Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis, Emphysema, Asthma, and Treatment with Traditional Chinese Medicine

On April 26, Mr. MT, 74 years old, came to the clinic and reported that he had asthma when he was young. He was diagnosed with COPD and emphysema last November. Now he feels short of breath, fatigued, and too weak even to walk. Even with the help of an inhaler, he can only take a few steps at home. His doctor prescribed Trelegy Ellipta and Roflumilast, but they were ineffective and caused diarrhea as a side effect. He also lost 3–4 pounds. In addition, due to anxiety and insomnia, he needs to take sleeping pills to help him sleep and is also taking antacids. Before came here, he underwent two months of acupuncture and herbal treatment in another clinic, but with no significant improvement. The patient hopes I can help him so that he can play pickleball and ping pong daily as he used to.

The patient’s tongue had a white coating, and his pulse was floating and slippery. I recommended a combination of acupuncture and herbal medicine. On that day, he received acupuncture treatment and was prescribed ten days of herbal medicine. After finishing the ten-day course, the patient did not feel any improvement and decided to stop taking the herbs and try acupuncture first. However, after eight acupuncture sessions (twice a week), there was still no significant improvement. I explained to the patient that treating COPD would not yield immediate results like treating a cough. Recovery would take time. I suggested he try herbal medicine again, and the patient agreed. Since the Western medication was ineffective and caused diarrhea, he decided to stop taking it and rely solely on herbal medicine.

On May 20, May 29, and June 14, I prescribed him 10 days, 10 days, and 15 days of herbal medicine, respectively.

On July 19, after continuously taking 35 days of herbal medicine, the patient returned to the clinic and told me that over the past two weeks, he had started walking 40 minutes daily and playing ping pong for an hour and a half. I prescribed another 15 days of herbal medicine.

On August 9, the patient came back to the clinic and reported significant improvements in his energy and mood, as well as weight gain. He had also started playing pickleball daily. I prescribed another 15 doses of herbal medicine.

On August 23, the patient said he was now playing pickleball and ping pong daily as before and had reduced his dosage of sleeping pills. Treatment is still ongoing.

Chronic Obstructive Pulmonary Disease (COPD) is a common, incurable lung disease. According to the WHO's 2019 Global Health Estimates (GHE) report, COPD is the third leading cause of death globally.

Chronic bronchitis and emphysema are the two most common pathological conditions leading to COPD. However, not all patients with chronic bronchitis or emphysema have COPD. COPD is diagnosed only when these conditions cause irreversible airflow limitation. In clinical practice, the vast majority of COPD patients exhibit pathological changes of chronic bronchitis and/or emphysema.

Below are the definitions and diagnoses of COPD, chronic bronchitis, and emphysema:

Chronic Obstructive Pulmonary Disease (COPD) is a functional diagnosis. Its core feature is persistent airflow limitation that is usually progressive.

o   Diagnostic Criteria: The gold standard for diagnosing COPD is pulmonary function testing. A post-bronchodilator FEV1/FVC (forced expiratory volume in one second/forced vital capacity) ratio of < 0.70 indicates persistent airflow limitation and confirms COPD.

Chronic Bronchitis is a clinical diagnosis. It refers to chronic non-specific inflammation of the trachea, bronchial mucosa, and surrounding tissues.

Diagnostic Criteria: A cough with sputum production lasting for at least three months per year for two or more consecutive years, after excluding other diseases with similar symptoms such as tuberculosis or bronchiectasis.

Pathogenesis: Inflammation causes hyperplasia and hypertrophy of the airway mucosa, leading to excessive mucus production (phlegm). This narrows the airways, obstructs airflow, and causes breathing difficulties, particularly during exhalation.

Emphysema is a pathological diagnosis. It involves the loss of elasticity, overinflation, and increased lung volume of the distal terminal bronchioles (respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli), accompanied by destruction of the airway walls.

Pathogenesis: The destruction of alveolar walls reduces the lungs’ ability to recoil normally during exhalation. As a result, air becomes trapped in the lungs and cannot be fully exhaled, significantly reducing the efficiency of oxygen exchange.

In short: Emphysema refers to damage to the small air sacs at the end of the lung airways, while chronic bronchitis involves chronic cough and phlegm due to airway inflammation.

Additionally, although COPD and asthma share similar symptoms (cough, wheezing, and difficulty breathing), they are fundamentally different diseases from a Western medical perspective. The former is an irreversible structural lung disease that typically develops in middle-aged or older adults. Its prognosis involves progressive decline in lung function. Asthma, on the other hand, is a reversible airway inflammation that usually begins in childhood or adolescence. Its prognosis is generally favorable with proper management, and lung function can be maintained normally.

Whether for COPD, chronic bronchitis, emphysema, or asthma, Traditional Chinese Medicine (TCM) treatment can yield significant results. For these chronic respiratory conditions, my personal experience is that herbal medicine is essential. Combining acupuncture with herbal medicine usually produces better outcomes, especially for severe asthma cases, where I always integrate both approaches. To prevent recurrence, San-fu-tie (dog-day patch) therapy during the summer is recommended in my clinic.

It is important to note that, the effectiveness of treatment may vary due to differences in TCM practitioners’ skills. If there is no improvement after a period of treatment at one clinic, it may be worthwhile to consult another TCM practitioner.