Chronic Obstructive Pulmonary Disease
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1 Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production and wheezing. It s caused by long-term exposure to gases of particular matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It is characterized by daily cough and sputum (phlegm) production. Emphysema is a condition in which the air sacs (alveoli) at the end of the smallest air passage (bronchioles) of the lungs are destroyed as a result of damaging exposure. COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. At Centers Plan for Healthy Living (CPHL) our goal is to provide you with helpful information that empowers you to better manage your health. It is our belief that the more you know, the better you can manage the everyday challenges you encounter with your chronic condition(s). We want to help you and your family stay healthy and active. One of our goals, here at CPHL, is to helping you develop specific self-management skills, improve your chronic condition(s), and optimize your overall health status. In this document you will find helpful educational information that can assist you with the understanding of COPD and how to manage this chronic condition. INDEX Risk Factors 2 Symptoms 2 Causes 3 Complications 3 Testing & Diagnosing 4 Treatments & Management 5-8 COPD Action Plan 9 1
2 Risk Factors Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers are at risk, as are people exposed to large amounts of secondhand smoke. People with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more. Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dust in the workplace can irritate and inflame your lungs. Age. COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin. Genetics. As noted above, the uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. Symptoms Symptoms of COPD often don t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is usually daily cough and sputum production at least three months a year for two consecutive years. Other signs and symptoms of COPD include: Shortness of breath, especially during physical activities Wheezing Chest tightness Having to clear your throat first thing in the morning, due to excess mucus in your lungs A chronic cough that produces sputum that may be clear, white, yellow or greenish Blueness of the lips or fingernail beds (cyanosis) Frequent respiratory infections Lack of energy Unintended weight loss (in later stages) Individuals with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. 2
3 Causes The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 25 percent of chronic smokers develop clinically apparent COPD, although up to half have subtle evidence of COPD. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed. Cigarette smoke and other irritants In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as genetic susceptibility to the disease, because only about 25 percent of smokers develop COPD. Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes. Complications of COPD include: Respiratory Infections- People with COPD are more susceptible to colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia will help prevent some infections. Heart Problems- For reasons that aren t fully understood, COPD increases your risk of heart disease, including heart attack. Quitting smoking markedly reduces this risk. Lung Cancer- Smokers with chronic bronchitis have a greater risk of developing lung cancer than do smokers who don t have chronic bronchitis. Quitting smoking also markedly reduces this risk. High Blood Pressure- COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension) Depression- Difficulty breathing can keep you from doing activities that you enjoy. Dealing with serious illness can contribute to development of depression. Talk to you doctor if you feel sad or helpless or think that you may be experiencing depression. 3
4 Testing & Diagnosing If you have symptoms of COPD and a history of exposure to lung irritants-especially cigarette smoke-your doctor may recommend these tests: Pulmonary Function Tests- Spirometry is the most common lung function test. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. Chest X-ray- A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. CT Scan- A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer, which is more common among people with COPD than it is among those who smoked but didn t develop COPD. Arterial Blood Gas Analysis- This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. 4
5 Treatments and Management Smoking Cessation The most essential step in any treatment plan for COPD is to stop smoking. It s the only way to keep COPD from getting worse-which can eventually reduce your ability to breathe. But quitting smoking isn t easy. This task may seem particularly difficult if you ve tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. It s also a good idea to avoid secondhand smoke exposure whenever possible. You can also talk to experts at the American Lung Association Lung Help Line and Tobacco Quit Line LUNGUAS Hours: Monday-Friday 7 a.m.-9 p.m. CT Weekends 9 a.m.-5 p.m. *After hours leave a message and they will respond the next business day. Coping and Support Living with COPD can be a challenge-especially as it becomes harder to catch your breath. You may have to give up some activities you previously enjoyed. Your family and friends may have difficulty adjusting to some of the changes. It can help to share your fears and feelings with your family, friends and doctor. You may also want to consider joining a support group for people with COPD. If you are interested in joining an online or in person support community you can visit Lung.org/community or call LUNGUSA for more information. 5
6 Medications Doctors use a variety of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. Each person's COPD is different; therefore, there is not a one for all medicine for COP treatment. Your doctor and healthcare team will work with you to set up the best plan to address your symptoms and needs. By taking the right medications as prescribed you can better manage your symptoms and have fewer flare-ups or exacerbations. Your care manager along with your interdisciplinary team at CPHL will work with you to develop a plan of care that will assist you and implement COPD management strategies, continuing medication and disease specific education to help you improve or maintain your chronic condition, and optimize your overall health status. Medical Equipment Use Metered Dose Inhaler Shake the inhaler. Take off cap. Stand or sit up straight. Breathe out. Put inhaler in or just in front of your mouth. As you start to breathe in, push down on the top of the inhaler and keep breathing in slowly. Remove the inhaler and hold your breath for 10 seconds. Breathe out. Repeat, if so instructed. Wait 1 minute between puffs. Rinse Mouthpiece after use and replace the cap. MDI Spacer Shake the inhaler and remove cap from inhaler and/or spacer. Attach the spacer to the inhaler. Breathe out, away from the spacer. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it. Press the top of your inhaler once. Breathe in very slowly until you have taken a full breath Hold your breath for about ten seconds, and then breathe out. 6
7 Nebulizer Use and Maintenance Nebulizer equipment: Tubing Mouth piece Mask Reservoir Cleaning of nebulizer equipment that includes mouth piece, mask and reservoir should be done in between usage: 70% isopropyl alcohol (5 minutes) 3% hydrogen peroxide (30 minutes) Boiling water (5 minutes) Dishwasher with detergent for 30 minutes, if the water is hotter than 158 F or 70 C. All items can be rinsed with tap water following cleansing Solution should be changed following each cleansing Solution cleansing should be done at least 3x per week Soap and water cleansing following each use Tubing should be changed when; Visible soiled or damaged Discolored (yellow) Condensation noted within the tubing Every days Nebulizer (Machine) should be cleansed following each use with household disinfectant. 7
8 Coughing Techniques Excessive mucus production is a common symptom of COPD and is a major cause of infection and difficulty breathing: The implementation of coughing technique can positively impact mucus expectoration. Deep Coughing: Start by taking a deep breath. Hold the breath for 2-3 seconds. Use your stomach muscles to forcefully expel the air. Avoid a hacking cough or merely clearing the throat. A deep cough is less tiring and more effective in clearing the mucus out of the lungs. Huff Coughing: Huffing is an alternative to deep coughing if you have trouble clearing your mucus Take a breath that is slightly deeper than normal Use your stomach muscles to make a series of 3 rapid exhalations making a ha, ha, ha sound Follow this by controlled diaphragmatic breathing Deep cough if you feel mucus moving 8
9 COPD Action Plan Get in the Zone Green Zone: You are doing well today. Symptoms are stable. Able to perform activity and exercise at usual level Usual amounts of cough and phlegm/mucus Usual sleep routine unaffected by breathing or cough Appetite is good Yellow Zone: Proceed with caution. Your symptoms indicate you may need to talk to your doctor. More breathlessness than usual (scale 1-10) Less energy to perform your usual activities Increase mucus production and viscosity Using quick relief inhaler/nebulizer more often More coughing than usual Chest tightness or a Chest Cold Breathing and coughing are affecting your ability to sleep Appetite is not good Red Zone: Danger. You need URGENT Medical Care. Unable to do any activity because of breathing Severe shortness of breath even at rest Feeling confused of very drowsy Chest pains Coughing up blood Fever or chills Unable to sleep due to symptoms Skin, lips or fingernails have turned a blue grayish color Heart or pulse rate is very fast or irregular Medicine does not help for very long or at all Actions Take daily medications as ordered Use oxygen as prescribed Continue regular exercise and diet Avoid irritants such as; cigarette smoking, extreme temperatures, dust and pollen Actions Continue daily medications Use quick relief inhaler as instructed Use breathing techniques Use oxygen as prescribed Rest Maintain posture Contact your nurse care manager Actions Call 911 or seek medical care immediately Continue to take your medication as prescribed 9
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