Kagoshima University Hospital found that supplements of omega-3 fatty acids appeared to improve patients' breathing difficulties -- possibly by countering the airway inflammation seen in the disease. Omega-3 polyunsaturated fatty acids are found largely in oily fish, and to a lesser extent in flaxseed, walnuts, soybeans and canola oil. Half of the 64 patients drank a liquid supplement rich in omega-3 fats each day; the other half drank a supplement containing omega-6 fats, another type of polyunsaturated fat found in many foods, including vegetable oils and meat. After two years, patients in the omega-3 supplement group showed an overall improvement on tests that measured their breathing during a short bout of exercise.

I have COPD breathing problem and have been taking flaxseed for the last 2 weeks and it may all be in my mind but I swear that my breathing has greatly improved. Can flaxseed be of benefit to COPD patients? I keep very active but generally run out of breath easily. This week I have been able to do so many things without being completely out of breath. The only thing I am doing differently is putting 1 tablespoon of ground flaxeed in my oatmeal. Have studies ever been made on the benefit of flaxseed on lung disease patients?
   We have not seen specific studies with flaxseed and COPD, but it could be possible since flaxseed has some anti-inflammatory properties.

Essential fatty acids in health and chronic disease.
Am J Clin Nutr. 1999. Simopoulos AP. Center for Genetics, Nutrition and Health, Washington, DC
Human beings evolved consuming a diet that contained about equal amounts of n-3 and n-6 essential fatty acids. Over the past 100-150 y there has been an enormous increase in the consumption of n-6 fatty acids due to the increased intake of vegetable oils from corn, sunflower seeds, safflower seeds, cottonseed, and soybeans. Today, in Western diets, the ratio of n-6 to n-3 fatty acids ranges from approximately 20-30:1 instead of the traditional range of 1-2:1. Beneficial effects of n-3 fatty acids have been shown in the secondary prevention of coronary heart disease, hypertension, type 2 diabetes, and, in some patients with renal disease, rheumatoid arthritis, ulcerative colitis, Crohn's disease, and chronic obstructive pulmonary disease.

Additional dietary supplements and questions
Have you  heard of anybody prescribing pregnenolone for COPD?
   No we have not. We would be quite cautious in using pregnenolone since most people get this lung condition from smoking, and smoking damages heart tissue which makes it prone to palpitations. Pregnenolone can aggravate heart rhythm problems.

I am 55 and a few years ago I was diagnosed with COPD. I recently read an article about the benefits of inhaled Glutathione. Is this inhaled glutathione effective? I currently use Qvar and Combivent.
   I am not familiar in any great detail about the benefits and risks of inhaled glutathione and whether it interacts with Qvar and Combivent.

I have a friend who recently was diagnosed with COPD and I'm wondering if there is a good supplement that supports lung health. I've run across White Tiger Return and wondered if that was the best or if there is something else. White Tiger Return active ingredients being: Inula helenium - elecampane root- certified organic, Thymus vulgaris - thyme herb, Oreganum species - oregano herb, Codonopsis pilosula - dang shen root, Trigonella foenum - hu lu ba - fenugreek seed, Althaea officinalis - marshmallow root, Salvia officinalis - sage herb, Verbascum thapsis-mullein herb, Schisandra chinensis - wu wei zi fruit, Citrus reticulata - chen pi - tangerine peel, Lactuca virosa - wild lettuce herb, Foeniculum vulgare - xiao hu xiang - fennel Seed, Grindelia species herb Glycyrrhiza uralensis - gan cao - chinese licorice prepared root Olea europaea – olive leaf herb.
   We are not familiar with this product.

Weight training
People with chronic lung disease like emphysema or bronchitis can strengthen their arms and legs with resistance training, and this strength may help them perform everyday tasks more easily. CHEST, November 2009.

Weight Loss
Among people with chronic obstructive pulmonary disease, usually emphysema, a low fat-free body mass index appears to be associated with greater mortality. There is a clear association between decreasing body mass index (BMI) and mortality both in the general population and in those with COPD. Fat mass is a metabolic inactive energy source, but fat-free mass contains the metabolic active organs, skeletal muscle being the largest of these organs.

Depression
Patients with COPD who suffer from depression have shorter survival times, suggesting that antidepressant medication, or natural antidepressants, or psychological interventions may improve their outcomes. Natural antidepressants such as low doses of 5-HTP or St. John's wort, are worth a try. Depression is more common in patients with COPD than in the general population.

Pathophysiology
COPD primarily affects the distal airways. As a rule, inflammation affects bronchioles at the level of the respiratory bronchiole extending to the alveolar wall.Airway walls are infiltrated with macrophages and lymphocytes. In contrast to asthma, the airway lymphocytes tend to be CD8+ rather than CD4+ cells. The CD4+ cells that are present in COPD tend to be Th1 rather than the Th2 cells found in asthma. Neutrophils are found in greater numbers in the airway lumen, and peribronchiolar fibrosis is seen in mid- to late-stage disease. Affected airways tend to be < 2 mm in diameter; airway obstruction results from structural narrowing caused by the inflammatory process, loss of elastic recoil due to breakdown of intra-alveolar elastic fibers, and loss of alveolar attachments from emphysema-induced alveolar septal destruction.

COPD and particle Inhalation
The pathogenesis mirrors a chronic inhalational dust-induced disease. The inorganic dust in cigarette smoke is aluminum silicate or kaolinite, a common component of clay soils. Kaolinite has been recovered in the alveolar macrophages of smokers and has been reported as a constituent of tobacco products. On inhalation, kaolinite deposition in the distal lung may promote macrophage accumulation within the terminal airways leading to a respiratory bronchiolitis. In the susceptible smoker, important genetic, environmental, immunologic, and mechanical factors interact and modulate this small airway inflammation, ultimately leading to the pathologic lesion of emphysema.

People who burn wood or other "biofuels" for heat or cooking have a higher risk of emphysema and related lung conditions. Biomass refers to biological materials that can be burned for energy, including wood, crops and animal dung. They are major sources of energy in the developing world, and are thought to be used for cooking and heating in half of homes worldwide. Chest, 2010.

People who spend years living near high-traffic roadways may be more likely to develop emphysema and related lung problems than those who live in less-traveled areas. American Journal of Respiratory and Critical Care Medicine, 2010.

What are the symptoms of COPD?
Cough is usually the first symptom to develop. It is productive with phlegm (sputum). It tends to come and go at first, and then gradually becomes more persistent (chronic). Breathlessness ('short of breath') and wheeze may occur only when you exert yourself at first (for example, when you climb stairs). These symptoms tend to become gradually worse over the years if you continue to smoke. The damaged airways make a lot more mucus than normal. This forms sputum (phlegm). Wheezing with cough and breathlessness may become worse than usual if you have a chest infection. Sputum usually turns yellow or green during a chest infection.

Screening
Chronic obstructive pulmonary disease (COPD) -- a serious disease that impairs breathing -- is the third leading cause of death in the United States. But an influential government panel says there's as yet no evidence to support screening for COPD in adults with no symptoms.

Patients with chronic obstructive pulmonary disease often have other medical diseases especially cardiovascular disease, diabetes, anemia, and osteoporosis.

COPD exacerbation
Steroids do improve several outcomes during an acute COPD exacerbation, and a 10- to 14-day course seems appropriate, but not long term use. Adding an inhaled steroid to a so-called "long-acting beta-2 agonist" may do more harm than good. The benefit of the two-drug approach is limited, and furthermore, it's accompanied by substantial risks of pneumonia and other infection. Chest, 2009.

Antibiotic use has been shown to be beneficial, especially for patients with severe exacerbation. Changes in bacteria strains have been documented during exacerbations, and newer generations of antibiotics might offer a better response rate. There is no role for mucolytic agents or chest physiotherapy in the acute exacerbation setting. Noninvasive positive pressure ventilation might benefit a group of patients with rapid decline in respiratory function and gas exchange.

Close to half of U.S. adults over 40 who have trouble breathing due to asthma or COPD still continue to smoke.

COPD and steroid inhaler treatment
Inhaled corticosteroid therapy can temporarily improve lung function, but after several months the decline in lung function resumes. Therefore, the long term benefit of inhaled steroid use by COPD patients is questioned.
   People with chronic obstructive pulmonary disease are more likely to get pneumonia if they use inhaled corticosteroid drugs.

Medications
The drug acetazolamide has been used for decades to help COPD patients breathe when they develop a dangerous condition called metabolic alkalosis. However there's no proof that the drug is actually effective in such cases.

Cough and mucus
In adults between 20 and 44 years of age, the presence of chronic cough and phlegm greatly increases the risk of COPD, even after adjusting for smoking. The presence of chronic cough and phlegm is not an innocent symptom, but is an early marker of airflow obstruction. American Journal Respiratory Critical Care Medicine 2007.

Smoking damages lung of women more than men
Women seem to be more susceptible to the harmful effects of smoking than their male counterparts. Dr. Inga-Cecilie Soerheim, from the University of Bergen, Norway has found that women are more susceptible to smoking-related lung damage and experience reduced lung function at an earlier age or after less smoking exposure than men. Dr. Inga-Cecilie Soerheim studied 954 subjects with moderate or severe COPD and 955 controls. All of the subjects were either current or former smokers. Women had worse lung function and more severe disease than men in subgroups with early-onset (<60 years of age) and low smoking exposure (<20 cigarettes/day for <20 years).