KEY POINTS:Alice describes herself as stubborn and old. She is 92 and has chronic obstructive pulmonary disease (COPD) as a result of her decades-long smoking habit. She lives with her 70-year-old daughter, Mary, who is in poor health. Alice and Mary would prefer to stay in their home, but Alice has been in and out of the hospital, leading the pair to believe that their time living safely at home is limited. Alice was managing her COPD well until about five years ago. Then, she went through a two-year period in which she resumed smoking and developed a series of viral infections that triggered her chronic bronchitis. Over the last year, Alice has been hospitalized for COPD exacerbations every month or two. Each time she was discharged from the hospital, she would have home health care for a while. As long as they were involved in her care, she was stable. However, as soon as she was discharged from home health care, she would slack off on her breathing exercises and treatments and end up being readmitted to the hospital.
- COPD is a progressive lungs disease that can be prevented and treated.
- The biggest risk factor for developing COPD is smoking.
- The treatment for COPD is multifaceted and requires a high level of commitment.
What is COPD?COPD is a chronic, progressive, irreversible lung disease. Inflammation and chronic phlegm production make it difficult to breathe. Emphysema and chronic bronchitis are both under the umbrella term COPD. Most people with COPD have small airway dysfunction (chronic bronchitis) and destruction of the air sacs in the lungs (emphysema). Damage to the airways causes a chronic cough, wheezing, and shortness of breath. Inflamed airways become narrower, and increased phlegm production serves as a breeding ground for bacteria and viruses. COPD is the third leading cause of death in the United States. Medical treatments such as breathing exercises and aerosols can slow the progression of COPD and ease breathing, which improves quality of life. Smoking is the biggest risk factor for COPD.
Can your lungs heal from COPD?Unfortunately, chronic inflammation, increased phlegm production, and frequent respiratory infections all contribute to lung damage and scarring. Chronic inflammation can decrease blood flow to the lungs, which thwarts its attempts to heal. Because smoking causes inflammation and impairs the immune system’s ability to repair lung damage and fight infection, quitting can help slow the progression of COPD. Smoking also increases the risk of bacterial and viral infections in the lungs, which causes additional lung damage and scarring. Aerosol treatments can help your airways stay open. Exercise can strengthen your breathing muscles, and avoiding cigarette smoke and pollution can decrease inflammation in your airways.
What COPD symptoms should you watch for?The symptoms of COPD tend to go through periods of exacerbation and remission. Recognizing an exacerbation and treating it aggressively can help prevent it from worsening. Symptoms of worsening COPD include:
- Shortness of breath that is persistent and progressive
- Coughing (may be intermittent and unproductive)
- Increasing fatigue
- Increased sputum production or color change to yellow or green
- Blood-tinged mucus
- Needing to sleep sitting up or with more elevation
- Symptoms of an infection such as fever, muscle aches, and chest tightness
- Leg swelling that is not relieved with elevation
- Inability to walk due to shortness of breath
What are the stages of COPD?COPD is classified into four stages, developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). They are based on measurements taken when using a spirometer, a device that you blow into. FEV1 stands for the amount of air you can forcibly blow out in the first second measured. FVC measures the amount of air you can forcibly exhale in one breath. GOLD Stages are measured when you have an FEV1/FVC ratio under 0.7
- Stage 1: Stage 1 is mild. FEV1: ≥80% predicted.
- Stage 2: Stage 2 is moderate. FEV1: 80%, < FEV1 ≥50%
- Stage 3: Stage 3 is severe. FEV1: 50%, < FEV1 ≥30%
- Stage 4: Stage 4 is very severe: 30%, < FEV1
How do I know what stage of COPD I have?The GOLD stage depends on spirometry measurements for classification because it measures how severely airflow is limited. Self-reported measurements of how much activity you can engage in before you become breathless and how you rate the severity of the following symptoms/factors are also considered.
- Mucus production
- Chest tightness
- Activity limitations
- Ability to leave your home
- Quality of sleep
- Energy level
At what stage of COPD do you need oxygen?When your blood oxygen levels fall, a condition called hypoxemia, oxygen therapy can help you breathe better and lengthen your lifespan. Oxygen therapy is not tied to a stage of COPD. Rather, it is prescribed when you have decreased blood oxygen levels.
What are the signs of dying from COPD?When your lung damage becomes too severe, your lungs cannot provide enough oxygen for the rest of your body. Oxygen therapy can help up to a point. After this point, the heart must work harder to move blood through your circulation faster. Moving the blood more quickly will temporarily compensate for decreased oxygenation. But, eventually, the heart cannot keep up. Contact us for help
Can COPD go into remission?COPD is a preventable and treatable but progressive disease, so it does not go into remission. However, you can maximize your lung function by taking the following steps:
- Quit smoking: This is the most important and frequently the most difficult step to take.
- Use your inhalers: Use your inhalers as directed to keep your airways open and decrease the risk of infection.
- Get vaccinated: Talk to your doctor to ensure all your vaccinations are current.
- Breathing exercises: Work on your breathing exercises regularly to keep your chest muscles strong.
- Diet: Eat a well-balanced, nutritious diet high in antioxidants that supplies the calories you need.
- Conserve energy: Learn strategies to conserve your energy and seek help when necessary.
How can home health care help you manage your COPD?Alice and Mary want to stay in their home, but Alice has frequent COPD relapses that result in rehospitalization. Alice contacted Sunland Home Care & Medical to arrange home nursing visits to help with managing her COPD. With help from Sunland nurses, Alice has been stable for the last four months. As a result, Alice and Mary can continue living at home, where they are most comfortable. Sunland Home Care and Medical can:
- Administer breathing treatments
- Check breathing status
- Coach with breathing exercises
- Administer medications
- Assess nutritional status
- Answer questions about lung function
- Provide COPD education
- Reduce the need for rehospitalization
- Develop an action plan