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HTN/COPD Treatment Options

HYPERTENSION


Lifestyle

Adopting healthy behavior may help to prevent high blood pressure and is important to its management. Some behavior modifications that may control blood pressure are:

  • Eating a better diet, which may include reducing salt
  • Enjoying regular physical activity
  • Maintaining a healthy weight
  • Managing stress
  • Avoiding tobacco smoke
  • Complying with medication prescriptions
  • Limiting alcohol  

Medication

In addition to behavioral changes, medication may be necessary to help control hypertension. There are multiple medications, known as antihypertensives, that may be used to treat and manage high blood pressure. Working with a healthcare professional determines the best course of action for an individual.

COPD


Non-Surgical Treatment Options

Smoking cessation is the single most effective intervention to slowing the progression of COPD. Treatment strategy for COPD is additive, meaning that medications are added, but not subtracted, as the disease progresses.

Stage I: Mild COPD
  • Smoking cessation
  • Good nutrition and exercise
  • Flu and pneumonia shots
  • Short-acting bronchodilator to dilate airways
Stage II: Moderate COPD
  • Pulmonary rehabilitation
  • This program combines education, counseling, exercise, nutrition and breathing therapies to help reduce COPD systems, improve quality of life and encourage patients to take an active role in treatment. While it will not cure COPD, pulmonary rehabilitation can help relieve shortness of breath and fatigue by training the mind, muscles and heart to get the most out of damaged lungs. Pulmonary rehabilitation is supervised and structured, and success relies on the patient’s active participation with his or her team of health professionals.
  • Long-acting bronchodilator replaces or is used in conjunction with a short-acting inhaler
  • Slow-release theophylline may be used in patients who don’t respond to bronchodilators
Stage III: Severe COPD
  • Regular use of inhaled steroids for severe and repeated exacerbations
Stage IV: Very Severe COPD
  • Long-term oxygen therapy
  • Consideration of surgical options

Surgical Treatment Options


Lung Volume Reduction Surgery (LVRS)

LVRS is a surgical procedure that reduces the size of the lungs by removing 20- 30% of the most diseased lung tissue. The surgery enables the diaphragm to return to its normal shape and the remaining healthier portion of the lung to perform better. Potential benefits may include improved breathing, exercise tolerance and quality of life, decreased dependence on oxygen (reduced hypoxemia), and a prolonged life. Because it is a relatively new surgical procedure, it is unclear how long the benefits will last.

Patients who would benefit most from LVRS are those with severe emphysema in the upper lobes of the lung and a low risk for surgery who have not responded to pulmonary rehabilitation. LVRS is an elective procedure that carries some risk, with a mortality rate of around 5% overall. Reported complications include pneumonia, respiratory failure and prolonged air leak from the lung. The surgery may either be conducted open-chest or through video-assisted thoracic surgery using a series of small cuts.

Lung Transplantation
Either single or double lung transplantation is a surgical option for patients with severe, end-stage COPD. Potential benefits may include improvements in pulmonary function, exercise capacity and overall quality of life. According to the American Lung Association, only 25% of those on the lung transplant waiting list received a transplant in 2005. Risks include mortality rates of 5-15% within the first 30 days and lifelong immunosuppression for survivors resulting in an increased risk of infection and other serious side effects. Whether lung transplantation provides a survival benefit to COPD patients remains unclear. As with any major surgery, patients spend several months regaining strength as their lungs heal.

Less Invasive Procedures


The ROX Medical Arterio-Venous Anastomosis for COPD

The ROX Anastomotic Coupling Procedure may be an option for some acute COPD sufferers, and offers a less invasive alternative, than LVRS or transplantation. By creating a therapeutic arteriovenous anastomosis in the illio-femoral region, blood rich in oxygen is allowed to flow from the artery to the vein, thereby increasing the oxygen content of blood returning to the lungs of COPD patients. This results in an increase in perfusion through the pulmonary system and may improve oxygen delivery to tissue and muscle. Improvement in COPD symptoms may include an increase in cardiac output, increased oxygenation of blood that is returning to the heart (reduced hypoxemia), and a potential reduction of pulmonary vascular resistance. Thus, creation of a therapeutic arteriovenous anastomosis aims to utilize reserve in the cardiovascular system to compensate for deficiencies in respiratory function.


Caution: Investigational device. Limited by United States law to investigational use.