Living with Chronic Obstructive Pulmonary Disease COPD
By now, most Americans have heard the term Chronic Obstructive Pulmonary Disease, or COPD for short. The disease can be caused by a number of contributing factors, most often from smoking or breathing unfit air over a period of time. People who live in urban areas where air pollution is a real problem are more likely to aggravate and/or suffer from all types of lung disorders.
COPD is actually the fourth leading cause of death in the United States and is characterized by chronic airflow limitation in the lings. Technically, COPD is most often a combination of two diseases, chronic bronchitis and emphysema, but it can and often does include other respiratory problems such as chronic asthma and severe bronchiectasis.
While COPD can be treated, ultimately it causes progressive damage to the lungs which become obstructed, causing extreme difficulty in breathing depending on the stage of development. According to the Center for Disease Control, more than 12 million Americans have been diagnosed with COPD, another 12 million likely have the disease and aren't fully aware of it.
Physicians say often times the disease is under-diagnosed because COPD can come on slowly, and far too often individuals are slow to consult a pulmonologist. Sooner or later, however, breathing difficulties generally reach a stage when those suffering from the disease are forced to see a specialist.
CAUSES AND SYMPTONS
Often seniors with COPD will blame their symptoms on age or the side effects of smoking. Most often, people are not diagnosed with COPD until they have lost 50 percent of their lung function. It's surprising how well some patients of COPD can continue to live a normal (though slower) life with as much as 50 percent lung capacity. It is also the nature of the disease to affect one lung more than the other, but this is not always so. Each case is different.
In general, if you are having difficulty breathing or if you find you tire easily after physical exertion or activity, you should consult with a physician. The sooner you are diagnosed with the disease, the sooner you can access help that can enable you to maintain an active lifestyle through therapy and treatment. That treatment may involve medications including inhalation treatments and pharmaceuticals, but it can also include oxygen therapy and even surgery to reduce the size of lungs once they fail to be fully functional. Lung transplant may also be an option for some patients.
Watch for these symptoms:
Shortness of Breath: At first, a person may get tired upon strenuous exertion, say while walking up a long flight of stairs. Later, a simple task such as a trip to the mailbox causes breathlessness.
Inability to Keep Up: Simple activities such as bathing and dressing may leave someone with COPD winded and exhausted.
Leading to each lung is a major airway (bronchus). This airway divides into 22 tubes inside each lung; these tubes are themselves divided into more than one hundred thousand tiny tubes (bronchioles) that end in clusters of tiny air sacs know as alveoli that expand and retract with each breath. These air sacs have membranes filled with tiny blood vessels. When a person breathes in, oxygen attaches to the red blood cells on the vessels and is delivered to the rest of the body; carbon dioxide comes back via these same cells and is expelled when the person breathe outs.
COPD causes these air sacs to lose elasticity, and here is where the problem starts. Air gets in but the carbon dioxide fails to escape because the air sacs are not functionally properly. This causes shortness of breath and leads to an imbalance in blood gases. In addition, music forms and further blocks the air's passageway, holding the air as the patient finds it difficult to fully expel. Breathing exercises can help over time, but the problem will continue as a result of the disease.
For patients that smoked cigarettes, the problem is exaggerated and more chronic and serious. At the firtst sign of COPD symptoms, smokers MUST immediately stop smoking, otherwise the disease will progress rapidly.
It is interesting to note that a history of frequent severe respiratory infections during childhood is also a major contributor to the development of the disease in later years of life, and also more women than men die of COPD (in the year 2000).
A simple breathing test called spirometry is the most common diagnostic test for COPD. Anyone older than 44 years of age who is a current or was a former smoker should have a spirometry test. Also, anyone of any age with a chronic cough, excess mucus production, shortness of breath on routine activity, or wheezing should have spirometry testing. The test uses a device called a spirometer, which consists of a mouth piece and breathing tube connected to a computer. The patient takes a deep breath and then blows out air as fast and hard as he can for at least six seconds. The computer reading includes the following set of numbers:
The stages of COPD are:
Stage I, or Mild: Few symptoms and mild airflow limitation.
Stage II, or Moderate: This is the stage where patients are typically compelled to see a doctor, as they have developed symptoms such as shortness of breath upon exertion.
Stage III, or Severe: Symptoms at this stage include worsening airflow limitation, increased shortness of breath, reduced exercise capacity, fatigue, and repeated exacerbations.
Stage IV, or Very Severe: Chronic respiratory failure can occur at this stage and COPD exacerbations can be life threatening.
For those diagnosed with COPD, a regular prevention and treatment regime should include:
Flu Shots - People with COPD should receive a flu shot every year. A bout of the flu can cause serious (perhaps deadly) exacerbations for patients.
This vaccine should be administered every five years for patients 65 and older. Pneumonia can cause serious (perhaps deadly) exacerbations for patients.
Other treatments might include:
Protein Therapy - For people with AAt deficiency, AAt protein infusions may slow lung damage.
Antibiotics - These are used sparingly for treating COPD exacerbations.
Bronchodilators - These work by relaxing the muscles around the airways, helping to open the airways and make breathing easier. Short-acting bronchodilators are usually initially prescribed during Stage I, while long-acting bronchodilators are added to treatment during Stage II and beyond.
Inhaled Glucocorticosteroids - These steroids can reduce inflammation in the airways. They are typically prescribed for Stage III patients who are on two different bronchodilators but remain symptomatic and have frequent exacerbations.
Pulmonary Rehabilitation - Usually patients in Stage II and higher attend pulmonary rehabilitation. This is a whole package of therapies that are designed to minimize the impact of COPD, making patients as fit and as healthy as they can be, despite their limitations, according to Lawrence. Components include exercise, disease management training, nutrition advice, and counseling to help patients physically and emotionally participate in daily activities.
Supplemental Oxygen This prescribed treatment is used at any stage of COPD, but typically not until Stage IV, when a patient has low oxygen levels in her blood. Depending on when the oxygen in the blood is low, some patients use oxygen only while exercising; some only while sleeping; while most use supplemental oxygen a minimum of 15 hours a day or continuously.
Surgery - A loved one who suffers from Stage IV COPD may benefit from either lung transplant surgery or lung-volume reduction surgery (LVRS). Only a handful of patients will benefit from either surgery, and the type of surgery depends on the patient, the expertise of the care center, and the distribution of the emphysema, says Doherty. An LVRS basically trims the areas of the lungs that aren't functional. With lung transplant surgery, COPD patients usually only receive one new lung.
For seniors with COPD, the National Lung Health Education Program advises self-care is important. Preventive habits include good hygiene such as frequent hand washing, getting scheduled flu and pneumococcal vaccines, staying out of crowds during winter, good nutrition, and regular exercise.
Support groups such as the American Lung Association's Better Breathers Clubs are also helpful. It's vital that patients still lead an active social life.