COPD. Helen Suen & Lexi Smith

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1 COPD Helen Suen & Lexi Smith

2 What is COPD? Chronic obstructive pulmonary disease: a non reversible, long term lung disease Characterized by progressively limited airflow and an inability to perform full exhalation This usually is due to 2 factors: Emphysema Chronic Bronchitis

3 Emphysema: narrowing of the small airways, breakdown of lung tissue and alveoli Chronic Bronchitis: inflammation of the bronchi, excess mucus Asthma: can play a role in COPD, but to a smaller extent The level of contribution from each of these factors to COPD varies from person to person Underlying Factors

4 Signs and Symptoms Cough: usually first symptom to appear, in combination with excess mucus, can be occasional Some people attribute to smoker s cough Excessive coughing can lead to rib fractures Shortness of Breath: often what is most bothersome, worse on exertion In later stages may be always present, even at rest Source of anxiety and poor quality of life

5 Signs and Symptoms Chest tightness Wheezing, decreased chest sounds Frequent lung infections (flu, pneumonia) Fatigue Depression Unexplained weight loss High pressure on lung arteries->cor pulmonale Shared risk factors with: heart disease, high blood pressure, diabetes, osteoporosis, lung cancer, etc.

6 Environmental Factors Smoking / second-hand smoking Leading cause of COPD cases in Canada Tobacco & marijuana

7 Environmental Factors Air pollutants Long-term exposure to lung irritants Industrial dust Chemical fumes Neonatal chronic lung disease

8 Genetic Factors Alpha-1 Antitrypsin Deficiency (AAT) Inherited condition Protein produced to protect organs from the harmful effects of other proteins Develop increased risk of liver cancer White people of European Descent Treatable but there is no cure Live close to normal lifespans without serious complications

9 Start in s with shortness of breath, wheezing and lessen ability to do PA Usually diagnosed with asthma first Respond well to medication Can develop emphysema in 40s-50s in more severe cases

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11 At risk for additional health problems Frequent chest infections ( flu, pneumonia) Pulmonary hypertension Heart problems Osteoporosis Eye problems ( glaucoma, cataracts) Cachexia Malnutrition Weak muscles Lung cancer

12 Exacerbation Periods Flare ups, or periods of worsened symptoms are common, especially in more advanced stages Characterized by increased shortness of breath, increased mucus production, change in mucus colour, general unwell feeling Fast breathing, fast heart rate, sweating, blue lips and fingers, confusion in severe flare ups Should seek medical attention immediately

13 Avoiding Flare-Ups Reduce chance of getting sick by washing hands often, avoid touching nose and mouth and get the annual flu shot Avoid triggers Cigarette smoke, very cold or very humid air, perfume

14 Diagnosis Diagnosis should be considered for anybody over 35-40, with a chronic cough, shortness of breath, excess mucus and a history of risk factors Spirometry is the most effective diagnostic tool -Measures the amount of airflow obstruction -Two measures taken: forced expiratory volume in 1 second and forced vital capacity -In the general population, 75-80% of the FVC is exhaled in the first second, but if less than 70%, with appropriate symptoms this person has COPD

15 Diagnosis Other diagnostic tools include chest X-ray and bloodwork Typical signs on a chest X-ray indicating COPD are: overexpanded lungs, flattened diaphragm, barrel shaped chest These tools can help to exclude other illnesses such as pneumonia or pneumothorax Lateral chest X-ray->barrel chest and flattened diaphragm Severe COPD- >small heart in comparison to lungs

16 Grading of COPD severity GOLD (Global Initiative for Obstructive Lung Disease) Measured using a spirometer

17 GOLD I : Mild COPD Mild airflow limitation FEV1 greater than or equal to 80% of predicted normal values Chronic cough and excessive mucus May not have COPD symptoms Rarely seek treatment

18 GOLD II: Moderate COPD Airflow limitation worsens and start to notice symptoms Shortness of breath upon exertion, coughing, mucus production FEV1 50%-70% Typically seek medical treatment

19 GOLD III: Severe COPD Airflow limitation significantly worsens Shortness of breath more evident COPD exacerbation (flare ups) more common FEV1 30%-49% Decrease in activity tolerance Increase fatigue

20 GOLD IV: Very Severe COPD COPD exacerbations are life threatening Quality of life greatly impaired Airflow limitation is severe FEV1 less than 30% Chronic respiratory failure may lead to heart complications ( ie. Cor Pulmonale)

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22 COPD Myths 1. COPD is an old person disease. MYTH -> it is most frequently diagnosed in middle age, often 20 years after a person started smoking 2. There are no effective treatments for COPD. MYTH -> while COPD has no cure, many treatments are available to increase quality of life, including protection from irritants and pulmonary rehabilitation programs 3. Only men get COPD. MYTH -> although more men were diagnosed in the past, the increase in women who smoke has raised the number of cases in women.

23 Treatment COPD can be treated but the lung damage is irreversible Can slow down the damage to the lungs

24 Treatment Smoking cessation Medicine Broncodialiators, corticosteroids, vaccination Pulmonary rehab program Oxygen therapy Lung surgery

25 Medication Cannot cure COPD but can improve symptoms to allow you to: Be more active Less coughing and shortness of breath Fewer flare-ups

26 Bronchodilators: open up the airways in the lungs Prescribed by doctors in the form of inhalers Beta 2 agonist: salbutamol (ventolin), terbutaline( bricanyl) Anticholinergics: ipratropium bromide (atrovent), Tiotropium (Spiriva) Side effects: fast heartbeat, irregular heartbeat, difficulty sleeping, hand tremors

27 Combination medicines: Reduce shortness of breath and bring down swelling in the airways For more severe COPD flare-ups Side effects: hand tremors, fast heartbeat, hoarse voice, thrush

28 Supplemental oxygen Prescribed by doctor only if you are hypoxemia ( low blood oxygen) Temporary lung damage from infection

29 Pulmonary Rehab Program Improves exercise tolerance, breathlessness & health-related quality of life Strongly recommended for COPD patients Educate patients in nutrition, coping skills, how to conserve energy in everyday activities, breathing techniques ( ie. Pursed lip breathing) STUDY: found that it improves quality of life physically and psychologically

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31 Exercise Benefits Reduces anxiety and fear towards symptoms Allows body to use oxygen more effectively and promotes efficient breathing patterns which increases level of activity able to be performed without shortness of breath Weight control and increased muscular strength, reduces risk factors for other diseases Improvement in mood and sleep patterns, which in turn decreases fatigue Regular physical activity has been shown to reduce hospital stays and mortality in COPD patients Slows inevitable decline of independence

32

33 Barriers to Exercise Shortness of breath often leads to exercise avoidance This can create a vicious cycle of declined aerobic fitness and muscular strength, greater breathlessness, loss of independence Some exercise is better than none, even if a person has advanced stage COPD they can still benefit from exercise SLOW AND EASY Even if only a few minutes at a time can be completed, most patients will be able to build up over several exercise sessions Begin with simple breathing exercises, progress to slow walking, biking, stair climbing

34 Barriers Avoid triggers Exercise inside when possible to avoid air pollutants Ensure environment temperature is neither too cold or too hot Avoid isometric exercises Muscle weakness is common and this type of exercise can worsen it Any additional issues Cardiac disease, uncontrolled hypertension, angina

35 OFITT - aerobic Objective: increase activity tolerance without experiencing breathlessness Frequency: 3-4 times / week Intensity: low-moderate intensity Time: 15-30mins Type: walking, cycling, stair climb, marching on a spot, water aerobics NOTE: start with short walks and if you get breathless before reaching 15mins, try to improve the distance every day by 10 feet without getting breathless

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37 Positions to relieve breathlessness Leaning forward ( sitting or standing) Leaning back while standing

38 OFITT resistance Objective: build strength in the respiratory muscles and every day activity Frequency: 2-3 times / week Intensity: low to moderate Time: 8-12 reps, 2-3 sets Type: arm curls, forward arm raises, calf leg raises, shoulder press

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40 Stretching & flexibility Yoga Pilates Tai Chi Enhances coordination, ROM and breathing

41 Questions: What instrument is used to diagnosed COPD? Name one barrier to exercise. What is the #1 treatment to prevent COPD? Fact or Myth: There is NO CURE for COPD.

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