In-Home Care: Chronic Obstructive Pulmonary Disease (COPD)

Posted in Articles, In-home Care: Diseases and Conditions on January 11th, 2010 | 12,388 Comments

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory illness that affects 16 million Americans, making it the 4th leading cause of death in the U.S.A. The term COPD refers mainly to emphysema and chronic bronchitis. Each disease causes damage to the lungs resulting in obstructed airways. Emphysema destroys the cells that support the air sacs of the lungs, enlarging the alveoli and in turn collapsing the bronchioles. The result is permanent airflow obstruction. Chronic Bronchitis is an inflammatory illness that produces spasms, excess mucus, and difficulty breathing. Large airways of the lungs are lined with glands, which when infected become enlarged and mucus secretion is increased. Airflow becomes blocked by the secretions as well as muscle spasms caused by the inflamed bronchioles. It is referred to as Chronic Obstructive Bronchitis if airflow obstruction is present. COPD can lead to arrhythmias and smokers have a higher risk of developing lung cancer.

Around 80%-90% of COPD cases are a result of long-term smoking. The disease typically takes hold after 10 years of steady smoking, and the symptoms are hardly noticeable. By age 60 the patient’s quality of life has deteriorated significantly, and the symptoms are greatly increased. At this stage of life humans are more susceptible to illness, and as a result, 95% of COPD deaths are patients over the age of 55. Men are more likely than women to get it, as well as whites over non-whites. Blue-collar workers are more susceptible than their white-collar counterparts because they are more likely to be around harsh chemicals and airborne debris. It is not proven whether or not COPD is hereditary, but some studies show that the disease occurs more often in some families.

Unfortunately, the damage caused by emphysema is irreversible, but muscle spasms, inflammation and increased secretions could possibly be treated. There is no cure at this point in time, but since some symptoms can be controlled it is possible to maintain a balance in the patient’s health.

What are the symptoms of COPD?

  • Chronic cough
  • Chest tightness
  • Difficulty breathing
  • Shortness of breath
  • Frequent throat clearing
  • Susceptible to lung infections
  • Increased production of mucus/sputum
  • Severe weight loss
  • Possibility of coughing up blood
  • Swelling of the legs
  • Morning headaches

Symptoms could worsen, possibly leading to acute respiratory failure.

What type of care does a COPD patient need?

Symptoms will be different for each COPD patient, but it is guaranteed that they will have breathing problems, making it harder to do simple daily activities. This means they will need one or more dedicated caregivers in order to function comfortably from day-to-day. Depending on the severity of the situation, a live-in caregiver may be needed. If no one in the patient’s family can do this, then a caregiver will need to be hired.

Quitting Smoking:

The first job as caretaker may be to help the patient quit smoking. Since cigarettes are the biggest cause of COPD, it is wise to cut them out of the patient’s life altogether. There are many treatments that will facilitate this process, and it is best to use several treatments at once to get maximum results. As always, a medical professional should be involved in the decision of what medicines or treatments to take. Some examples:

  • Nicotine Replacement Therapy – gum, inhalers, tablets, patches, and nasal spray. These help reduce cravings, allowing the patient to quit
  • Antidepressant Therapy – used alone or w/ nicotine replacement therapy. Wellbutrin for example, may help quitting
  • Clonidine – used mainly to treat high blood pressure. In this case it may be helpful in treating nicotine withdrawal symptoms

There are several mood-changing practices to help quit smoking as well. The problem can potentially be treated physically (by suppressing the body’s need for nicotine) or psychologically (by reducing the need to smoke by changing behavioral patterns). Giving up this habit will be hard for the patient, so it is best to eliminate any desire to smoke. The caregiver should preferably not smoke, but if they do steps should be taken to keep any temptation away from the patient. They should not take cigarette breaks while providing care and shouldn’t smoke on the way to the job. They should always wear clean clothes that do not have the smell of cigarette smoke in the fabric.

Quitting smoking will bring about a new batch of symptoms. These can include insomnia, anxiety, poor concentration, weight gain or depression. These are common problems for the patient to be facing at this time, but should be monitored closely to see if symptoms get worse. Depression may persist well after the quitting stage, and it should be treated to avoid complications and improve the patient’s quality of life.

Comfort:

The caregiver should ensure the patient’s home environment is comfortable. The patient may wish to remain on the main floor of their house to avoid using stairs or to wear shoes without laces so they don’t have to bend over to tie them. Simply reaching for something stored in a high place may cause unnecessary strain for the patient. Because of this, any objects that are used frequently should be lowered from high shelves to allow for easier access. The caregiver should help with daily activities such as preparing food, helping the patient dress, and any chores, errands or housekeeping. When preparing food, the caregiver should make several small meals a day instead of a large lunch or dinner. Smaller meals are easier to digest, allowing the patient to use less effort. Foods that cause heartburn or gas are to be avoided, as these make it harder for a person to breathe.

Record Keeping for Medical Help:

An organized system should be established to keep things on a schedule and to keep the disease in check. The caregiver must manage medications, coordinate physician visits, maintain fluid intake (to help break down secretions), and moderate simple exercise for the patient. Consult a doctor about which exercise is appropriate for the patient’s condition to ensure they are not overworking themselves. Exercise may improve heart and lung function, so it is not something to be overlooked. Keep routine medications and doctor prescribed oxygen tanks in constant supply.

It is highly recommended that a log be kept of all things relating to the illness. Keep track of all medications taken, including what time of day they are administered and what quantity given. If any side effects are felt, these should be entered into the log and brought up at the next doctor visit. Daily assessments should be made about:

  • Breathing – the level of difficulty/coughing
  • Medications – what is being taken and when
  • Diet and activities
  • Whatever problems/complications arise

This log should also have a section where the most important phone numbers are kept. This can include doctors, hospitals, specialists or anyone else who may need to be contacted in the event of an emergency. The log should be brought to every doctor visit to ensure the proper issues are being addressed. Be sure to ask the doctor lots of questions about how to improve the current situation and what to expect in the future.

Additional Medications:

The doctor will put the COPD patient on any number of medicines or treatments they feel will help the current symptoms. This could include anything from oxygen therapy to medications that cut down on inflammation, reduce muscle spasms and help loosen and expel mucus. Flu and pneumonia shots are a necessity for COPD patients because they are more at risk of contracting these diseases. Since their lungs are not in good shape to begin with, catching either disease could prove life threatening.

Here’s a quick list of some medications/treatments the doctor may recommend:

  • Antibiotics when infection sets in: if prescribed antibiotics, don’t quit taking them if your symptoms get better. Continue to take them until the prescription has run out to avoid a relapse.
  • Bronchodilators – relax the airway wall muscles to allow you to breathe better
  • Corticosteroids: manages COPD when taken orally by improving lung function, decrease possibility of early relapse
  • Aerosol Therapy – a Nebulizer that dispenses medication as a vapor. Primarily uses bronchodilators, relieves spasms in lungs, decreases swelling, makes secretions easier to cough up
  • Pulmonary Rehabilitation: This is for serious cases for people with debilitating symptoms that affect their daily activities. This will be accomplished by a team of medical professionals who treat all aspects of the disease

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