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Chronic Obstructive Pulmonary Disorder (COPD) Management Techniques

06 October, 2014

What is COPD?

Chronic obstructive pulmonary disease (COPD) is a long-term lung disease often caused by smoking. Sufferers have trouble breathing efficiently and, as a “progressive” disease, the symptoms often get worse over time.

COPD is an umbrella term, covering both chronic bronchitis and emphysema. Bronchitis causes inflammation of the bronchi (lung airways), and emphysema is damage to the lung alveoli (air sacs and smaller airways).

Causes of COPD

The best way to prevent or reduce the symptoms of COPD is to refrain from smoking, with smoking being the leading cause of this disease.

In most Western countries, an average of 80% of all COPD cases are as a result of smoking, with other causes being:

Second-hand smoke - Otherwise known as environmental tobacco smoke (ETS), second hand smoke is a common indoor pollutant affecting many non-smokers.

Air pollution - Long-term exposure to low-level air pollution can exacerbate COPD. Occupational exposures such as organic and inorganic dusts, chemical agents and fumes greatly increase COPD risk, as does biomass heating and poor ventilation.

Lung growth and development - The processes that occur during gestation and birth, as well as exposures during childhood and adolescence, can play a role in the level of COPD risk. Children with repeated lung infections are considered at increased risk.

Age and Gender - Often listed as a factor, age reflects the amount of exposure one has received over the years.

Genes - Alpha-1 antitrypsin is a major circulating inhibitor of serine proteases and is hereditary. It’s rare, but it does illustrate the interaction between genes and environmental exposures leading to COPD.

Asthma - While not conclusive, some studies have suggested that sufferers of asthma are far more likely to be diagnosed with COPD than someone with no history of breathing difficulties once smoking has been considered.

Infections - HIV and tuberculosis have been found to accelerate the effects of COPD.

Symptoms of COPD

Cough - Coughing is generally the first symptom associated with COPD, often thought of as a “smokers cough”. Coughing may come and go, but will worsen as the disease takes hold.

Shortness of breath - When exerting yourself (such as climbing a large flight of stairs) you may start to notice a slight wheeze. If smoking is continued, breathing will become more and more difficult.

Coughing sputum - When airways are damaged, they produce more mucus than they otherwise would, resulting in increased sputum (phlegm).

Chest infections - A common cold can suddenly worsen the symptoms of COPD. Lung infections tend to stay around a lot longer in sufferers of COPD.

Tight chest - Following exertion, muscles in the chest can become tightened and strained.

Fatigue - Tiredness is nearly three times greater in a patient suffering from lung disease than in a healthy adult.

Weight Loss - Many people suffering emphysema feel a decreased appetite, and weight loss is common.

Sleep Apnoea – It is common for those with COPD to develop sleep apnoea, which is when a person repeatedly nearly stops and even stops breathing properly during sleep. This can result in sleeping disorders ranging from insomnia to chronic fatigue, and can also have a detrimental effect on a patient’s general health.

Difference between COPD and asthma

The major difference between COPD and asthma is that COPD is permanent, whereas asthma symptoms can come and go.

In COPD, there is permanent damage to the airways. Treatment is limited and symptoms are usually persistent and progressive.

In asthma, the airways are inflamed, causing muscles to constrict the airways. The severities of asthma symptoms vary at different times, and asthma can respond well to treatment.

Another difference is age. Asthma is common even in very young children, whereas COPD is rarely seen in people under 35.

Also, night-time waking and wheeziness is more associated with asthma than COPD.

Statistics and hospital admissions of patients with COPD in Australia

A 2007 study by the Australian Institute of Health and Welfare revealed that COPD was the second leading cause of avoidable hospital admissions in Australia, based on data collected in 2001/02. In 2008, it was then estimated that 5.6% of all Australians had COPD, costing the healthcare system an estimated $900 million.

Currently, 7.5% of Australians aged over 40 have been recorded as having COPD.

Flare-ups and what to do

When COPD symptoms worsen, or when new symptoms develop, it’s referred to as a “flare-up” or exacerbation.

Flare-ups can be deadly; therefore it is vital that they be prevented through taking care of yourself. Eat healthy, exercise regularly, get enough sleep and have a flu shot every year. Also, try to avoid touching your face or nose and stay away from sick people. Most importantly, stay away from tobacco smoke.

COPD flare-ups usually come with a few warning signs, so familiarise yourself with signs to look out for. If you recognise any signs, call your doctor or go to the hospital emergency department:

· Increase in breathlessness

· Change of colour in phlegm (more green, yellow or brown than usual)

· Extra or thicker mucus

· Fever

· Cold symptoms (runny nose, sore throat)

· Swollen ankles

· Fatigue and a general unwell feeling

Certain warning signs may inform you that your condition is about to decline rapidly, therefore it is recommended you call 000 immediately should you recognise any of the following signs:

· Chest pain

· Blue lips or fingers

· Bewilderment or stupefaction

· Drowsiness

· Difficulty in breathing (very short breath)

It’s important you treat flare-ups as quickly as possible.

Breathing techniques

Living with COPD means that you need to get the most out of every breath. Pulmonary rehabilitation programs are available and can be extremely useful, but there are many things you can do at home to make living with COPD easier.

If you feel short of breath, it’s important you stay calm. Take a seat in a comfortable chair and lower your head to your shoulders. Breathe in through your nose and blow out through your mouth as fast as you feel necessary. Gradually slow down your breathing to long, deep breaths.

While in this position, it’s important not to put weight on your arms. Lay your hands and forearms on your thighs with your palms facing upwards and keep your feet on the floor. Remain in this position for at least five minutes.

Another position could be to sit at a table and lower your head to rest on a pillow on the table surface.

If standing, find yourself the nearest wall and - with your feet slightly apart - relax against the surface.

Diaphragmatic breathing: Recommended for sufferers of COPD, diaphragmatic breathing helps to quickly reduce trapped air in your lungs and maximise the amount of oxygen entering the bloodstream.

Step 1: Place one hand on your upper chest and the other on your stomach, just above your waist.

Step 2: Breathe in slowly through your nose. You should notice that your hand remains still on your chest, while the hand on your belly starts to move out. 

Step 3: As you breathe out, check to see that the hand on your belly is moving back in.


Treatment options

While COPD can’t be cured, the good news is that it can be treated with the help of a few lifestyle changes. First things first, it’s essential you quit smoking or refrain from being in places where second-hand smoke is prominent.

In some extreme cases, a doctor may recommend surgery, but these should always be used as a last resort.

Lung volume reduction surgery is essentially removing the parts of your lungs that aren’t working. Some medical experts believe that reducing the mass of the lungs will help the airflow and make breathing easier.

A lung transplant is reserved for those who have tried all the other avenues only to find that symptoms have continued to progress. Lung transplants are risky, and a recipient will find themselves on anti-rejection medications for the rest of their lives.

Medications

Bronchodilators - A bronchodilator inhaler can be extremely useful when exerting yourself, such as after exercise. It helps to open up the airways, allowing you to breathe easier. The speed in which bronchodilators work varies, and relief times can be anywhere from 4-24 hours.

Xanthines or theophyllines - Rarely used, low-onset bronchodilator pills can have serious side effects and may interact with certain foods or medicines. For this reason, it is rare that a doctor will prescribe this type of treatment.

Living with COPD

COPD can play a large influence on your life, but with the right care you can learn to live well with COPD. Learn to conserve your energy and reduce fatigue by performing household chores a little differently. Also consider holiday destinations carefully; avoid areas that have a large amount of tobacco smoke or extreme temperatures, and rest whenever you get the chance.

Chronic disease management programs

A Chronic Disease Management Program (CDMP) can help you develop the knowledge and skills required to best take care of yourself when diagnosed with a chronic lung disease. A CDMP helps you to make smarter decisions in terms of your health and, by working alongside your doctor, a care plan can be built with your well-being in mind.

CODP management

The four main goals of COPD management are to assess and monitor the disease, reduce risk factors, maintain stable COBD and to manage flare-ups.

A good management plan will ensure that side effects from treatment are kept to a minimum, and the individual’s needs are catered for.

Management plans are strongly recommended for progressive diseases that need regular monitoring.

Why CBHS’s CDMP program can help you manage COPD

CBHS works closely with you and your doctor to help you better manage your chronic condition. The emphasis of these programs is on education, equipping participants with the right level of knowledge needed to breathe easier and reduce the risk of flare-ups.

Programs can assist with the management of medications and appointments and trained professionals will help you every step of the way on your journey to better health. They are designed to improve your quality of life and show you how best to live with COPD.If you have COPD and would like to know more about our Chronic Disease Management Programs, please contact Karen (wellness@cbhs.com.au), our Health and Wellness Consultant, on 02 98437620 or Sam (wellness@cbhs.com.au), our Clinical Health Manager, on 02 9843 7616.

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