Supplements and Herbal Medicine for COPD

From the WebMD Archives

Many people with COPD (chronic obstructive pulmonary disease) turn to dietary supplements and herbal medicine, as well as conventional Western medicine, to treat the lung disease.

"The curiosity is definitely there," says Cleveland Clinic pulmonologist Umur Hatipoglu, MD. "And there is pretty convincing emerging data that we should look into."

Of the many remedies touted for COPD, N-acetylcysteine (NAC), ginseng, and vitamin D "are the three big ones," says naturopathic physician Jeremy Mikolai, ND, a researcher at the National College of Natural Medicine in Portland, Ore.

NAC (N-Acetylcysteine)

NAC is an antioxidant supplement that has shown promise in some studies but not in others.

"NAC is a robust treatment for COPD that reduces phlegm and cough, thins mucus, and eases expectoration," says Mikolai. It's said to decrease the deterioration of lung function. However, the evidence to support that claim is weak, according to a research review done in 2006 on how NAC affects COPD. That review said the design of the study in question did not allow for "firm conclusions."

Meanwhile, a large, three-year research project known as the BRONCUS study found that NAC did not prevent decline in lung function.

The BRONCUS study also looked at NAC from another angle. Could the supplement, the authors asked, cut the number of COPD flare-ups people get in a given year?

The authors report that NAC did not prevent flare-ups, but additional analysis suggested that the rate of flare-ups might be less in people not taking an inhaled steroid.

Despite that limited positive result, Hatipoglu says, NAC was "almost buried for dead after that study."

Still, he does often recommend NAC for its ability to loosen sputum, although its effectiveness hasn't been fully established.

"If my patients say they are doing better on it, I keep them on it," says Hatipoglu, who adds that NAC is quite safe. Though NAC is safe, it does contain sulfur, which gives it an odor "like rotten eggs," he says. In the BRONCUS study, researchers reported no side effects from NAC use.

Duffy MacKay, ND, says that he found NAC, which can also be inhaled via a nebulizer, to be similarly effective in his practice.

"The constant buildup of mucus -- that's where NAC seems to be most active," says MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade group that represents the dietary supplement industry.

Continued

Vitamin D

People with COPD may not have enough vitamin D. That could happen for several reasons:

  • Not enough time outside. (Sunshine helps the body make vitamin D.)
  • Because of their age. "Most COPD patients are older," Hatipoglu says, and with age, it's harder for the body to make vitamin D.
  • Not enough vitamin D in their diet. Vitamin D is added to milk and some other fortified foods. It's also available in supplements.

Higher levels of vitamin D have been linked to better lung function test results, Mikolai points out. But does that mean that supplements will help treat COPD? We don't know yet, Hatipoglu says.

In a 2012 study, high doses of vitamin D did not reduce the number of flare-ups for most COPD patients. The only people who benefited were those who had extremely low levels of vitamin D. The study was small, though, so it's not the final word.

Hatipoglu checks his patients' levels every one to three months and recommends supplements if their vitamin D levels are lower than normal.

Ginseng

An herb with a long history of use in Chinese medicine, ginseng has shown some promise in treating COPD symptoms. However, studies touting its benefits have been questionable, Hatipoglu says.

"There have been ten or twelve such studies, the quality of which are very poor," he says. "It may have a use, but I don't use it for my patients. It really requires good quality ... studies, but I remain curious about it."

Mikolai says ginseng may improve lung function. But, he stresses, it should only be taken after consulting with a doctor or other health professional, because it interferes with several types of medications, including blood thinners, stimulants, diuretics, some antidepressants, and drugs that suppress the immune system.

"You and your doctor have to decide if the benefits outweigh the risks," Mikolai says. He also points out that most ginseng studies lasted no longer than three months.

"We don't know about its long-term safety," he says.

Safety First

Be sure you discuss any supplements you take with your doctor or other health care professional, so they can watch for any side effects or interactions with your medications.

"Many people have the misconception that natural medicine is harmless," Mikolai says, "but if it has the power to help, it also has the power to harm."

It's also crucial to work with someone who is knowledgeable about complementary and alternative treatments, MacKay says.

"The variable is working with a qualified person rather than simply rolling into a health food store," he says. "The type of clinician who has the right kind of knowledge can have an immense impact."

His advice is to find a doctor who is a "holistic thinker" who will add lifestyle changes, nutrition, and other appropriate interventions into your treatment plan.

"Not letting the disease progress -- that's the name of the game," MacKay says.

WebMD Feature Reviewed by Louise Chang, MD on September 19, 2012

Sources

SOURCES:

Umur Hatipoglu, MD, Respiratory Institute, Cleveland Clinic.

Jeremy Mikolai, ND, National College of Natural Medicine, Portland, Oregon.

Duffy MacKay, ND, vice president, scientific and regulatory affairs, Council for Responsible Nutrition, Washington, D.C.

Guo, R. European Respiratory Journal, August 2006.

Sadowska, A. International Journal of COPD, December 2006.

Dekhuijzen, P. International Journal of COPD, June 2006.

Lehouck, A. Annals of Internal Medicine, January 2012.

Decramer, M. Lancet, April 2005.

NYU Langone Medical Center: "N-Acetyl Cysteine."

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