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What is COPD?
COPD is the abbreviation for chronic obstructive pulmonary disease. COPD is a lung disease that results from obstructions in the airways of the lungs that lead to breathing problems. Although COPD is a progressive disease, early diagnosis and treatment may slow its progression. COPD may be complicated by chronic bronchitis or emphysema; some patients develop both problems that lead to additional breathing problems. Some clinicians consider chronic bronchitis and emphysema as simply further manifestations of COPD.
Shortness of breath is the primary symptom of COPD. It occurs with daily activities and is caused by blocked or clogged airways and damaged or destroyed alveoli where oxygen is absorbed and carbon dioxide is released. Other symptoms may include wheezing, chest tightness, and a chronic cough. The affected individual may tire easily, have frequent colds and flu infections, and produce excessive mucus or sputum. Symptoms of COPD slowly worsen.
Advanced Symptoms of COPD
As stated in the previous slide, symptoms usually progress; people with advanced symptoms of COPD may:
- Be obese from lack of exercise
- Have muscle loss and declining endurance
- Have morning headaches
- Have a bluish or greyish color underneath the fingernails due to decreased oxygen levels in the blood.
Conversely, patients with COPD and emphysema may lose weight.
COPD: Chronic Bronchitis
Many patients with COPD also develop chronic bronchitis (cough that is chronic and inflammation of the airways, mucus overproduction, and frequently associated with viral or bacterial infections). Since smoking is often the cause of chronic bronchitis, the "smoker's cough" is a likely sign of COPD and chronic bronchitis.
Emphysema is a disease of the lung. In emphysema, the alveoli (small air sacs in the lungs that facilitate the exchange of carbon dioxide and oxygen) are damaged and die. Carbon dioxide and oxygen is not exchanged, and eventually the alveoli die leaving holes in the lungs that result in lost lung tissue and increased symptoms of COPD. People with emphysema do not exhale easily.
Diagnosis: Physical Exam
An important part of the diagnosis of COPD is the physical exam, the patient's breathing history, smoking history, and family history of COPD. The first simple, non-invasive test performed usually is with a pulse oximeter (shown in the picture on this slide). Oximetry measures the amount (% saturation) of oxygen in your blood.
Diagnosis: Spirometry Breath Test
Spirometry is a test that measures how much air you can move in and out of your lungs over a short period of time, and is used to test for COPD. The test can identify early COPD, and even help determine the stage of COPD in the patient. The test also may show how well certain medicines affect a person's COPD symptoms.
Diagnosis: Chest X-Ray
A chest X-ray may be able to show enlarged lungs that can occur in some patients with COPD (due to hyperinflation). However, X-ray is more useful to help rule out or rule in other problems that may cause symptoms similar to COPD (for example, pneumonia).
Bronchodilators are medications that are commonly used to treat COPD by relaxing airway muscles that result in opening airways. Some are short-acting (4 to 6 hours) and are used when symptoms increase sharply, while longer-acting bronchodilators are used on a once a day basis to treat more chronic COPD symptoms. People with COPD may use both types, depending on their symptoms.
Corticosteroids reduce the inflammation in airway tissues and thus allow the airway to open. This medicine is often taken by inhaler, but also may be administered by pills and/or injection. Both corticosteroids and bronchodilators are often prescribed to patients with COPD.
Treatment: Lung Training
It is possible to significantly slow COPD progression and to improve breathing with pulmonary rehabilitation classes. Part of this rehabilitation includes stress management and breathing control techniques.
Breathing Better With COPD
Some examples of learning to breathe better with pulmonary therapy are as follows for people with COPD:
- Pursed lip breathing involves pursing the lips (like you are whistling or kissing) making exhaling easier for the person, and they also are able to extend exhalation, which provides improved oxygen and carbon dioxide gas exchange.
- Extended exhalation and diaphragm breathing may help a person with COPD increase their total air volume exchange and some people may find it easier to breathe with this method.
Treatment: Oxygen Therapy
COPD lowers oxygen in the blood. As COPD progresses, many people have oxygen levels so low that they get very short of breath doing simple everyday tasks like walking a few steps or just standing up for a few minutes. These people with COPD usually get some relief with supplemental oxygen administered through nasal tubing as pictured on this slide. Care must be taken when near someone using supplemental oxygen because it is flammable. Smoking, lit candles, or other open flames or sparking items (such as sparklers or gas cooking flames) should not be near someone using supplemental oxygen.
Unfortunately, partially or completely blocked airways full of mucus are good places for pathogens (agents that causes disease such as a virus or bacterium) to occupy and multiply. People with COPD are at a higher risk for infections because they have partially or completely blocked airways. If fever accompanies an increase in shortness of breath, people with COPD should see their doctor quickly to avoid serious infections. For example, antibiotics may be prescribed for bacterial infections.
Surgery is not often used to treat people with COPD, but some people may benefit from certain procedures. The surgical procedures most used are as follows:
- Bullectomy: removal of bullae (air filled sacs of lung that do not function) may allow some lung expansion
- Lung volume reduction: removal of emphysematous lung tissue allowing functional airways to do better gas exchange
- Lung transplant: improves COPD symptoms and the quality-of-life for some select patients (average survival is about 5 years after transplant).
COPD and Exercise
All people with COPD are usually advised to exercise, even those on supplemental oxygen. Walking is considered by most clinicians as the best form of exercise to begin with and to develop endurance. Patients can start slowly and gradually increase their endurance. Check with your doctor about exercising before you begin any exercise program.
What Causes COPD?
Smoking and secondhand smoke plays a significant role in causing COPD. About 85% to 90% of all COPD deaths are related to smoking. The other causes are related to environmental irritants (pollution), and a rare few are genetically passed through family members (for example, people with Alpha-1 antitrypsin deficiency [AAT] are likely to develop COPD symptoms).
How Quitting Smoking Helps
People who are diagnosed with COPD and who continue to smoke will have COPD progress faster. Smokers who quit will have COPD progress slower. Smoking cause the airway tissues to become damaged or destroyed (for example, the cilia that help clear airways); in addition, the many toxins in cigarette smoke can increase blood pressure, heart rate, and increase the risk for lung cancer.
COPD and Diet
A healthy diet can help lessen symptoms of COPD. Obesity can make breathing and daily chores more difficult, while being too thin may cause weakness. Your doctor or a nutritionist can give you some guidance about a healthy diet for you. The following are some general dietary suggestions:
- Avoid under and over eating
- Drink water, not caffeinated or carbonated drinks
- Eat high fiber foods (bran, fresh fruit)
- Avoid gas-producing foods (fried foods, beans)
- Eat small meals (3) with healthy snacks (2-3) every day
COPD and Cancer
As mentioned previously, smoking, the leading cause of lung cancer, is also a major cause of COPD. Consequently, it is not surprising that many people with COPD also develop lung cancer. What is the best thing you can do to prevent COPD and lung cancer? Stop smoking, now.
Living With COPD
Living with COPD can be very difficult, but there are ways that can help you diminish symptoms and slow the progression of COPD. Although several have been described in the preceding slides, here is a list of ways to improve your daily life:
- Stop smoking
- Eat a healthy diet
- Stay active (exercise to improve your endurance)
- Use your medications as directed
- Get the flu vaccine every year and get vaccinated against pneumococcal pneumonia
- Use sanitary hand washing techniques and avoid people with respiratory infections or those that have symptoms (cough, sneezing, nasal drip)
- Contact your doctor immediately if you develop increasing symptoms of COPD and develop a fever.
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