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Wednesday, October 7, 2009

How should COPD be treated?

Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs that can cause a patient to become progressively more short of breath over time. Thankfully, however, there are treatments for COPD patients that can help them improve their lung function and maintain a relatively normal lifestyle.
What follows is a list of some of the methods the COPD patient/physician team might try.*
  1. Admittance: In order to get help, you have to seek it.
  2. Quit smoking: The best way to stop further progression of the disease is to stop smoking.
  3. Pulmonary Rehabilitation Programs: These programs can help a COPD patient get back into action. Staying physically active is very important to managing this disease and maintaining quality of life.
  4. Exercise: This is a great way to strengthen your lungs and here.
  5. Rescue inhalers: These are beta agonists or short acting bronchodilators or rescue inhalers. The medicine is inhaled and attaches to beta agonist receptor sites in the lungs to cause the airways in the lungs to dilate. Common rescue inhalers are xopenex and albuterol.
  6. Nebulizers: This is a device that looks like a peace pipe (or click here) that you hook up to a portable air compressor. You put the mouthpiece into your mouth and inhale the medicine. A treatment can take between 5 and 20 minutes depending on the flow generated by your air compressor. The most common medicines placed in a nebulizer cup are Albuterol or Xopenex (bronchodilators) Duoneb (Atrovent and Albuterol combination). Atrovent can also be mixed with Xopenex. Other medicines like Pulmicort and Mucomyst are also inhaled via a nebulizer.
  7. Long-acting bronchodilators: (Serevent or Formoterol) These are similar to rescue inhalers, only they are used as controller medicines to treat bronchospasm and preventative medicines to prevent ongoing bronchospasm. This medicine can be used alone or in the form of a combination inhaler, either Advair or Symbicort (see below).
  8. Inhaled Corticosteroids: (like Flovent or Pulmicort) These treat the chronic inflammation in COPD lungs, thus making the lungs stronger. They also create more beta agonist receptor sites in the lungs, making the rescue inhalers work better.
  9. Systemic Corticosteroids: (At home oral Prednisone and in the hospital an injection of solumedrol) These may be needed during an exacerbation (acute COPD episode) to treat inflammation which is usually the culprit in COPD exacerbations. It usually takes about an hour to start working. Solumedrol (or a similar drug) is given in the ER and while in the hospital. Prednisone is usually given for home use. It is important to note that you cannot just stop taking systemic steroids, you have to be weaned off of them. Systemic corticosteroids is a medicine you MUST take exactly as prescribed by your physician.
  10. Advair and Symbicort: These are inhalers that have both an inhaled corticosteroid and a long acting bronchodilator. This medicine is highly recommended for COPD, is safe if you rinse after each use, and is proven to improve lung function.
  11. Spiriva: This is an anticholinergic. It blocks the cholinergic response that causes your airways to narrow. This medicine has been proven to improve lung function in COPD patients and is highly recommended. It can be used with other COPD medicines and is very safe.
  12. Antibiotics: Due to excessive secretions, chronic bronchitis lungs tend to be breeding grounds for bacteria. Antibiotics can help prevent and treat infection (pneumonia).
  13. Supplemental oxygen: Many COPD patients have trouble getting oxygen to their tissues, and require supplemental oxygen. Most require a low flow of oxgyen. Some only need to wear it at night, some as needed, and some 24/7. Studies show that emphysema patients who wear their o2 as prescribed can add many years to their lives.
  14. Chest Physiotherapy and postural drainage: This is where a person cups his hands and claps the chest of a patient in order to create vibrations to help move thick secretions. Electronic percussors can also be used, but are more expensive. This is part of what we call the pulmonary toilet, which consists of strategies to help patients move and expectorate thick secretions that are otherwise trapped in the lungs.
  15. Mucomyst: This is usualy only used in hospitals to help thin secretions to make them easier to bring up. This should never be given by itself, and always with a bronchodilator. Usually this is provided prior to physiotherapy. This is another part of the pulmonary toilet.
  16. Morphine: This is an opoid that is often used as a mild bronchodilator. It is most often used at end stage COPD to ease the feeling of dyspnea (breathlessness).
  17. Xanax: This is an anti anxiety medicine to ease anxiety common with COPD due to fear of getting short of breath, or shortness of breath itself.
  18. BiPAP: This is a mask worn over the face and nose that provides positive pressure during inspiration to maintain a good tidal volume and help the patient blow off CO2. It also maintains a pressure during exhalation to help keep the alveolar sacks in the lungs open to help improve oxygenation. It is usually worn while sleeping, but on occasion can be used more often. This is something that also might be tried to treat sleep apnea if CPAP (mentioned below) does not work.
  19. CPAP: This is a mask worn over the nose or mouth that provided positive pressure on exhalation to keep the alveolor sacks of the lungs open to improve oxygenation while sleeping. It also helps keep the upper airway from collapsing while sleeping (used for sleep apnea).
  20. Air Conditioner: Humid air tends to be more difficult to breath for COPD patients, and therefore air conditioning is nice because it cools and dries the air making it easier to inhale.
  21. Dehumidifier: Humid air is hard to inhale, and thus dehumidifiers are a step down from air conditioners in humid conditions.
  22. Lifestyle changes: To prevent further worsening of their disease, COPDers may often find they need to make changes in their surroundings, which include quitting smoking, avoiding people who smoke, not allowing smokers in their homes, avoiding homes or places that have other COPD irritants like dust mites and mold or strong smells.
  23. Good Hygeine: Wash hands, take baths, and use overal good hygeine to prevent the spread of bacteria and viruses.
  24. Vaccination: It is recommended COPDers get the flu and pneumonia vaccination yearly. This is especially important for chronic bronchitis patients because they often have excessive secretions in their airways due to a decreased mucociliary system. This makes their lungs breeding grounds for bacteria, and increases the chance of getting illnesses such as the flue. It's also important to note that pneumonia is the #1 cause of COPD exacerbations.
  25. Breathing exercises: Pursed lip breathing exercises are sometimes needed to help a person get trapped air out of the lungs and to help the patient relax and cope with breathlessness.
  26. Incentive spirometer: A device that encourages patients to take slow, deep inspirations while measuring the amount of air (in liters) a patient can draw in. It creates a slight resistance to inspiration to exercise the lung muscles. It can also be used to help loosen sputum. It is encouraged that with each inspiration a patient hold his breath 3-5 seconds. This is done in an attempt to exercise the lungs and to prevent (or treat) pneumonia. (Click here for more information).
  27. Cough and deep breathing exercises: Encouraging slow-deep inspirations is a good way to exercise the lungs and exercise the portion of the lungs that are not used while a patient is resting. It's another good way of preventing pneumonia. It's also a good tecnhique to help bring up sputum. I have never had a patient who could not do this, and with good coaching I think this method is the best and most ideal way of treating and preventing pneumonia, even better than the incentive spirometer mentioned above.
  28. Proper diet: It is encouraged the COPD pations eat a good diet of fruits, vegetables and protein. Likewise, they should avoid drinking carbonated beverages as this results in the build up of CO2 and causes a bloated stomach. For more dietary tips click here.
  29. Avoid or limit alcohol consumption: It dries out your lungs and can make it more difficult to breath.
  30. Avoid beer and pop: Drinking carbonated beverages can result in buildup of CO2 and can cause bloatation of the stomach and causing it to push up against the diaphragm thus resulting in increased shortness of breath due to less lung volume.
  31. Drink lots of fluid: This helps keep the lungs well hydrated to help with the expectoration (spitting up of sputum.)
  32. Flutter valves: I love these devices, and along with cough and deep breathing exercises (I think) are the best way to strengthen the lungs and help with secretion clearance. This is a simple to use hand held device that creates vibrations upon exhalation that help loosen secretions. The nice thing about this is you can use it on your own, and because it's easy to use.
  33. Psychological support: I mentioned earlier that COPD can cause anxiety. It can also cause depression for the same reasons. Depression can be treated, so you should make sure to let your doctor know if you have are feeling blue. It can be treated with psychological support, group thereapy and, if necessary, medication.
  34. Surgery: In certain cases, there are surgical options available to help you. To read more about this you can click here.
Note #1: Most of the above information I obtained from my own experience or from the COPD Wisdom at the
Note #2: One must remember the medical field is an art based on a science, and what works best for one patient may not work for others. It may take some time for you and your physician to find out what therapies/medicines work best for you.

1 comment:

Nitrile Gloves said...

Standard jet units are the common type of nebulizer. Air pressure is used to turn medication into mist that can be inhaled through a mouthpiece or a mask.

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