Contributed by Khiroon Khan, R.N., C.A.E., N.A.R.T.C.,/Diploma in Asthma Care
Asthma/COPD Nurse Educator
Chronic Obstructive Pulmonary Disease (COPD)
What is COPD?
This term COPD (Chronic Obstructive Pulmonary Disease) is used to describe chronic airflow obstruction in the lungs. Sometimes, referred to a (COPD) Chronic Obstructive Lung Disease or (COAD) Chronic Obstructive Airway Disease. Regardless of what terminology is used it describes:
1) Chronic Bronchitis which involves chronic inflammation and narrowing of the large and small airways. Cough and sputum is present most days for at least three months per year for at least two consecutive years.
2) Emphysema which involves enlargement and destruction of the air sacs (alveoli) and supporting structures causing them to collapse. This may affect the exchange of gases e.g. carbon dioxide and oxygen leading to progressive shortness of breath. Cough and sputum may or may not be present.
3) Combination of bronchitis/emphysema and chronic asthma. Common symptoms include shortness of breath, cough, sputum, wheezing and chest discomfort. Additional treatment will be required.
Who gets this condition?
Generally, adults develop this condition usually around age 60 but the disease can manifest itself in people as young as 40 years of age.
What causes COPD?
The most common cause is cigarette smoking. Although only 20% of people who smoke gets this condition, it is the 5th leading cause of death. Smoking destroys the inner lining of the airways resulting in chronic inflammation and mucus buildup in the air passages and also destruction of the air sacs. Smoking cessation is highly recommended. Exposure to certain things at the workplace can also contribute to the development of COPD for example working with asbestos, mining, welding. A small number of people have a heredity condition called Alpha-1 Antitrypsin Deficiency. These people may experience symptoms such as shortness of breath and signs of COPD much younger in life.
How is COPD diagnosed?
The diagnosis of COPD is made by taking a detailed medical history and confirmed by special breathing tests to document airflow obstruction and to determine the severity of the condition. It is important to differentiate between asthma and COPD so the proper treatment and management is followed.
What can make symptoms worse?
Both indoor and outdoor pollutants can make breathing symptoms worse. For example: cigarette smoke, fumes, household cleaning products, humidity or temperature change, emotions or respiratory infections. Avoiding and reducing your exposure to these may be helpful. Respiratory infections should be treated promptly.
Treatments
What treatments are available?
Although there is no cure for this condition, the focus is aimed at improving the quality of life. This can be achieved by:
1) Stop smoking - several methods are available e.g. patches, tablets, nicotine gum and smoking cessation programs. Many successful ex-smokers quit smoking by themselves realizing the harmful effects on their health.
2) Vaccination - to prevent chest infection, influenza and pneumonia
3) Medical management with bronchodilators to keep the airways open and anti-inflammatory drugs or antibiotics where indicated to reduce inflammation in the air passages and to treat acute problems. Oxygen therapy may be necessary to assist with the activities of daily living and prolong life.
4) Surgery - in special cases Lung reduction surgery is done to remove a portion of the lungs with over distended airsacs to make room for the lungs to expand.
5) Coping with daily activities - Shortness of breath can limit the activities of the individual including sex. Education on techniques to break this cycle:
Learn breathing exercises and how to conserve energy will allow you to do more.
Get exercise training to keep active and continue walking where possible.
Learn relaxation techniques to reduce anxiety and take control of your breathing.
Use proper inhaler technique to benefit from inhaled medication.
Seek nutritional counselling with advice on how to prepare meals and conserve energy.
Learn how and when to rest including how to get a good night's sleep
6) Know when to seek help. Prevent hospitalization and emergency room visits by having an action plan in place and keep regular follow up visits with your healthcare provider.
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COPD Inhaler Technique Kay Khan demonstrates use of MD1 and spacer. |
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| By using the puffer with a spacer, coordination is easier and more medicine goes farther into the lungs where it is needed and less in the mouth. A spacer with a face mask in place of the mouthpiece is available for small children. The only disadvantage with a spacer is the extra size. |  |
Shake inhaler, remove cap and attach to aerochamber. |
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Breathe slowly and deeply. |
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Hold your breath. |
Inhaling Your Medication
Asthma inhalers are designed to send medicine directly to your lungs where it is needed. One advantage of this is that you usually need less medicine compared to oral doses (pills or liquids). Less medicine means less side effects. Initially the inhalers may be more difficult to use compared to swallowing pills. However once comfortable using them, they become very routine. By learning to use them properly, you can:
1. better control your asthma by getting the proper dose to your lungs
2. reduce inhaler use and therefore decrease costs
3. reduce side effects by getting more medicine to your lungs and less to your mouth
Different Types of Asthma Inhaler Devices
A pMDI (pressurized Metered Dose Inhaler), or puffer as it is commonly called, is a very convenient and effective type of inhaler when used properly. Examples include Ventolin, Intal, Tilade, Atrovent, Becloforte and Flovent. Puffers are portable and compact, and treatment time is minimal. After properly shaken and the puffer canister is pressed down, a set amount of medicine is released under pressure and sent out the mouthpiece. Since this can be difficult to coordinate while breathing in, a spacer (eg.Aerochamber, Space Chamber) can be used. It is important to inhale the medication from a pMDI slowly and deeply.
Another method for inhaled medication delivery is the dry powder inhaler (DPI), in which the user inhales a unit dose of fine powder medication. The powder is contained in a drug reservoir (eg. Pulmicort or Bricanyl in a Turbuhaler), a capsule (eg. Intal in Spincaps), or sealed blisters (eg. Salbutamol in a Ventodisk, or Flovent in a Diskus). The DPIs are also portable and compact with a short treatment time, and since the medication is not released under pressure, no breath coordination is needed. However, to get the optimal use out of a DPI, the breath in should be fast and deep (compared to the puffer, which is slow and deep). Also, if the device is not held properly, the powder may fall out of the chamber before it is inhaled.
Nebulizers are also used to deliver inhalational medication. There are different types of nebulizers, but they all have a lot in common. They all have a drug reservoir to hold the medication, they produce small particles of fairly consistent size (in general, the smaller the particle size, the deeper in the lungs they travel), and these particles are moved to the user by a carrier gas (usually air).
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