UPDATED January 22, 2020 – A recent report titled The Global Burden of Disease Study by the World Health organization reported over 250 million new cases of COPD and nearly 5% off all deaths around the world each year are due to this family of airway obstruction diseases. Chronic obstructive pulmonary disease (COPD) & Emphysema results in the rapid loss of lung tissue and airway obstruction due to chronic inflammation of the airways resulting in progressive destruction of lung parenchyma (alveolar ducts, alveoli, and respiratory bronchioles.) The use of lung stem cells offers a new regenerative therapy to address the biological damage caused by chronic lower respiratory diseases. The two most common types of COPD are Pulmonary emphysema & recurring bronchitis disease.
What is COPD?
COPD is short for Chronic Obstructive Pulmonary Disease. COPD is a progressive illness that makes it very difficult to breathe properly. “Progressive” means that the disease gets worse with time. One of the most common symptoms with this condition is heavy coughing. Coughing produces a lot of mucus (a slimy substance produced by the body) causing chest tightness, wheezing and labored breathing. Cigarette smoking is generally regarded as one of the main triggers for Bronchiectasis and Chronic Obstructive Pulmonary disorders but can also be developed as a complication from other disorders/diseases such as autoimmune lupus. Most people suffering from COPD are also usually smokers. Long-term exposure to large amounts of lung irritants such as air pollution, smoke, dust, chemical fumes is also big contributors to people being diagnosed with acute lung injury. To better understand COPD, its beneficial to know about the function of the pulmonary system and how the breathing processes take place. The air coming in through the mouth goes straight to your windpipe, then to the bronchial tubes. Inside your lungs, there are also many other smaller, thinner tubes that branch out from the bronchial tubes called bronchioles.(25937817)
The bronchioles are directly inter-connected as a group of small round air sacs called the alveoli. The tiny blood vessels known as capillaries run inside the walls of the alveoli. As soon as air goes to the alveoli, the oxygen in the air goes through the walls of the air-filled spaces then into the blood through the capillaries. At the same time, the carbon dioxide waste gas goes into the alveoli sacs coming from the capillaries. This procedure is known as gas exchange.(22352751)
The alveoli and the airways are quite flexible and elastic by nature. Every time you breathe the alveoli sacs fill up like little balloons. Whenever you breathe out, the opposite happens, the air-filled spaces then deflates, and air goes out.
COPD Management Guidelines
The Function of the Respiratory Tract
All cells in the human body require a consistent stream of fresh oxygen to stay alive. The respiratory system is responsible for delivering oxygen to all the cells in the human body while also removing the waste product of carbon dioxide, which can be lethally accumulated in excess. Several parts make up the respiratory system, including the airway, voice box, windpipe, and respiratory tract. The airway consists of the nose, larynx, pharynx, bronchi, mouth, bronchioles and trachea. The airways are usually divided into the upper respiratory tract and lower respiratory tracts. After the trachea, the airways divide into an ever smaller bronchial tree (bronchi) and at the end of which tree are where the individual alveoli sacs are located.
Symptoms of COPD
Causes of COPD are numerous, but for many onset cases of COPD, the patient may not display indications. As the disease progresses, signs and complications start become much more articulated. The most commons signs & indications for COPD diagnosis are:
- “Smokers Cough” which is another name for a persistent cough or coughing that produces a lot of excess mucus
- Labored Breathing: Especially occurs during physical stress such as playing sports or climbing stairs
- Strange sounds while breathing: A dry, squeaky, whistling or wheezing sound when exhaling can indicate early stage COPD
- Frequent tightness in the chest area is an early warning sign of chronic inflammatory COPD
- A persistent cough occurs primarily in the morning due to airway inflammation or being blocked with thick viscous mucus
Although many COPD patients notice such complaints, they do not take them very seriously. Coughing is usually the first symptom but initially not noticed or very alarming for most. People who are not very physically active may only recognize COPD when it has reached an advanced stage where breathing is difficult even at times of rest. Researchers have also found that many heavy smokers may already have COPD but might not feel any manifestations until it’s confirmed with a lung function test. Having COPD can also damage your bodies defense mechanisms resulting in frequent colds or other respiratory-related infections influenza.
Advanced Signs of COPD
The severity of patients indications depends entirely on how much lung damage a person has. Patients who keep smoking will cause (lung fibrosis) and damage to the lung tissue much faster than those who stopped smoking. Intractable signs of end-stage COPD may cause swelling in the feet area, ankles, legs, and result in rapid weight loss reduction in overall muscle endurance that can result in injuries to the hips & knees.
The disease develops slowly. But there are always phases in which the signs suddenly worsen, especially for patients of COPD with acute exacerbations. The trigger is then usually a respiratory tract infection, and these exacerbations significantly accelerate the progression of chronic inflammatory COPD. Over time, COPD exacerbations become increasing, and reduction in lung capacity/lung function can also increase the risk of other diseases such as rheumatoid arthritis, Parkinsons, ataxia, and brain strokes.
What is Emphysema?
Pulmonary emphysema is part of a family of lung diseases called COPD. Emphysema is a chronic pulmonary disease that is diagnosed after critical damage (permanently dilated or destroyed) to the alveoli. These over-inflated lung sections retain “old” air in the air sacs, so less “fresh” atmosphere can be absorbed. Overinflation of the alveoli increases during physical exertion and is then the leading cause of winded breathing. The damage to the alveoli can be done in several ways, including being:
Over-inflation of the alveoli is a result of a breakdown of the walls of the air sacs, which causes a decrease in respiratory health and frequent breathlessness. Any damage to the air sacs reduces the inner surface of the alveoli, which are critical for the gas exchange between air and blood. The reduction in cell mass results is an increasing decline of oxygen in the blood and vital organs that can lead to peripheral neuropathy, CHF, pulmonary hypertension and heart attacks. Damage to the alveoli sacs can be challenging to manage using traditional medications as the chronic inflammation crates permanent holes in the lower lung tissue. Persistent coughing and sputum are also other common manifestations concomitant inflammation (bronchitis).
Some Common Risk Factors and Causes of Pulmonary Emphysema include:
- Recurrent respiratory infections such as bronchitis, asthma, and pneumonia
- Environmental Pollutants such as coal, cadmium, grains, and isocyanates
- automobile exhaust gases or specks of dust and gases found in the workplace
- Mineral dust & cotton dust are also COPD risk factors
- Hereditary predispositions such as Alpha-1-antitrypsin deficiency ( α1-antitrypsin ) a deficiency of a protective protein (protease inhibitor, PI) The condition is genetic and causes the body to produce too little alpha-1-antitrypsin (AAT), resulting in an AAT deficiency.
Genetic Testing for Lung Disease & Pulmonary Cancers
The Lung Regeneration Center offers DNA screenings for mutated genes that lead to lung diseases including:
- FLCN gene which is associated with Birt-Hogg-Dubé syndrome (pulmonary cysts)
- TSC1, TSC2 genes which are associated with TSC (tuberous sclerosis complex) and lung tumors
- COPA genes which are associated with autosomal dominant interstitial disease (autoimmune)
- PGM3, SPINK5, DOCK8, STAT3 genes associated with Hyper IgE syndrome, an immunodeficiency that causes frequent lung infections
- EGFR gene which is associated with autosomal dominant genetic squamous cell lung carcinoma
- MARS gene which is associated with autosomal dominant Charcot-Marie-Tooth disease and autosomal recessive interstitial disease
Genetic screening of pulmonary illnesses is recommended for family members of patients who have a family history of lung diseases or cancers or as a tool to confirm an existing diagnosis. Early intervention key for managing Pulmonary diseases. We do not offer lung transplantation or gene therapies to treat pulmonary disease, but there are several Phase 1 clinical trials underway with the hopes of one day curing COPD completely.(15833071) To help reduce any risk of developing COPD, emphysematous lungs and pulmonary hypertension considers making lifestyle changes and getting regular exercise.
Diagnosing COPD Emphysema
Diffuse parenchymal lung disease (DPLD) and Emphysema are types of chronic obstructive pulmonary disease that displays abnormal and permanently enlarged in the terminal bronchioles of the lungs. Emphysema and dyspnea usually occur in patients with bronchitis and obstructive pulmonary and respiratory problems. It is rare for patients to be diagnosed with pure emphysema ( without displaying other indications ) unless it’s related to COPD due to hereditary/genetic abnormalities. Most patients we treat at the Lung Regen Center have a combination of bronchitis, emphysematous lungs, or cardiometabolic diseases caused impairment of the airways. This combination of the dyspnea is casually referred to as COPD or COLD (chronic obstructive lung disease).
There are three primary types of Emphysema, including:
- Centriacinar emphysema begins in the patient’s respiratory bronchioles and then starts to spreads in the upper half area of the lungs. This type of emphysema is usually caused by long-term tobacco/cigarette smoking.
- Panacinar emphysema is primarily found in the lower regions of the pulmonary system and tends to destroy the alveolar tissue that causes wheezing. This type of lung disease is commonly found in patients displaying an antitrypsin deficiency with alpha-1 antitrypsin and is a genetic/hereditary disease and often seen in patients with end-stage emphysema.
- Paraseptal emphysema occurs in and around the pleura or septae. This type of disease is mostly associated with chronic autoinflammatory conditions that arise after a lung infection or dyspnea
The 4 Stages of COPD
|Stage of Pulmonary Disease||FEV1/FVC – Tiffeneau-Pinelli Index|
|Stage I = Mild||More than or equal to 80%|
|Stage II = Moderate||Less than 80%, More than 50%|
|Stage III – Severe||Less Than 50%, More than 30%|
|Stage IV – Very Severe||Less than 30%, Less than 50% Respiratory Failure|
Newest Clinical Options for COPD Patients
Theraputic options for chronic pulmonary infections and COPD vary patient to patient depending on severity but can help to ease some signs, prevent further complications, and gradually slow the progression of the disease using a variety of methods starting with smoking cessation.
Medications for COPD – Some medications can help to reduce indications of chronic COPD and reduce frequent exacerbations & flare-ups. Unfortunately, the effectiveness of medicines is different on different patients so your pulmonary specialists might recommend several options to reduce inflammation, relax the airway muscles, or widen the airways to help breathe easier. Some common COPD medications include:
- Theophylline is generally the first clinical option for COPD patients to help prevent flare-ups, ease dyspnea and chest tightness. Taken in pill form this older medication is known to cause side-effects
- Bronchodilator medications are delivered through a nebulizer or inhaler to loosen tight muscles of your airways. There are two types of Bronchodilators including anticholinergics and selective beta-2-agonist and is often used as a COPD exacerbation treatment
- Glucocorticosteroids to help reduce inflammation in the airways can be taken in pill form or inhaled via nebulizer
- Phosphodiesterase-4 inhibitors can be taken as a pill to relax the airway path and help reduce inflammation. Generally reserved for patients with late-stage COPD or chronic bronchitis.
- Antibiotics and antivirals to fight some respiratory infections. Vaccines for COPD Bronchitis such as pneumococcal vaccination or PNEUMOVAX 23 can also be given to high-risk patients to help reduce the risk of getting respiratory infections or for protection from getting whooping cough (pertussis)
Oxygen therapy for Chronic Obstructive Pulmonary Disease – For patients with low blood oxygen levels, supplemental oxygen is prescribed and can be taken via a nasal cannula or a mask to help patients breathe better. A portable oxygen unit is sometimes needed to allow patients to get around easier.
Surgeries for COPD – Surgeries are usually reserved for severe cases of COPD often as a last resort when other clinical options have failed. Surgery is more commonly used for cases with severe emphysema. One such type of lung surgery is known as a bullectomy. During a bullectomy surgery, large, abnormal bullae (air spaces) are removed. Another type of surgery is called lung volume reduction surgery, and this is used to surgically removes injured areas in the upper lung tissue. The riskiest and most difficult treatment option is lung transplants where new lungs totally or partially replace a patient’s damaged organ from a living or deceased donor.
Stem Cell Therapy for COPD
Patients having clinical intervention at the Lung Regeneration Center usually already tried a wide range of COPD trials with various levels of success or failure. Patients seeking a more modern approach such as stem cell therapeutics for COPD have tried other medical options first but often, find it difficult to deal with the serious side effects or positive long term results. Lung stem cell transplants offer patients a safe alternative that can help repair the air sacs and diseased tubes inside the lungs with healthy lung tissue. Lung regeneration is a gradual process, but once the damaged areas get repaired, the indications slowly begin to disappear, lung capacity increases, and patients can breathe more freely. With COPD, there are much fewer air flows in and out of the airways resulting in frequent exacerbations. Restrictive chronic airway obstruction symptoms are due to one or more of the following reasons:
- Airways and air sacs shed their elastic abilities due to an underlying medical condition
- The walls between the alveoli are diseased or destroyed
- The walls inside the airways become inflamed and too thick for gas exchange
- Too much mucus is produced by the airways which cause it to clog the airways
CLINICAL TREATMENT PRECAUTIONS & RISKSPlease note COPD and atelectasis treatment are ideal for Mild-Moderate cases of Emphysema and lung failure only. Endogenous lung stem cell transplants and bioengineered therapies are not appropriate for all candidates. Patients with multiple underlying conditions, end-stage COPD, damage to the endobronchial valve or travel restrictions due to needing for constant Oxygen assistance might not be ideal candidates for the 2-3 week protocol.
Repair & Restore Lung Function
On the basic level, Stem cells are recognized as the building blocks of biology due to their incredible regenerative properties. These totipotent cells offer a promising therapeutic approach using natural sources of cells in human tissue and blood cells. In COPD Stem Cell Treatments, the destroyed lung tissues and cells, causing the various types of complications are targeted for the regeneration of signaling pathways needed for lung repair. Recent studies have also shown that patients with airway inflammation diseases, such as COPD, have a higher prevalence of inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease.
Treatment for Emphysema
Using isolated and enhanced mesenchymal stem cells (MSC+) allows us to target specific regions of the lung structure to slow/stop the spread of the disease, eliminate bronchitis and reduce inflammation (in alveoli pathway.) Improvements in the pulmonary system occur through a function known as immunomodulation making it a powerful but safe and natural therapy for COPD. The goal of the Regeneration Center therapies for COPD and other pulmonary diseases such as Idiopathic Pulmonary Fibrosis (IPF), bronchiectasis, Atelectasis, and Emphysema is to help create the optimal environment for angiogenesis to build new capillaries plus reduce inflammation in the lungs which lead to tissue repair and improved lung function.(25834280)
Natural Way to Stop Chronic Airway Obstruction
Interstitial lung diseases pose a significant challenge for pulmonologists and lung bioengineering. Diseases such as asthma, pulmonary fibrosis, lung cancer, COPD, Cystic fibrosis, Emphysema, Atelectasis & hyaline membrane disease are just some of the diseases that can be managed effectively via lung stem cell therapies. Due to the complexity and locations of the diseased regions, it has always been challenging to deliver cell therapeutic agents effectively. The Regeneration Center has developed a unique and effective protocol using a combination delivery method to target diseased or damaged lung tissue. Our lung therapy uses multiple vectors for cell delivery, including Intravenous, direct injection, endotracheal transplants. Our proprietary Intranasal delivery method (mesenchymal stem cell nebulizer) is for available for painless and targeted delivery of endogenous lung progenitor cells, lung epithelial stem cells to both the airway and vascular system to better organize pulmonary structures for functional improvements of Lung parenchymal damage.(26797607)
Is Lung Regeneration the Best Treatment for COPD?
Lung Cell Transplant – Requirements
Total Clinical Sessions For COPD & Emphysema will depend on patient needs. End-stage COPD options are limited and Exogenous Pulmonary mesenchymal Stem Cells (MSC+) are ideal for mild to moderate pulmonary diseases. The therapeutic approach will include combination therapy of endogenous lung epithelial cells, lung progenitors cells, airway progenitor cells and pulmonary alveolar epithelial cells (for tracheal regeneration) delivered in multiple stages over a 2-3 week course. Long-term effects depend on the severity of existing condition and candidates with progressive respiratory diseases, end-stage COPD, bullous lung disease, Popcorn Lung (Bronchiolitis Obliterans) disease, other COPD complications, chronic respiratory system inflammation, and structural alveolar degeneration may not be good candidates depending on the severity of airflow obstruction. (23648014)
Pulmonary Rehabilitation After Therapy (Optional): Pulmonary Rehabilitation and breathing exercises for COPD are strongly recommended and are available at affiliated local hospitals in Bangkok, depending on the patient’s travel limitations and timing constraints. A dedicated lung rehabilitation specialist will be available upon request for 2-5 hours per day and up to 6 days per week. Medical visas and accommodations for an extended stay with an oxygen nebulizer for the patient can also be provided upon special request.
Total Treatment Length: The Lung Regeneration Center protocol will require multi-stage over a period of 14-21 nights in Bangkok (depending on the severity/spread of the underlying disease.
COPD Treatment Benefits & Guidelines
Due to the varying degrees of lung damage, our medical team will need to review a patient’s preclinical and clinical records to understand his/her needs better. Learn more about COPD clinical trials around the world. To get more information about lung cell therapy or to begin the COPD lung stem cells review process please prepare your recent pulmonary tests and medical records (MRI or Chest CT Scans) and contact us today.