COPD requires unique treatment

Dear Dr. Roach: I read your recent column on pulmonary fibrosis. I especially appreciate knowing that there are medications known to slow progression of lung disease, reduce exacerbations and reduce mortality. With a 20-yearold diagnosis of COPD and having been prescribed medications to reduce exacerbations, you might imagine my interest in your article.

I’m wondering how pulmonary fibrosis differs from COPD and if the two medications that you mention (pirfenidone and nintedanib) might be helpful in slowing the progression of lung disease in patients such as myself. Have any studies been completed using these medications on patients with COPD?

S.A. Answer: Chronic obstructive pulmonary disease usually, but not invariably, is a result of long-term exposure to lung toxins, especially smoke. In the most common case of COPD, due to cigarette smoking, stopping the exposure will dramatically slow down further damage. Unfortunately, there are no established treatments that can restore lung function in people with moderate to advanced COPD.

Pulmonary fibrosis is, by contrast, a rare disease; about 30,000 people in the U.S. are diagnosed each year. The exact mechanism of action of pirfenidone and nintedanib is not known, but they are not thought to be effective in COPD.

Dear Dr. Roach: I have a friend who recently found out that she’s prediabetic. She’s also very obese. She has started juicing her fruits and vegetables in order to lose weight and get healthier. Isn’t it just healthier to eat produce whole as opposed to making juice out of it?

N.F.E. Answer: Eating more vegetables and fewer simple sugars and processed starches is a good idea for nearly all people who want to eat healthier, and it may help people lose weight.

Fruits are also an important part of diet, but for people with or at high risk for diabetes, I recommend no more than one or two fruits with meals, and that the fruits be whole.