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COPD

Understanding a leading cause of death

By Laura Kuhn

Chronic obstructive pulmonary disorder, or COPD, is a leading cause of death in the U.S. and around the world, ranking fourth behind heart attacks, cancer and strokes.1 It's also a condition that is most commonly diagnosed in middle-aged and elderly people, including residents in long-term care facilities.2

COPD actually refers to a group of lung diseases that block airflow as a person exhales, making it increasingly difficult to breathe. The two main conditions that comprise COPD are emphysema and chronic bronchitis.3 Most people with COPD have both diseases. COPD is progressive, which means it worsens over time.2

How does COPD affect the body?

COPD interferes with the body's ability to exchange oxygen and carbon dioxide in the lungs, which is caused by damage to the airways.3

With emphysema, the walls between air sacs in the lungs become damaged, making them floppy and shapeless. Emphysema can also destroy the walls of air sacs, creating fewer and larger air sacs instead of a multitude of tiny ones. This reduces the amount of gas exchange in the lungs.2

People with chronic bronchitis have airways that are constantly irritated and inflamed. This causes the airway lining to thicken. An abundance of mucus forms in the thickened airway, making it difficult to breathe.2

What causes COPD?

The majority of COPD is caused by long-term smoking and can be prevented by not smoking or quitting soon after starting. It can also be caused by extended exposure to airborne irritants, including tobacco smoke, dust, chemical fumes and air pollution. In rare cases, a genetic disorder known as alpha-a antitrypsin can play a role in the development of COPD.3

COPD typically develops slowly and most symptoms don't appear until age 40 or later. Symptoms often worsen over time and can begin to affect a person's ability to perform routine activities. Severe COPD can prevent sufferers from doing even basic activities such as walking, cooking or caring for themselves. The damage that COPD inflicts on the lungs is irreversible.2

Symptoms and diagnosis

Symptoms of COPD can vary, depending on whether emphysema or chronic bronchitis is more prevalent. Most people with COPD have more than one of these at the same time3:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Chronic cough
COPD can be diagnosed through imaging tests, lab tests and pulmonary function tests.3

Complications

People who have been diagnosed with COPD are at a higher risk of developing respiratory infections, high blood pressure, heart problems and depression.3 Although COPD symptoms usually worsen slowly over time, some complications can cause them to worsen very quickly. For example, a cold, the flu or lung infections can make it much more difficult for someone with COPD to catch his breath. These illnesses can also cause chest tightness, more coughing, fever and changes in the amount and color of sputum.2

Treating COPD

There is no cure for COPD, but treatments and lifestyle changes can help to slow the progression of the disorder.2 Treatment options for COPD include medicines (bronchodilators and steroids), vaccines (flu shots and pneumococcal vaccines), pulmonary rehabilitation, oxygen therapy and surgery (bullectomy and lung volume reduction surgery). Lung transplants may be done for people who have very severe COPD.2

Lifestyle changes can significantly slow lung damage. The Mayo Clinic makes the following suggestions3:

  • Quitting smoking is the single most important step someone with COPD can take to make the condition more manageable. Avoiding secondhand smoke can also make a big impact.
  • Clear the airways. Controlled coughing, drinking lots of water (unless the resident has heart disease) and using a humidifier can help to clear mucus that collects in the airways.
  • Exercise regularly. It might seem counterintuitive for people who have trouble breathing to exercise, but regular exercise has been shown to improve strength and endurance as well as strengthen respiratory muscles.
  • Maintain a healthy diet. Healthy foods can help people with COPD maintain their strength. Overweight people might find that losing weight can significantly help their breathing, especially during exertion.
  • Avoid crowds and cold air when possible. Crowded situations make it more likely that germs will reach the lungs and cause an infection. Cold air can trigger bronchospasm and shortness of breath. If it is not possible to avoid crowds or cold air, a mask should be worn to minimize the impact of these situations. Limit contact with visitors, staff and other residents who may have an infection.
  • Control breathing. Doctors and respiratory therapists might be able to suggest techniques for breathing more efficiently throughout the day as well as breathing positions and relaxation techniques to use when COPD sufferers are short of breath.
Caregivers who work with residents diagnosed with COPD should strive to help relieve their symptoms, prevent complications and assist the resident with adjusting to lifestyle changes. The role of the caregiver involves both support and coaching: support in dealing with symptoms as they occur and coaching in techniques that will help residents live more comfortable lives.4

The following tips can be utilized by caregivers to help make residents with COPD more comfortable4:
  • To help clear secretions that might have gathered in the lungs, encourage the resident to sit at the bedside or in a comfortable chair, hug a pillow, bend his head down a little, take several deep breaths and cough strongly.
  • Place residents who are experiencing dyspnea (difficult or labored breathing) in a high Fowler position. This improves lung expansion.
  • Placing pillows on the overbed table and having the resident lean over them can help ease breathing.
  • Administer oxygen with caution because of the resident's carbon dioxide retention. The recommended oxygen amount is one to two liters not to exceed three liters). Often, oxygen is administered 12 hours a day with some benefit.
Although COPD is not curable, it is almost 100 percent preventable through education and elimination of the most common risk factors for developing the disorder.

References

  1. Centers for Disease Control and Prevention. FastStats. Deaths and Mortality. Available at: http://www.cdc.gov/nchs/fastats/deaths.htm. Accessed March 23, 2011.
  2. National Heart Lung and Blood Institute. Diseases and Conditions Index. COPD. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html. Accessed March 23, 2011.
  3. Mayo Clinic. COPD. Available at: http://www.mayoclinic.com/health/copd/DS00916. Accessed March 23, 2011.
  4. Health Care Council of Illinois. Chronic Obstructive Pulmonary Disease In-Service. Clinical Capsule. 2004;9(10).