Parish Nurse

From the Parish Nurse – September 2017 ….

AIR SCARE – EARLY DIAGNOSIS CAN SLOW THE PROGRESSION OF COPD

More than 120,000 Americans die from chronic obstructive pulmonary disease (COPD) each year in the United States.   Of the nation’s top three causes of death-only heart disease and cancer outrank it-COPD is the only one that is increasing rather than decreasing in prevalence.

About 15 million adults in the United States report that a doctor has diagnosed them with COPD.  “The actual prevalence may be much higher than that because many people don’t undergo pulmonary function testing to establish a diagnosis,” says Meilan Han, associate professor of internal medicine at the University of Michigan and a spokeswoman for the American Lung Association (ALA).  The ALA says it could be as high as 24 million.

Unfortunately, many people don’t talk to their doctors when they experience early signs and symptoms, such as shortness of breath, coughing, wheezing, excess mucus or phlegm.  People often dismiss their symptoms as a part of normal aging, or may curtail activities so they are not short of breath.  This behavior can contribute to a delay in diagnosis.

On the other hand, plenty can be done early to reduce symptoms, improve exercise tolerance and reduce the frequency of flare-ups often associated with the disease, Han says.

WHO GETS COPD?  COPD goes by some other names, such as chronic bronchitis or emphysema.  “Those are both a part of COPD,” Hans says.  “Both fit under the umbrella.”

COPD is an equal opportunity disease in that it affects men and women alike.  However, some doctors still view it as an “old man’s disease.”  This holdover attitude may contribute to its being underdiagnosed in women, Hans says.  In fact, more U.S. women are hospitalized-and more die-from the disease every year.

People at high risk are those who smoke or used to smoke.  Middle-aged and older adults are most likely to develop COPD, but lung function decline associated with smoking starts in early adulthood, Han says.  Other risk factors include those who have been exposed to lung irritants like industrial pollutants and secondhand smoke, according to the COPD Foundation.  Nonsmokers can also get COPD, Han says.

“When you have COPD, you have a hard time breathing air out,” Han says.  Your airways narrow and the air sacs in your lungs are destroyed, leading to breathing difficulties.

COPD cannot be cured but can be treated, Han says.  Stopping smoking is the most important thing patients can do to change the course of the disease, Han says.  If you need help quitting, your doctor may suggest smoking cessation programs as well as gum, patches or medications.  The ALA also offers online resources.

TREATMENT OPTIONS – When you have COPD, your doctor may prescribe medications.  Depending on the severity of symptoms, you may be given bronchodilators, which may relax the muscles around your airways and make it easier to breathe.  Short-acting bronchodilators last about four to six hours and are used on an as-needed basis.  Long-acting bronchodilators last 12 to 24 hours.  If your COPD is severe or you have frequent exacerbations, your doctor might suggest inhaled steroids.  Inhaled steroids are not usually prescribed alone in COPD but in combination with bronchodilators, Han says.

Pulmonary rehabilitation, a program of prescribed exercises, can also help you cope with COPD, along with nutritional and psychological counseling.  Your doctor can refer you to a pulmonary rehab program near you.

Some people with severe COPD may need oxygen to breathe better.  You and your doctor will determine if you need oxygen for rest, exercise and/or sleep, and how much in liters per minute you need for your activity.  You and your doctor will also determine how many hours a day you require oxygen.

Surgery is usually a last resort, reserved only for those with severe COPD, Han says.  Surgical options include a lung transplant or lung volume reduction surgery, in which a part of the lung is removed to make room for the rest of it to work better.

If you have COPD, it’s important you get vaccinated for the flu and pneumonia.

GET TESTED – If you’re short of breath for any reason, you should talk to your doctor about a spirometry test.  Spirometry is a simple, non-invasive test that measures how fast you can blow into the mouthpiece of a machine known as a spirometer.  Depending on the results, you may need additional testing to determine if you have COPD or another lung disorder.

“The most important thing is to not ignore symptoms and to discuss them with your doctor,” Han says.

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