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Tips for Caring for Someone with COPD

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Top Takeaways 

  1. There are 2 kinds of COPD: Emphysema and Chronic Bronchitis; People diagnosed with COPD can suffer from booth diseases
  2. If your loved one has COPD, it’s important to watch for signs of a flare up, known as COPD Exacerbation, in which a COPD patient has increased wheezing and coughing 
  3. Oxygen therapy, Pulmonary Rehab are two treatments that may help your loved one in addition to prescribed medications  
  4. Home modifications, such as adding fans to improve indoor air flow can help
  5. It’s important to encourage healthy habits, and create a smoke-free environment 



Intro 

 

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that causes obstruction (blockage) of airflow out of the lungs when exhaling. “Inflammatory lung disease” means damage and injury through mechanisms of chronic irritation. Although there is no cure for COPD, there are ways to control symptoms and improve quality of life. 



COPD Consists of 2 Diseases
  

 

  1. Emphysema

In normal lungs, the tiny air sacs (called alveoli) fill with fresh air and expand when someone inhales. Alveoli deflate when a person exhales and blows air out of the lungs. Emphysema damages the alveoli, causing them to trap air and become less elastic. When a person with emphysema exhales, these air sacs do not properly empty the old air, so they cannot take up new fresh oxygen during the next inhalation. As a result, the person loses their ability to exhale all the old air from their lungs. This causes shortness of breath and reduced fresh oxygen in the blood.  

  1. Chronic Bronchitis

Chronic bronchitis inflames the lung airways (the bronchi), causing cough and mucus. The buildup of mucus combined with swelling and inflammation causes the airways to narrow and restrict airflow.   

People diagnosed with COPD can suffer from both diseases and can also have some asthma. 

 

Symptoms of COPD

  • Shortness of breath with activity. As the disease progresses, shortness of breath may occur with minimal activity or even at rest.
  • Frequent coughing 
  • Chronically coughing up mucus (phlegm)
  • Chest tightness or discomfort
  • Sensation of inability to inhale a full breath of air or to fully empty the lungs on exhaling
  • Wheezing or rattling sounds when exhaling
  • Becoming thin-appearing (with emphysema) or having a bloated appearance around the face or neck (with chronic bronchitis)
  • Needing a long time to exhale or empty the lungs of air
  • Increasing frequency of colds and nose and throat infections 

 

If you suspect your loved one might have COPD, the best person to talk to is your loved one’s healthcare provider, who can review their medical history and do an exam. 

 

Watch for Signs of a Flare-Up / COPD Exacerbation 

 

COPD exacerbation refers to episodes where COPD flares up and worsens compared to baseline. Exacerbation is a common reason people with COPD seek emergency treatment and need admission to the hospital. 

 

Signs of a COPD flare-up include: 

  • Increased wheezing, coughing, chest tightness, and/or chest-rattling that doesn’t resolve with usual home measures
  • Worsened shortness of breath that doesn’t improve with usual home measures
  • Coughing more than expected or experiencing worsened coughing-related chest pain
  • Increased mucus production or change in mucus color 
  • New-onset or increased trouble sleeping due to shortness of breath
  • New-onset of increased swelling in the hands or feet
  • Need to increase baseline oxygen usage (if any) to feel more comfortable
  • Lack of usual effectiveness of inhalers or other medications
  • Bluish, whitish, or cool fingers and toes
  • Changes in mental functioning or alertness
  • Worsened fatigue or weakness

 

If your loved one is having a flare-up, it’s important to call the doctor. The sooner you get treatment, the less likely your loved one ends up in the hospital. 

 

Discuss with the Doctor Certain Danger Signs that Require Immediate Emergency Care

Examples include, but are not limited to:

  • Inability to focus or concentrate
  • Confusion or disorientation
  • Inability to arouse the person
  • Gasping for air
  • Very little if any air appears to be moving in or out of the lungs with breathing
  • Hypotension (very low blood pressure)
  • Very low, very high, or absent pulse
  • Cool or discolored feet, hands, or lips
  • Very rapid breathing or very slow/absent breathing



Oxygen Therapy 

 

Oxygen therapy can help if your loved one isn’t getting enough oxygen in their blood despite appropriate treatment with medication. 

  • Oxygen can be delivered via several different types of devices. 
  • Doctors can prescribe oxygen for use continuously, intermittently on a fixed schedule, or “as needed” (for certain activities or particular symptoms).
  • Use oxygen as prescribed and instructed. 
  • Contact the doctor if a prescribed oxygen dose is not controlling symptoms or if there appears to be any problem with the oxygen delivery device.
  • Always contact a health care provider promptly if your senior feels they need to increase their oxygen dose. This can indicate that the COPD is not well-controlled or that there is an exacerbation. 
  • In some cases, it can be dangerous to increase the oxygen dose on your own without medical approval; in some cases, the person’s breathing might slow down or stop.




Pulmonary Rehabilitation Programs

 

Many people with COPD can benefit from pulmonary rehabilitation programs, which combine prescribed exercise, nutrition counseling, disease education, and support. Check with the doctor if pulmonary rehabilitation is suitable for your loved one. Pulmonary rehab can:

 

  • Help your loved one’s breathing
  • Reduce their shortness of breath
  • Increase their overall strength and health
  • Improve their overall quality of life

 

NOTE: It’s important to provide exercise motivation. Exercise can help people with COPD feel better and stay stronger. 

    • If COPD symptoms or other medical conditions make it difficult to exercise, try a slower approach: three to five minutes of activity at a time, several times a day, working up to longer periods.
    • Only exercise as approved by a medical provider. Due to certain medical conditions or situations, exercise may not be appropriate or major modifications may be needed. 

 

Medications for COPD

 

  • Beta-agonist is A type of COPD medication that typically comes in an inhaler-type device. Beta-agonists are used to relax the muscles around the airways in the lungs, allowing the airways to open up and expand for better airflow. This type of drug is called a bronchodilator. There are two main classes of beta-agonists:
    • Short-acting: each dose lasts a short time (up to a few hours)
    • Long-acting: each dose lasts more hours

NOTE: Doctors use each class of beta-agonist for somewhat different purposes. Discuss with the doctor the difference between the two types and how your senior should use each.

  • Steroids are usually inhaled into the lungs or taken orally (by mouth). Steroids help reduce airway inflammation and irritation; they may reduce the frequency of COPD exacerbations. 
    • Inhaled steroids are preferable over oral steroid pills for routine ongoing therapy. 
    • Steroid pills by mouth have far more undesirable side effects than steroids taken by inhalation into the lungs. 
    • Talk with your senior’s medical provider to discuss trying inhaled steroids, if possible, before resorting to steroid pills.
    • Some people unfortunately require chronic oral steroid pills to control their symptoms.
    • Steroids are usually given orally and/or intravenously for hospitalized patients with exacerbations since much higher doses are required.
    • Oral steroids are frequently given to patients at discharge from a hospital or for home-treated exacerbations since they are “stronger” than inhaled steroids. 
    • The medical term for steroids used for COPD is “glucocorticoid.” This is very different from the kind of steroid you might have heard that weightlifters use.

  • Long-acting muscarinic antagonists (LAMA) are given via an inhaler-type device. They are also known as “anticholinergic” medications. They act as bronchodilators. Although short-acting LAMAs exist, doctors usually give long-acting ones for home use.

  • Combination Inhalers use different combinations of the above three types of inhaled medications into one single inhaled dose. 

  • Phosphodiesterase-4 inhibitor is a medication that can help your loved one if they are suffering from severe COPD, and multiple other medications are not controlling symptoms. This is a newer category of drug that relaxes airways and increases the function of the diaphragm muscle during breathing.

  • Theophylline pills can help improve your loved one’s breathing and prevent further episodes. Due to side effects and difficulty monitoring the proper dosing range, doctors don’t use theophylline very often.

  • Antibiotics can help if your loved one gets a respiratory infection caused by bacteria. 
    • A specific antibiotic, azithromycin, is occasionally used to decrease the frequency of exacerbations
    • Azithromycin isn’t often recommended due to multiple potential side effects.

 

Other Ways to Improve and Moderate COPD Symptoms 

In addition to medication and pulmonary rehab programs, there are more ways you can help your loved one improve and moderate their symptoms of COPD, including:  

  • Encourage them to quit smoking
  • Prevent them from exposure to second-hand smoke in the home or elsewhere
  • Ensure they get the pneumonia vaccine and yearly flu shots
  • Ensure they exercise regularly (if cleared by a medical provider)
  • Maintain a healthy diet
  • For more severe COPD, conserve energy where possible (EX: Install a shower seat) 
  • Help them reduce stress levels 
  • Encourage them to learn ways to control or improve breathing. The doctor or a COPD rehabilitation program should have information about this. 
  • Monitor for COPD flare-ups and ensure they take medications as prescribed. This includes oxygen, if prescribed.



Modify your home to better accommodate a COPD Patient 

 

  • Reduce Clutter: If your loved one uses a walker, make sure the floors are cleared of anything that’s easy to trip on, such as cords and throw rugs

  • Promote physical energy conservation: More advanced COPD can drain a person of energy, so it’s important to make the home in a way that reduces need for extra energy use, as much as possible

    • Organize the home so most of their needs are on a single level / floor
    • Lower shelves so your loved one doesn’t have to reach 
    • Put a shower chair in the shower or assist with showering as needed.

  • Set up a fan or air conditioner: Some patients with COPD have found that they can breathe more easily when a fan is running on their faces. When air is hot and humid, air conditioning can prevent exacerbations.

  • Improve Indoor Air: Indoor air can be more polluted than outdoor air, and can exacerbate COPD. What contributes to bad air quality:

    • Beauty products with heavy scents (Perfumes, aftershaves, lotions, hairsprays) 
    • Fumes from harsh chemicals (Cleaning products)  
    • Inadequate ventilation
    • Other allergens (dust, dirt, pollens, pets, dust mites), particularly if the doctor feels your senior has some asthma in addition to COPD

  • Get Monitoring Equipment: If your loved one is on oxygen therapy, it’s a good idea to have an FDA-approved pulse oximeter monitor on hand that helps you know if they’re getting enough oxygen. Pulse oximeters are easy to use and read. 

    • Be sure you understand the specific range of oxygen levels recommended for your loved one.
    • Reaching the highest possible oxygen level is usually not desirable. In some cases. it can be dangerous and life-threatening.

Encourage Healthy Habits 

 

  1. Help them quit smoking: Quitting smoking is a top priority for someone with COPD, and slows the progression of the disease. Help your loved one quit by:
    • Don’t smoke inside the house or near them
    • Remove smoking accessories from the home (Lighters, ashtrays, cigarettes, etc)  
    • Distract them with alternative, healthy activities when a craving arises 
    • Discuss medical and behavioral therapies with a healthcare provider
  2. Encourage Exercise
    • Start slow: you can encourage your loved one to practice 3-5 minutes of exercise at a time, and work up to longer periods
    • Exercise alongside your loved one
    • Heed the exercise precautions noted earlier in this article

  3. Prepare Nutritious Meals
    • If your loved one is suffering from COPD, they need a healthy and well-balanced diet to maintain their energy and perform daily activities to the extent possible
    • A nutritious diet includes: 
      1. Fresh fruits and vegetables
      2. Limited red meats and processed foods
      3. Alternative protein sources, such as nuts and seeds, low-fat dairy, lean meats, poultry, and fish
Stephen Engle, MD

Stephen Engle is a United States-trained physician (M.D.) and Diplomate of the American Board of Internal Medicine who is board-certified in internal medicine. He has experience as a medical director in administrative medicine with the largest private payer in the US, as well as experience in internal medicine at all levels (clinic, urgent care, emergency room, inpatient general and intensive care, clinical consultative medicine, and peer review.)

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