Managing COPD

The words Chronic Obstructive Pulmonary Disease mean:

Chronic - Long term, continuing

Obstructive -Blockage

Pulmonary - All parts of the lung

Disease - illness

COPD is composed of two diseases, chronic bronchitis and emphysema. You can have one or you can have components of both with one presenting more.

Chronic bronchitis -Unlike acute bronchitis, which is short term and goes away, is when the airways becomes inflamed, filled with mucus and blocked. Then they constrict due to hypersensitivity to irritation. You could present with a lot of coughing, phlegm and problem breathing that does not stop.

Emphysema - The lungs have something called air sacs that become stretched out and damaged. The lung becomes less elastic and does not expand and contract normally. This causes air to be trapped in the lung and less gets out. This causes the shortness of breath.

Asthma - is not considered COPD, it used to be classified with it but no longer and has its own protocol. Asthma is considered a reversible airway disease and COPD is considered not fully reversible. A person can have both asthma and COPD.

Early symptoms of COPD can be dismissed as being out of shape or the effects of getting old. COPD can present with chronic cough, shortness of breath, excess mucus, chest tightness and wheezing. It is unclear why some longtime smokers get the disease and others do not. Some clinicians believe it is in the genes.

It can be determined if it is the disease by taking a test called a spirometry and signs and symptoms. The spirometry is one test in a group of tests called pulmonary function tests. The results can help determine if the disease is present. The test can be given in your primary care doctors office and it does not take long. Spirometry needs the patient's active participation in order to get good and accurate results. If the patient knowingly has a cold or other acute respiratory infection they should call the doctor to reschedule the test. Taking this test with a cold could give false results.

The patient will be seated and asked to breath into a tube that is attached to a machine. First they will be asked to breath normally than to take a deep breath in, and to blow it out as fast and hard as they can for at least six seconds. After resting they will be asked to do it at least two more times. Depending on those results they might be given a short acting bronchodilator and asked to do the test again to determine if there was obstruction and if it is reversible as in asthma.

Not everyone who smokes gets COPD, but the vast majority of people who have COPD got it from smoking. Quitting smoking is of the utmost priority but not an easy task. The nicotine in cigarettes make smoking an addiction. People also become depressed while trying to quit, especially if they have to change their behavior in order to avoid being tempted.

Second hand smoke is implicated in heart and lung disease. It is also implicated in an increase risk for dementia.

OUTDOOR TRIGGERS

Air Pollution
Pesticides
Pollen, grasses, trees
Traffic fumes
Wind
Weather extremes- cold and dry, hot and humid
Sudden change in weather
High altitude

INDOOR TRIGGERS

Smoke- cigarette, fireplace
Scents- perfume, air sprays, scented candles, air fresheners
Dust, Dust mites
Viruses- Colds, Flu
Fumes- paint, cleaning products, glues
Pesticides
Mold and Mildew
Pets- hair, dander, saliva;

First and foremost is if you smoke you need to stop. Smoking will make your condition worst. Damage to your lungs can't be reversed but the progression can be slowed down and symptoms can be improved.

EDUCATION
learn all you can about your condition and learn about things that you can do.

LUNG FUNCTION
Use Pulmonary Function Test (PFT) to find out how much damage there is to your lung. Arterial Blood gas (ABG) will measure how much oxygen is in the blood.

MEDICATION THERAPY
Short acting bronchodilators, long acting bronchodilators, anticholinergics, theophylline, antibiotics, mucolyptics, steroids. Need to stick to a regime that prevents exacerbation of your symptoms.

OXYGEN
If oxygen levels are low might need supplementary O2, but too much can cause problems.

LIFESTYLE
Need to eat right and keep a proper weight, get proper sleep, keep as active as possible, yoga, tai chi. Understand what are your triggers and work to avoid them.

PULMONARY REHABILITATION
improves endurance and helps reduce symptoms. Skeletal-muscle dysfunction is indicated in this disease and can be reversed with exercise. There is some third party reimbursement.

OTHER THERAPIES
Hypnosis, acupuncture, biofeedback, relaxation techniques, music therapy, visualization, breathing exercises ( Buteyko, Pranayama, Papworth)

SURGERY
Bullectomy
Lung Volume Reduction Surgery (LVRS)
Lung transplantation

Oxygen is classified as a drug and is given by prescription. It falls to the doctor to determine how much is needed and for how long during the day. There is no cure so this is a long term treatment that will be needed for the duration of the persons life. Supplemental oxygen is given when the body has low oxygen levels in the blood and tissues. The extra oxygen increase the levels in the body. The benefit is having less distressed breathing, better quality of life and by extending their lives. Not having the supplementary oxygen for some people can cause death. Chronic low oxygen can cause cardiac, kidney and other medical problems.

Extra care must be taken when giving oxygen to people with COPD. Too much oxygen can be harmful to the person and can cause ill effects. They might not breath out enough CO2 and retain it. This can cause a reduction in respiratory effort and a change in mental status and eventually unresponsiveness and death. So remember a little may be beneficial but a lot may not be beneficial. That is why it is given by prescription and needs to be monitored.

Delivery systems are liquid oxygen units, oxygen concentrators and compressed into tanks and hyperbaric oxygen. It can be administered by mechanical ventilators, nasal cannulas, various masks and manually via an ambu bag.

Oxygen for the most part is safe but there are instances where it can cause harm. There are people who cannot tolerate a lot of oxygen. The carbon dioxide goes up and their breathing becomes depressed or stops and they do not properly ventilate. Another is oxygen toxicity where there can be lung and neurological damage from high concentrations of oxygen.

Oxygen needs to be handled correctly. Oxygen supports combustion so it should not be around flames or anything that sparks. Oxygen saturated items like clothes burn quicker and more intensely. Behavior like smoking or cooking with oxygen running is very dangerous. The fire departments in the US responds to approximately 182 supplemental oxygen related fires according to the National Fire Protection Association (NFPA). Forty-six people die per year and many more are left with burn related injuries. Most are thought to be related to smoking while using oxygen.

The tanks should not be dropped or if made of metal, should not be taken anywhere near an MRI machine.

People who find they have breathing problems, thinking it's from COPD, asthma and other lung diseases might have Alpha-1 antitrypsin deficiency and not know it. It is a genetic disorder that sometimes is misdiagnosed as uncontrolled asthma. Alpha-1 lung disease is considered an atypical COPD. It confuses doctors because the symptoms present themselves earlier than regular COPD and has no cigarette connection. Because of the young age of those it affects means it may be confused with asthma and treated as such.

It is now recommended by the American Thoracic Society and the European Respiratory Society to test sufferers with COPD, asthma, other lung and certain kidney diseases for this genetic disorder. It is a relatively eastest and can be done with routine blood tests.

People living with COPD are prone to sleep disorders. They find themselves with fatigue and shortness of breath and day time sleepiness. The reason can be related to in part fragmented sleep, insomnia and obstructive sleep apnea . Coughing and breathlessness at night will keep them up also. It is well understood that circadian rhythm also plays a role. All people breath better during the day and as night comes breathing gets worse. People who have no breathing problems it is not an issue. But It can be an issue for people with COPD and other breathing problems.

Holidays are a time to be around your friends and family. For the person living with COPD it can be trying. Hospitals notice an increase in admissions from exacerbation of COPD around the holidays. So care needs to be taken in order to have an enjoyable holiday.

Make sure you keep to your schedule and continue to take your medications. Always remember to have your rescue medication with you and don't be embarrassed to take it if you feel symptoms coming on. If you feel sick you might have to go home or to the doctor, remember you need to take care of yourself so you can return an party another day.

Being around people is good for you. You have to be careful of people with colds and other respiratory symptoms that they can pass on. Try to avoid people who are coughing and sneezing and delicately try to avoid too much kissing and hand shaking. Always wash your hands before any food contact and carry and use your personal hand sanitizers.

You have more control over your environment if you are at home and receive visitors but if you are visiting someone else you need to discuss things with your host and hostess. If you get reactions from scents like candles, perfumes and potpourri. If you get sick around pets or smoke you can discuss those with them. It is better if you had been there before to see how you react to the environment.

There are some homes that you need to stay away from or at least don't stay long and don't spend the night because of pets, dust and other irritants. You can visit them by the free videoconferencing or someplace neutral like a restaurant or a irritant free home.

One of the good reasons for joining a local COPD group is that there are like minded people there and you can socialize with them in comfort. Or make friends with people who are allergic, have asthma or COPD and will be living similar to you.

Lastly remember not to over eat. Over eating can make you symptomatic, so taste everything in small portions.